Clinical Issues - April 2024.

Cell phone cleaning Key words: electronic device, disinfect, hand hygiene, bacteria, cell phone. Laundry facility accreditation Key words: linen, laundering, inspection, accreditation standards, Healthcare Laundry Accreditation Council (HLAC). Cleaning hybrid OR floor tracks Key words: hybrid OR, between-patient cleaning, terminal cleaning, maintenance, tracking system. Nail coverings in the perioperative setting Key words: nail lacquer, enhanced nail lacquer, artificial nails, natural nails, hand hygiene.

Effect of the age of garments used under real-life conditions on microfibre release from polyester and cotton clothing.

The release of microfibres from fabrics during laundering represents an important source of plastic and natural microfibres to aquatic environments. Garment age - how long the garment has been used - could be a key factor influencing the rate of release, yet most studies of microfibre shedding have only assessed newly manufactured products. To this end, we quantified microfibre release during laundering in domestic washing machines from polyester (PES) and cotton garments (n = 38) used in real-life conditions for periods between 1 and 31 years with different use intensities. In addition, to better understand the factors involved in microfibre releases, fibre composition (different PES percentages) and type of garments (T-shirts, polo shirts, uniforms, sports shirts, and sweatshirts) were examined. All garments released microfibres during washing, while the older garments presented higher releases for clothing with a PES/cotton blend. In general, older garments (15-31 years) released nearly twice as many fibres when washed than newer garments (1-10 years). The mass of microfibres released was consistently greater in garments with a higher proportion of cotton than PES (up to 1.774 mg g-1 in 2% PES and 0.366 mg g-1 in 100% PES fabrics), suggesting that cotton might be released more readily such that the relative proportion of PES in the garments could increase over time. Additionally, SEM images showed fibre damage, with fibres from the older garments exhibiting more peeling and splitting. While it is important to note that the overall environmental footprint is undoubtedly reduced by keeping garments in use for longer periods of time, older garments were shown to release more microfibres.

Microfiber Pollution: A Systematic Literature Review to Overcome the Complexities in Knit Design to Create Solutions for Knit Fabrics.

The absence of standardized procedures to assess microfiber pollution released during laundering, alongside textile complexities, has caused incomparability and inconsistency between published methodologies, data formats, and presentation of findings. Yet, this information needs to be clear and succinct to engage producers and consumers in reducing microfiber pollution through solutions, such as eco-design. This review analyses source directed interventions through design and manufacturing parameters that can prevent or reduce microfiber shedding from knit fabrics during washing. Contradicting results are critically evaluated and future research agendas, alongside potential areas for voluntary and involuntary sustainable incentives are summarized. To do this, a systematic review was carried out, using the PRISMA approach to verify which fabrics had been investigated in terms of microfiber shedding. Using selected keywords, a total number of 32 articles were included in this review after applying carefully developed inclusion and exclusion criteria. The influence of fabric parameters such as fiber polymer, length of fibers and yarn twist alongside fabric construction parameters such as gauge of knit and knit structure are critically evaluated within the systematically selected studies. This review highlights the agreed upon fabric parameters and constructions that can be implemented to reduce microfiber pollution released from knit textiles. The complexities and inconsistencies within the findings are streamlined to highlight the necessary future research agendas. This information is critical to facilitate the adoption of cross-industry collaboration to achieve pollution reduction strategies and policies. We call for more systematic studies to assess the relationship between individual textile parameters and their influence on microfiber shedding. Additionally, studies should work toward standardization to increase comparability between studies and created more comprehensive guidelines for policy development and voluntary actions for the textile and apparel industry to participate in addressing more sustainable practises through eco-design.

Impact of quantification method on microfiber assessment - A comparative analysis between mass and count based methods.

