Several studies have documented health care laundry facilities as sources of nosocomial outbreaks of fungal and bacterial infections, but new research published in the July 2021 issue of Clinical Infectious Diseases creates a roadmap for identifying and remediating these outbreaks. 

According to researchers with the University of Pittsburgh, University of Minnesota Department of Environmental Health and Safety, and the University of Virginia Division of Infectious Diseases and International Health, collaboration between hospital infection prevention experts and laundry facility leadership is key in creating a targeted and effective remediation. 

The study, “Remediation of Mucorales-contaminated Healthcare Linens at a Laundry Facility Following an Investigation of a Case Cluster of Hospital-acquired Mucormycosis,” outlines the process of investigating the off-site laundry facility that was deemed the source of several cases of health care-associated infections caused by Mucorales fungi. The investigation identified air vents and lint buildup across rooftop air intakes and throughout the building as the most likely sources of fungal contamination. 

The researchers note that it is common practice for large commercial laundries to cool linens using outside air. However, in this case, the unfiltered outside air was carrying fungal spores through an intake ventilation system covered by thick layers of lint. The lint fibers serve as a nutrient source for Mucorales, and the warm, moist environment of the laundry provides an ideal environment for its spores to proliferate. Lint had also accumulated heavily within the exhaust air vents that faced the intake vents, resulting in contaminated loops of recirculated air.

Working closely with the infection prevention team at the University of Pittsburgh Medical Center, the laundry facility’s leadership implemented a number of remedial interventions based on these findings. The researchers concluded that environmental remediation, in addition to quality-assurance measures and education around these potential infection sources, helped deliver a marked and sustained reduction in Mucorales-contaminated linens delivered to the medical center.

While the team still periodically tests surveillance cultures of newly delivered health care linens, there have been no further health care-associated mucormycosis cases diagnosed for the facility in the four years since this remediation. 

As a result, the researchers conclude with a renewed “call for increased collaboration between hospital epidemiologists, infection prevention practitioners, clinicians, hospital administrators, industry leaders and public health officials to develop reasonable standards for producing, testing and certifying hygienically clean [health care laundry facilities] that balance patient safety, workflow and costs.”