Our Vice President, Kerry Holden, attended the Trent Branch’s Darling Bugs of May Conference on 12th May. A highlight was Professor Katie Laird’s session on the risks of C. difficile spores surviving healthcare laundry processes, and the collaborative work with IPS to improve linen management guidance in care settings. Learn more in this blog by Kerry.
On the 12th May I had the real privilege of attending the Darling Bugs of May Conference held by the Trent Branch. It was a phenomenal programme and was a fantastic opportunity to see IPC friends and engage with our amazing industry partners. A session that I really enjoyed and got the neurons sparking was delivered by Professor Katie Laird, Professor of Microbiology, De Montfort University, on Linen within healthcare.
Of particular interest to me was her work on the survival of C. difficile spores on hospital bed sheets through a commercial UK NHS healthcare laundry process. Katie and her colleagues study investigated whether C. difficile spores survive industrial healthcare laundering, potentially contributing to healthcare-associated infections. C. difficile produces robust spores that can persist in the environment, resist standard decontamination, and spread via contaminated surfaces, including textiles. HTM 01-04 outlines thermal disinfection requirements for infected linen (≥71°C for ≥3 minutes), but the efficacy of these standards in fully eliminating spores remains uncertain.
Katie and her colleagues inoculated 100% cotton hospital sheet swatches with C. difficile spores under simulated soiling conditions and then subjected them to laundering in washer extractors using industrial detergent and thermal disinfection. Both laboratory simulations and real-world tests with naturally contaminated sheets from infected hospital wards were conducted. Spore recovery methods were assessed, with vortexing proving significantly more effective than stomaching.
Their results showed that although industrial laundering with detergent and thermal disinfection significantly reduced spore counts (by >6 log₁₀ in simulations), viable spores remained on both inoculated and previously sterile fabrics. In naturally contaminated sheets, average pre-wash spore loads were 51 cfu/25 cm², and post-wash loads were still 33 cfu/25 cm²- a 40% reduction. Cross-contamination of clean items during washing was also observed.
Scanning electron microscopy confirmed the presence of spores after laundering, often aggregated in soiling residues. The study found that detergent use was key in reducing spore load; thermal disinfection alone was insufficient. These findings raise concerns that current laundering standards. While partially effective, it does not guarantee full decontamination of C. difficile spores. Residual contamination on “clean” linen could pose an ongoing risk for transmission and sporadic CDI outbreaks in healthcare settings.
Katie also discussed her work on developing a standardised international protocol for evaluation of the disinfection efficacy of healthcare laundry wash processes. This work highlighted the lack of international standardisation in validating the disinfection efficacy of industrial laundering, especially for healthcare textiles. Current methods vary widely, leading to inconsistent decontamination results. Their work developed standardised methods to measure microbial kill within laundering processes, favouring agitation-based recovery techniques over surface sampling. Bioindicators, particularly those using PES membranes, proved effective for assessing disinfection across different temperatures and chemicals. Traditional methods like swatch testing underestimated microbial kill due to dilution effects. Their work concluded that standardised bioindicator-based protocols could better ensure textile hygiene and patient safety, especially when integrated into international standards such as BS EN 14065 for biocontamination control.
Katie also spoke about the IPS impact award winning ‘Guidance for the Safe Management of Linen in Residential, Nursing or other Social Healthcare Environments’, which was co-created by our very own IPS Care home SIG.
This guidance came about through examination of the infection control policies in care homes regarding the laundering of resident textiles. Surveying over 1,000 care home managers and healthcare workers, they found that less than half believe bed linen, clothing, and uniforms are always properly laundered. Only half of care home managers reported that staff receive formal laundry training, yet 87% of workers expressed interest in further education. Most participants also wanted more support for managing on-site laundries. Focus groups held emphasised the need for better training and clearer policies. In response, a Laundry Management Working Group was formed with the IPS Care home SIG to develop accessible guidance for safe linen management in care homes. This guidance, available here aligns with HTM01-04 and Care Quality Commission standards, and aims to clarify best practices using scientific evidence on infection transmission, textile contamination, and disinfection. It emphasises training and covers safe linen handling, laundry processes, equipment maintenance, and chemical risks.
Education resources are now being development which includes online learning modules and we are exploring some further research to look at implementation of the guidance by care homes, so look out for more information in future Digests.