Microfiber from textiles is one of the new anthropogenic pollutants which attracted a wide range of researchers. Domestic laundry, being the most common cause of microfiber release from textiles, is widely studied. Studies exhibit a broad range of quantities of microfibers owing to the distinct quantification methodologies employed due to their convenience and resource availability. Out of several such estimation processes, reporting microfiber quantity in numbers or mass (mg or g) is quite common with respect to the unit area or weight of the textile used. However, results reported by different literature vary significantly. Hence, this study aims to analyze the microfiber release from knitted polyester fabric using count- and mass-based methods. Four different fabrics were used for this study with three different counting processes from literature along with direct weight difference estimation. The results of the direct counting method showed that the average microfiber release of selected fabrics is 13.28-33.16 microfibers per sq.cm, whereas, the direct weight estimation showed an average weight of 0.0664 ± 0.0289 mg/sq.cm. The subsequent conversion showed a release of 887.89 ± 633.49 microfibers/sq.cm of the fabric. Further, the microfiber mass was also estimated using the number of microfiber count and found that a sq.cm of fabric releases up to 0.0010-0.0024 mg of microfibers. While comparing the results, the weight-based estimation showed a significantly higher microfiber release (41.3-42.9 times) than the direct counting method. The deposition of surfactants in detergents, contaminants from the water, atmospheric contaminants, and finishes released from the fabric can be the sources of additional weights noted in the direct mass estimation. As the weight-based method is quite simple and the fastest way to quantify the microfibers, future studies must focus on this area to reduce the error percentage in quantification.

Synthetic microfiber emissions from denim industrial washing processes: An overlooked microplastic source within the manufacturing process of blue jeans.

In recent years, domestic laundry has been recognized as a relevant source of microfiber (MF) pollution to aquatic environments. Nevertheless, the MF emissions from industrial washing processes in real world scenarios have not been quantified. The aim of this study was to quantify the MF emissions from 3 industrial washing processes (rinse wash, acid wash and enzymatic wash) commonly employed in the manufacturing process of blue jeans. The blue jeans were characterized by ATR-FT-IR, SEM and TGA to study the morphology, the polymer chemical identity and the proportion of synthetic and natural fibers, respectively. The MF emissions were quantified as the MF mass and number emitted per washed jean. All the industrial washing processes released a majority of synthetic MF. The enzymatic wash produced the highest amount of MF, with 1423 MF per gram of fabric (MF/g) equivalent to 381.7 MF grams per gram of fabric (MF g/g), followed by the acid wash with 253 MF/g equivalent to 142.7 MF g/g and lastly the rinse wash with 133 MF/g equivalent to 62.3 MF g/g. Statistically significant differences between the MF sizes for all washing processes were found when evaluating the emissions by MF/g, however, the previous trend was not found for MF g/g. Moreover, the total MF emissions of an industrial washing process of a pair of blue jeans during its manufacture process are up to 10.95 times higher than the reported domestic washing estimates performed by the consumer available in the published literature. We demonstrate that studying industrial washing procedures of textile garments will improve the accuracy of the current estimates of MF emissions available in published reports, which will ultimately aid in the development of regulations for MF emissions at an industrial level.

Use of Preliminary Exposure Reduction Practices or Laundering to Mitigate Polycyclic Aromatic Hydrocarbon Contamination on Firefighter Personal Protective Equipment Ensembles.

Chronic health risks associated with firefighting continue to be documented and studied, however, the complexity of occupational exposures and the relationship between occupational exposure and contaminated personal protective equipment (PPE) remains unknown. Recent work has revealed that common PPE cleaning practices, which are becoming increasingly more common in the fire service, are not effective in removing certain contaminants, such as polycyclic aromatic hydrocarbons (PAHs), from PPE. To better understand the relationship between contaminated firefighter PPE and potential exposure to PAHs, and to gain further understanding of the efficacy of cleaning practices, we used a standardized fire exposure simulator that created repeatable conditions and measured PPE surface contamination levels via wipe sampling and filters attached to firefighter gear worn by standing mannequins. This study examined the effects of repeated (40 cycles) PPE cleaning (laundering and on-scene preliminary exposure reduction (PER) techniques) and repeated exposures on PAH concentration on different surfaces. Further exploration included examination of contamination breakthrough of turnout jackets (comparing outer shell and interior liner) and evaluation of off-gassing PAHs from used gear after different cleaning treatments. When compared by jacket closure type (zipper and hook and dee), total PAH concentration wiped from gear after exposure and cleanings showed no significant differences. Regression analysis indicated that there was no effect of repeated exposures on PAH contamination levels (all sampling sites combined; before fire 10, 20, and 40; after fire 1, 10, 20, and 40; p-value > 0.05). Both laundering and on-scene PER significantly reduced contamination levels on the exterior pants and helmets and were effective at reducing PAH contamination. The jacket outer shell had significantly higher PAH contamination than the jacket liner. Both laundering and wet soap PER methods (post-fire) are effective in reducing surface contamination and appear to prevent accumulation of contamination after repeated exposures. Semi-volatile PAHs deep within the fibers of bulky PPE are not effectively reduced via PER or machine laundering, therefore, permitting continued off-gassing of these compounds. Further research is needed to identify the most effective laundering methods for firefighter turnout gear that considers the broad spectrum of common contaminants.

