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Merettig N, Bockmühl DP. Virucidal Efficacy of Laundering. Pathogens 2022; 11:993. [PMID: 36145425 PMCID: PMC9503802 DOI: 10.3390/pathogens11090993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
Viruses contribute significantly to the burden of infectious diseases worldwide. Although there are multiple infection routes associated with viruses, it is important to break the chain of infection and thus consider all possible transmission routes. Consequently, laundering can be a means to eliminate viruses from textiles, in clinical settings well as for domestic laundry procedures. Several factors influence the survival and inactivation of microorganisms, including viruses on hard surfaces and textiles. Therefore, textiles should be regarded as potential fomites. While in clinical and industrial settings laundry hygiene is ensured by standardized processes, temperatures of at least 60 °C and the use of oxidizing agents, domestic laundry is not well defined. Thus, the parameters affecting viral mitigation must be understood and prudently applied, especially in domestic laundering. Laundering can serve as a means to break the chain of infection for viral diseases by means of temperature, time, chemistry and mechanical action.
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Affiliation(s)
| | - Dirk P. Bockmühl
- Faculty of Life Sciences, Rhine-Waal University of Applied Sciences, 47533 Kleve, Germany
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2
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Everts RJ, Al Ghusaini S, Telfar-Barnard L, Barclay E, Tan S, Jekel S, Jennings L, Choi DH, Hilson D, Gibson B. Liquid-Immersion Reprocessing Effects on Filtration Efficiency of 'Single-Use' Commercial Medical Face Masks. Ann Work Expo Health 2022; 66:246-259. [PMID: 34564717 PMCID: PMC8500144 DOI: 10.1093/annweh/wxab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Medical masks have inferior filtration efficiency and fit to filtering facepiece respirators (FFRs) but are widely used in healthcare and the community. These masks are intended for disposal after use but in the event of mask shortage re-use after reprocessing may be an option. We investigated eight reprocessing methods that each involved washing or soaking in liquid, are likely to eliminate respiratory viruses, and are safe and available in most community and healthcare settings. METHODS Three brands of EN 14683 standards-compliant commercial medical mask were each reprocessed 10 times by one of eight methods. We measured filtration efficiency for poly-dispersed sodium chloride particles and pressure differential. RESULTS Compared with new medical masks, reprocessed masks had significantly reduced filtration efficiency. The reduction was mild-moderate (6.5-25.8%) after warm water wash, hot water soak or boiling water soak; and moderate-large (24.1-51.5%) after detergent, soap or laundry machine wash, or bleach soak. There were mixed and minor changes in pressure differential. Most reprocessed standards-compliant masks had better filtration efficiency than new non-standard commercial masks and then cotton and cotton-polyester mix fabric samples, even triple-layered fabrics. CONCLUSIONS High-quality commercial medical masks reprocessed 10 times by water immersion methods had better filtration efficiency than new non-standard masks and washable fabrics. These findings have particular relevance for community and low-resource healthcare settings.
