Should linen in newborn intensive care units be autoclaved?

The American Academy of Pediatrics' Standards and Recommendations for Hospital Care of Newborn Infants recommends that linen in newborn intensive care, intermediate care, continuing care and admission observation areas be autoclaved. Questionnaires sent to 269 directors of newborn intensive care units (69% returned) showed that 74% of the respondents do not autoclave linen used in their newborn intensive care unit. There were 284 linen cultures performed in our newborn intensive care unit where linen is not autoclaved; 68% of the cultures were positive, but only 2.5% had a colony count greater than 20 colonies per plate. The most common organisms obtained were Staphylococcus epidermidis, diphtheroids, and Micrococcus species. Two cultures grew Staphylococcus aureus, one colony and two colonies per plate. Three-factor analysis of variance showed that the location of the linen in the top of the pile exerted a statistically significant effect on the bacterial contamination rate. The fact that three fourths of neonatal intensive care centers in this country do not autoclave nursery linen, the lack of reports in the literature relating linen contamination to nosocomial infections, and the microbiologic results of this study suggest that the recommendations of the American Academy of Pediatrics merit further study and reevaluation.