Quantification of microfibre release from textiles during domestic laundering.

Domestic laundering of textiles is being increasingly recognised as a significant source of microfibre pollution. Reliable quantification of microfibre release is necessary to understanding the scale of this issue and to evaluate the efficacy of potential solutions. This study explores three major factors that influence the quantification of microfibres released from the domestic laundering of textiles: test methodologies, laundering variables, and fabric variables.A review of different test methods is presented, highlighting the variation in quantification created by using different methodologies. A reliable and reproducible method for quantifying microfibre release from domestic laundering is used to explore the impact of laundering and fabric variables experimentally. The reproducibility and reliability of the method used was validated through inter-laboratory trials and has informed the development of European and international testing standards. Our results show that increasing the wash liquor ratio and wash agitation results in a greater mass of microfibres released, but we found that fabric variables can have a greater influence on microfibre release than the laundering variables tested in this study. However, no single fabric variable appeared to have a dominant influence.Using the data obtained and assumptions for washing load size and frequency, results were scaled to reflect possible annual microfibre release from untreated domestic laundering in the UK. Depending on different laundering and fabric variables, these values range from 6490 tonnes to 87,165 tonnes of microfibre discharged in the UK each year.

Evaluation of the detectability of different ages of bloodstains on fabrics in different washing conditions and at various wavelengths.

PURPOSE: The detection of bloodstains at crime scenes is extremely useful in forensic investigations. This study aimed to investigate the effects of washing temperature, fabric type, fabric color, and stain age (time from staining to laundering) on the detection and identification of bloodstains on fabrics after washing. MATERIAL AND METHOD: A total of 240 fabrics (4 different colors and 5 different types) were stained with blood and washed in 4 different washing temperatures with 3 different lag times. The evaluations of fabric images were performed using the FLS system (Forenscope-Mobile Multispectral UV-VIS-IR Imaging Systems®) on a total of 1200 images using 5 different wavelengths and filter options. The bloodstained areas of the fabric pieces were then excised, and the hemoglobin presence was analyzed using the SERATEC® HemDirect hemoglobin test. RESULTS: The analyses of laundered samples using the FLS system revealed that the best images were obtained from velvet, cotton fleece, denim, and polyester fabrics, in that order. Except for polyester fabrics, the SERATEC® HemDirect hemoglobin screening test, which was used to detect bloodstains on fabrics, showed positive results after washing at low temperatures (approximately 15 °C and 30 °C). At higher temperatures (60 °C and 90 °C), the SERATEC® HemDirect hemoglobin test yielded negative results. CONCLUSION: The fabric type and color played a crucial role in stain detection using the FLS system on the laundered fabrics. The FLS system and the SERATEC® HemDirect hemoglobin test revealed that stain age had a limited effect on the stain's detectability.

Complete genome sequence of Bacillus Licheniformis NWMCC0046, a candidate for the laundry industry.

In this study, selected properties of protease and the complete genome sequence of Bacillus licheniformis NWMCC0046 were investigated, to discover laundry applications and other potential probiotic properties of this strain. Partial characterization of B. licheniformis NWMCC0046 showed that its protease has good activity both in alkaline environments and at low temperatures. Also, the protease is compatible with commercial detergents and can be used as a detergent additive for effective stain removal at low temperatures. The complete genome sequence of B. licheniformis NWMCC0046 is comprised of a 4,321,565 bp linear chromosome with a G + C content of 46.78% and no plasmids. It had 4504 protein-encoding genes, 81 transfer RNA (tRNA) genes, and 24 ribosomal RNA (rRNA) genes. Genomic analysis revealed genes involved in exocellular enzyme production and probiotic properties. In addition, genomic sequence analysis revealed specific genes encoding carbohydrate metabolism pathways, resistance, and cold adaptation capacity. Overall, protease properties show its potential as a detergent additive enzyme. The complete genome sequence information of B. licheniformis NWMCC0046 was obtained, and functional prediction revealed its numerous probiotic properties.

The Detection of Foreign Items in Laundry Industry by Dual-Energy X-ray Transmission-Advantages and Limits.