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Affiliation(s)
- Richard J Everts
- Infectious Disease Service, Nelson Bays Primary Health, 281 Queen St, Richmond, Nelson, New Zealand
| | | | - Lucy Telfar-Barnard
- Department of Public Health, University of Otago, 23a Mein St, Newton, Wellington, New Zealand
| | - Ella Barclay
- University of Otago, 2 Riccarton Ave, Christchurch, New Zealand
| | - Shaun Tan
- Lanaco, 2–4 Sultan St, Ellerslie, Auckland, New Zealand
| | - Sonja Jekel
- Lanaco, 2–4 Sultan St, Ellerslie, Auckland, New Zealand
| | - Lance Jennings
- Department of Pathology and Biomedical Sciences, University of Otago, 2 Riccarton Ave, Christchurch, New Zealand
- Canterbury Health Laboratories, Hagley Ave, Christchurch, New Zealand
| | - Dong Hoon Choi
- Biomedical Engineering Department, Nelson Hospital, Tipahi St, Nelson, New Zealand
| | - Dougal Hilson
- University of Otago, 2 Riccarton Ave, Christchurch, New Zealand
| | - Barbara Gibson
- Infection Prevention and Control Service, Nelson Hospital, Tipahi St, Nelson, New Zealand
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Katoh I, Tanabe F, Kasai H, Moriishi K, Shimasaki N, Shinohara K, Uchida Y, Koshiba T, Arakawa S, Morimoto M. Potential Risk of Virus Carryover by Fabrics of Personal Protective Gowns. Front Public Health 2019; 7:121. [PMID: 31179258 PMCID: PMC6538680 DOI: 10.3389/fpubh.2019.00121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
Personal protective gowns and coveralls are classified based on barrier efficiency that validates protection from fluid penetration under certain pressures. Materials standardized in this system have been found suitable for emergency medical practices confronting highly contagious diseases. Nevertheless, adhesion of blood, and body fluids from virus-infected patients to the surface of protective clothing still imposes a risk of pathogen transmission in the process of doffing, or undressing. We performed a small-scale experiment to test the possibility of infectious virus carryover on the surface of different fabrics used in commercially available protective gowns. Application of a lentivirus vector that expresses green fluorescent protein allowed easy monitoring of infectious viral loads on fabrics. Results indicate that fabrics of level-3 surgical gowns serve better to reduce virus transmission compared to fabrics of chemical protective clothing with the same or higher barrier efficiency. Analysis of sliding angles provided indexes of fluid repellency, which were inversely related to virus carryover potentials. Droplets of infectious body fluids may easily roll off fabrics with water-repellent finishing. Thus, virus carryover is a measurable risk factor to be considered for better choice of personal protective clothing.
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Affiliation(s)
- Iyoko Katoh
- Oral Health Science Research Center, Kanagawa Dental University, Yokosuka, Japan
| | | | - Hirotake Kasai
- Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Kohji Moriishi
- Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Noriko Shimasaki
- Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Katsuaki Shinohara
- Division of Biosafety Control and Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yukiko Uchida
- Faculty of Health and Welfare, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Tomoko Koshiba
- Faculty of Fashion Science, Bunka Gakuen University, Tokyo, Japan
| | | | - Michiko Morimoto
- Faculty of Health and Welfare Science, Okayama Prefectural University, Soja, Japan
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Kilinc Balci FS. Isolation gowns in health care settings: Laboratory studies, regulations and standards, and potential barriers of gown selection and use. Am J Infect Control 2016; 44:104-11. [PMID: 26391468 DOI: 10.1016/j.ajic.2015.07.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
Although they play an important role in infection prevention and control, textile materials and personal protective equipment (PPE) used in health care settings are known to be one of the sources of cross-infection. Gowns are recommended to prevent transmission of infectious diseases in certain settings; however, laboratory and field studies have produced mixed results of their efficacy. PPE used in health care is regulated as either class I (low risk) or class II (intermediate risk) devices in the United States. Many organizations have published guidelines for the use of PPE, including isolation gowns, in health care settings. In addition, the Association for the Advancement of Medical Instrumentation published a guidance document on the selection of gowns and a classification standard on liquid barrier performance for both surgical and isolation gowns. However, there is currently no existing standard specific to isolation gowns that considers not only the barrier resistance but also a wide array of end user desired attributes. As a result, infection preventionists and purchasing agents face several difficulties in the selection process, and end users have limited or no information on the levels of protection provided by isolation gowns. Lack of knowledge about the performance of protective clothing used in health care became more apparent during the 2014 Ebola epidemic. This article reviews laboratory studies, regulations, guidelines and standards pertaining to isolation gowns, characterization problems, and other potential barriers of isolation gown selection and use.
