Clostridium difficile Cross Contamination in the Textile Laundering Process: The Importance of Selecting an Appropriate Hard Surface Disinfectant

Background: Products with sporicidal efficacy claims against Clostridium difficile have recently been approved by the US Environmental Protection Agency; however, some healthcare facilities still choose to remediate contaminated surfaces through meticulous cleaning with reusable wipers saturated with non-sporicidal cleaning products.  It is theorized that when Clostridium difficile contaminated surfaces are cleaned in this manner, although the spores may be physically removed by the wiper, they remain viable in the wiper and can contaminate other co-mingled items in the laundry process.  It is also theorized that when similarly contaminated surfaces are cleaned using reusable wipers saturated with sporicidal products the spores are similarly removed but then rendered non-viable in the cloth thereby substantially reducing the risk of cross contamination in the laundry process.

Objective: Investigate the relative risk of Clostridium difficile cross contamination in the laundry process associated with cleaning contaminated surfaces with reusable wipers saturated in either sporicidal or non-sporicidal hard surface disinfectants.

Methods: Stainless steel coupons (N=15), inoculated with Clostridium difficile ATCC 700792 spores (>1x10⁶ spores per coupon), were cleaned with microfiber cloths previously saturated in (i) EPA registered sporicidal disinfectant (ii) EPA registered non-sporicidal disinfectant (iii) water.  Each set of cloths (N=5 per product) was laundered with a quantity of new microfiber cloths (N=20) using a representative commercial wash process.  Following the wash process, each of the new cloths was manually agitated in a buffer solution to dislodge any spores deposited during the wash process.  The solution was vacuum-filtered through a 0.45 μm membrane filter and the resulting filter incubated anaerobically with growth media for 72 hours.  The presence of Clostridium difficile was confirmed in the resultant colonies using Gram stain, colony morphology, and catalase tests. 

Results: Cross contamination occurred on cloths in the (iii) water and (ii) non-sporicidal disinfectant groups and the resultant cultures were too numerous to count.  While some cross contamination was observed in the (i) sporicidal disinfectant group, the number of cloths contaminated and the resulting culture counts were significantly reduced.

Conclusions: Cleaning Clostridium difficile contaminated surfaces with wipers saturated with non-sporicidal disinfectant creates a vector for cross contamination to other textiles via the laundry process.  Cleaning contaminated surfaces with wipers saturated with sporicidal disinfectant may not completely eliminate this vector but it does substantially reduce the associated risk.