Firefighters, paramedics, nursing staff, and other occupational groups are in constant need of fast and proper cleaning of their professional workwear, not only during a pandemic. Thus, laundry technology needs to become more efficient and automated. Unfortunately, some steps of the cleaning process, such as finding and removing foreign items from pockets or belts, are still completed manually. This is not just time-consuming but potentially dangerous for the workers due to the hazardous nature of items such as scissors, scalpels, or syringes. Additionally, some items may damage the garments by staining or harm the laundry machines, causing malfunctions and process failure. On the one hand, these foreign items are often hidden inside the clothes, making detection very challenging with conventional superficial sensors. On the other hand, these items can be diverse and cannot be detected by metal detectors alone. X-ray transmission has proven to be a powerful tool for detecting items inside of objects. The dual-energy approach (DE-XRT) even allows obtaining quantitative information about the chemical composition of the measured materials. In this study, working garments were accompanied and filled with realistic foreign items. The potential of DE-XRT to detect those items was successfully shown.

Detection, characterization and possible biofragmentation of synthetic microfibers released from domestic laundering wastewater as an emerging source of marine pollution.

Synthetic microfibers are universally recognized as an emerging pollutant in all ecosystems. The present investigation focuses on the evaluation and quantification of synthetic microfiber released from domestic laundering wastewater from different regions of Bhubaneswar city of Odisha state of India. The estimated number of microfibers collected from 500 ml of sample varied from 200 to 500 in numbers with an average amount of biomass in the range of 0.4-4 g. The surface morphology of the samples was assessed by Scanning Electron Microscopic analysis which revealed that the fibers were having a length of approximately 10-30 mm and diameter of 10-20 µm. Carbonyl (CO) stretching band at 1711 cm-1 and Aldehyde (CH) Weak bond at 2917.38 cm-1 absorption were recorded from Fourier transform infrared spectroscopic analysis. As microfibers released from synthetic apparels are major source of environmental microplastic pollution their precise detection could help in controlling this problem.

Survival of Clostridioides difficile spores in thermal and chemo-thermal laundering processes and influence of the exosporium on their adherence to cotton bed sheets.

Clostridioides difficile spores were previously demonstrated to survive industrial laundering. Understanding interactions between heat, disinfectants and soiling (e.g. bodily fluids) affecting C. difficile spore survival could inform the optimization of healthcare laundry processes. Reducing spore attachment to linen could also enhance laundering efficacy. This study aimed to compare the sensitivity of C. difficile spores to heat and detergent, with and without soiling and to investigate adherence to cotton. Survival of C. difficile spores exposed to industrial laundering temperatures (71-90°C), reference detergent and industrial detergent was quantified with and without soiling. The adherence to cotton after 0 and 24 h air drying was determined with the exosporium of C. difficile spores partially or fully removed. Clostridioides difficile spores were stable at 71°C for 20 min (≤0·37 log10 reduction) while 90°C was sporicidal (3 log10 reduction); soiling exerted a protective effect. Industrial detergent was more effective at 71°C compared to 25°C (2·81 vs 0·84 log10 reductions), however, specifications for sporicidal activity (>3 log10 reduction) were not met. Clostridioides difficile spores increasingly adhered to cotton over time, with 49% adherence after 24 h. Removal of the exosporium increased adherence by 19-23% compared to untreated spores. Further understanding of the role of the exosporium in attachment to cotton could enhance spore removal and aid decontamination of linen.

Determining Viral Disinfection Efficacy of Hot Water Laundering.

This protocol provides an example of a laboratory process for conducting laundering studies that generate data on viral disinfection. While the protocol was developed for research during the coronavirus disease 2019 (COVID-19) pandemic, it is intended to be a framework, adaptable to other virus disinfection studies; it demonstrates the steps for preparing the test virus, inoculating the test material, assessing visual and integrity changes to the washed items due to the laundering process, and quantifying the reduction in viral load. Additionally, the protocol outlines the necessary quality control samples for ensuring the experiments are not biased by contamination and measurements/observations that should be recorded to track the material integrity of the personal protective equipment (PPE) items after multiple laundering cycles. The representative results presented with the protocol use the Phi6 bacteriophage inoculated onto cotton scrub, denim, and cotton face-covering materials and indicate that the hot water laundering and drying process achieved over a 3-log (99.9%) reduction in viral load for all samples (a 3-log reduction is the disinfectant performance metric in U.S. Environmental Protection Agency's Product Performance Test Guideline 810.2200). The reduction in viral load was uniform across different locations on the PPE items. The results of this viral disinfection efficacy testing protocol should help the scientific community explore the effectiveness of home laundering for other types of test viruses and laundering procedures.