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Kilinc FS. A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties. JOURNAL OF ENGINEERED FIBERS AND FABRICS 2015; 10:180-190. [PMID: 26989351 PMCID: PMC4791533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The threat of emerging infectious diseases including Ebola hemorrhagic fever, pandemic influenza, avian influenza, Hepatitis B, Hepatitis C, and SARS has highlighted the need for effective personal protective equipment (PPE) to protect healthcare workers (HCWs), patients, and visitors. PPE is a critical component in the hierarchy of controls used to protect HCWs from infectious hazards. HCW PPE may include gowns, respirators, face masks, gloves, eye protection, face shields, and head and shoe coverings. Important research has been conducted in certain areas, such as respirators and protective masks, but studies in other areas, particularly gowns, are scarce. Gowns are identified as the second-most-used piece of PPE, following gloves, in the healthcare setting. According to the Centers for Disease Control and Prevention's Guideline for Isolation Precautions, isolation gowns should be worn to protect HCWs' arms and exposed body areas during procedures and patient-care activities when anticipating contact with clothing, blood, bodily fluids, secretions and excretions. Isolation gowns currently available on the marketplace offer varying resistance to blood and other bodily fluids depending on the type of the material, its impermeability, and wear and tear. While some studies show no benefit of the routine use of isolation gowns, others demonstrate that its use is associated with a reduced infection rate. This paper reviews isolation gowns in healthcare settings, including the fabrics used, gown design and interfaces, as well as critical parameters that affect microorganism and liquid transmission through fabrics.
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Affiliation(s)
- F Selcen Kilinc
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA UNITED STATES
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Todd ECD, Michaels BS, Greig JD, Smith D, Holah J, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 7. Barriers to reduce contamination of food by workers. J Food Prot 2010; 73:1552-65. [PMID: 20819372 DOI: 10.4315/0362-028x-73.8.1552] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Contamination of food and individuals by food workers has been identified as an important contributing factor during foodborne illness investigations. Physical and chemical barriers to prevent microbial contamination of food are hurdles that block or reduce the transfer of pathogens to the food surface from the hands of a food worker, from other foods, or from the environment. In food service operations, direct contact of food by hands should be prevented by the use of barriers, especially when gloves are not worn. Although these barriers have been used for decades in food processing and food service operations, their effectiveness is sometimes questioned or their use may be ignored. Physical barriers include properly engineered building walls and doors to minimize the flow of outside particles and pests to food storage and food preparation areas; food shields to prevent aerosol contamination of displayed food by customers and workers; work clothing designated strictly for work (clothing worn outdoors can carry undesirable microorganisms, including pathogens from infected family members, into the work environment); and utensils such as spoons, tongs, and deli papers to prevent direct contact between hands and the food being prepared or served. Money and ready-to-eat foods should be handled as two separate operations, preferably by two workers. Chemical barriers include sanitizing solutions used to remove microorganisms (including pathogens) from objects or materials used during food production and preparation and to launder uniforms, work clothes, and soiled linens. However, laundering as normally practiced may not effectively eliminate viral pathogens.
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Affiliation(s)
- Ewen C D Todd
- Department of Advertising Public Relations and Retailing, Michigan State University, East Lansing, Michigan 48824, USA.
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Gerba CP, Kennedy D. Enteric virus survival during household laundering and impact of disinfection with sodium hypochlorite. Appl Environ Microbiol 2007; 73:4425-8. [PMID: 17526793 PMCID: PMC1932823 DOI: 10.1128/aem.00688-07] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study was conducted to determine whether enteric viruses (adenovirus, rotavirus, and hepatitis A virus) added to cotton cloth swatches survive the wash cycle, the rinse cycle, and a 28-min permanent press drying cycle as commonly practiced in households in the United States. Detergent with and without bleach (sodium hypochlorite) was added to washing machines containing sterile and virus-inoculated 58-cm2 swatches, 3.2 kg of cotton T-shirts and underwear, and a soiled pillowcase designed to simulate the conditions (pH, organic load, etc.) encountered in soiled laundry. The most important factors for the reduction of virus in laundry were passage through the drying cycle and the addition of sodium hypochlorite. Washing with detergent alone was not found to be effective for the removal or inactivation of enteric viruses, as significant concentrations of virus were found on the swatches (reductions of 92 to 99%). It was also demonstrated that viruses are readily transferred from contaminated cloths to uncontaminated clothes. The use of sodium hypochlorite reduced the number of infectious viruses on the swatches after washing and drying by at least 99.99%. Laundering practices in common use in the United States do not eliminate enteric and respiratory viruses from clothes. The use of bleach can further reduce the numbers of enteric viruses in laundry.
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Affiliation(s)
- Charles P Gerba
- Department of Soil, Water and Environmental Science, University of Arizona, Tucson, AZ 85721-0038, USA.
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Hanaya T, Sato N, Yamamoto H. The First Chemical Synthesis of 6-Thio-D-fructopyranose via Methyl 6-Bromo-6-deoxy-1,3-O-isopropylidene-α-D-fructofuranoside as a Key Intermediate. HETEROCYCLES 2007. [DOI: 10.3987/com-06-10965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Christian RR, Manchester JT, Mellor MT. Bacteriological quality of fabrics washed at lower-than-standard temperatures in a hospital laundry facility. Appl Environ Microbiol 1983; 45:591-7. [PMID: 6830218 PMCID: PMC242329 DOI: 10.1128/aem.45.2.591-597.1983] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We determined whether the bacteriological quality of fabrics cleaned in a hospital laundry could be maintained at wash temperatures lower than 75 degrees C by the use of economically reasonable formulas and wash conditions. Three groups of bacteria were examined to determine bacteriological quality: aerobic, nonexacting chemoorganotrophs, staphylococci, and total coliforms. The distribution of bacteria on soiled fabric was patchy, with staphylococci and total coliforms ranging from less than 0.1 to greater than 4 X 10(3) CFU/cm2 and chemoorganotrophs ranging from less than 0.1 to greater than 5 X 10(5) CFU/cm2. The washing process routinely produced fabric containing less than 1 CFU/cm2. Low-temperature (47.8 to 60.0 degrees C) wash procedures eliminated all bacterial groups at least as effectively as did high-temperature procedures. The effectiveness of bacterial density reduction at low temperature was augmented by increased concentrations of bleach. Successful low-temperature washing such as that shown here may save both energy and money for hospitals.
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Jaska JM, Fredell DL. Impact of detergent systems on bacterial survival on laundered fabrics. Appl Environ Microbiol 1980; 39:743-8. [PMID: 7377775 PMCID: PMC291413 DOI: 10.1128/aem.39.4.743-748.1980] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The survival of Staphylococcus aureus was determined from inoculated swatches laundered in either a phosphate or a phosphate-substitute detergent. In a Plackett-Burman design study, the independent variables of detergent type, concentration, and variation, wash water temperature, soil load, cycle time, and water hardness were assigned high and low values. Wash water temperatures of 27, 38, 49, and 60 degrees C were employed. Viable bacteria were recovered from macerated swatches. Statistical analysis disclosed that there was no practical difference in the ability of phosphate or phosphate-substitute detergents to reduce the level of S. aureus on the laundered swatches in this controlled design. Analysis did reveal that water temperature was the most significant independent variables. The remaining variables did not appear to have any practical significance upon bacterial reduction. This bacteriological study did not evaluate other essential detergent properties.
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Wiksell JC, Pickett MS, Hartman PA. Survival of microorganisms in laundered polyester-cotton sheeting. Appl Microbiol 1973; 25:431-5. [PMID: 4572894 PMCID: PMC380823 DOI: 10.1128/am.25.3.431-435.1973] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The effects of wash-water temperature, cold-water or regular detergent, wash-cycle design, drying, and drying temperature on survival of four microorganisms on polyester-cotton sheeting were examined. Escherichia coli T3 bacteriophage survived washing at 24, 35, 46, and 57 C, but not at 68 C. Serratia marcescens survived only the lowest three wash temperatures. Levels of residual Staphylococcus aureus were diminished at the highest two wash temperatures, but survival was substantial even at 68 C. Counts of Bacillus stearothermophilus spores were not altered appreciably by wash temperature. Type of detergent had no practical effect on observed counts. The regular wash cycle was significantly more efficient in removal of microorganisms than the permanent-press cycle. Counts, especially of the bacteriophage and the gramnegative bacterium, were decreased by drying; after drying, the effects of wash-water temperature on S. aureus and B. stearothermophilus were not significantly different. Microorganisms were transferred from inoculated to sterilized sheeting during laundering. The public health significance of these observations is discussed.
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