International ring trial to validate a new method for testing the antimicrobial efficacy of domestic laundry products.

Due to greater environmental awareness, domestic laundry habits are changing, and antimicrobial control by chemical methods has become an essential factor to compensate for the use of lower temperatures during washing machine cycles. Disinfectants added to laundry detergents are a preventive strategy to reduce the transmission of bacteria, fungi, and viruses in the home, correct aesthetic damage (e.g., spotting, discolouration, and staining), and control the microbial contamination that leads to malodour. In Europe, disinfectants are regulated by the EU Biocidal Products Regulation (No. 528/2012), which stipulates that antimicrobial efficacy must be evaluated according to standardized methods. Current European standards for laundry sanitization only apply to clinical settings (EN 16616: 2015) and are restricted to the main wash cycle. Therefore, there is a gap in the EU standards regarding the testing of product efficacy in household laundering. With the aim of addressing this gap, an international ring trial was organized to evaluate the robustness of a new method (prEN 17658) designed to test the efficacy of antimicrobial laundry products in a domestic setting. The seven participating laboratories were equipped with 5 different laboratory-scale devices to simulate the washing process, and they evaluated 7 microbial parameters for 2 experimental conditions and 3 levels of active substance. The analysis of data according to ISO 5725-2 and ISO 13528 demonstrated that the method was robust. All reproducibility standard deviation values were between 0.00 and 1.40 and the relative standard deviation indicates satisfactory reproducibility. Values of logarithmic reduction ranged from less than 2 log10 for tests with water to more than 5 log10 when disinfectants were added. The evidence generated by the ring trial was presented in a proposal for a standardized method under CEN/TC 216, in which the SOP used in the ring trial is referred to as the prEN 17658 phase 2 step 2 test method covering chemothermal textile disinfection in domestic settings.

What's Up Your Sleeve? A Scoping Review of White Coat Contamination and Horizontal Microbial Transmission.

OBJECTIVES: White coats have been suggested to serve as fomites carrying and transmitting pathogenic organisms and potentially increasing the risk of healthcare-associated infections (HAIs). We aimed to examine the current evidence regarding white coat contamination and its role in horizontal transmission and HAIs risk. We also examined handling practices and policies associated with white coat contamination in the reviewed literature. METHODS: We conducted a literature search through PubMed and Web of Science Core Collection/Cited Reference Search, and manually searched the bibliographies of the articles identified in electronic searches. Studies published up to March 3, 2021 that were accessible in English-language full-text format were included. RESULTS: Among 18 included studies, 15 (83%) had ≥100 participants, 16 (89%) were cross-sectional studies, and 13 (72%) originated outside of the United States. All of the studies showed evidence of microbial colonization. Colonization with Staphylococcus aureus and Escherichia coli was reported in 100% and 44% of the studies, respectively. Antibacterial-resistant strains, including methicillin-resistant Staphylococcus aureus and multidrug-resistant organisms were reported in 8 (44%) studies. There was a lack of studies assessing the link between white coat contamination and HAIs. The data regarding white coat handling and laundering practices showed inconsistencies between healthcare facilities and a lack of clear policies. CONCLUSIONS: There is robust evidence that white coats serve as fomites, carrying dangerous pathogens, including multidrug-resistant organisms. A knowledge gap exists, however, regarding the role of contaminated white coats in HAI risk that warrants further research to generate the evidence necessary to guide the current attire policies for healthcare workers.

Enzyme hydrolysis of polyester knitted fabric: A method to control the microfiber shedding from synthetic textile.

Synthetic textile materials are noted as one of the major contributors to microfiber release from household laundry. The higher usage of synthetic textiles was noted as one of the major reasons for the leaching of microfibers into the aquatic system. Though few laundry aids are available to control the release of microfiber from laundry, no successful methods were developed to control it in the fabric itself. Hence, this research aimed to analyze the effectiveness of surface modification of polyester fabric using lipase enzyme and its impact on microfiber shedding. Taguchi's L9 orthogonal array was adopted to optimize the enzyme treatment process parameters to reduce microfiber shedding. The results showed that enzyme concentration was the major influencing factor with a contribution of 35.56%, followed by treatment pH (35.247%), treatment time (17.46%), and treatment temperature (11.74%). The optimization with S/N ratio showed minimum microfiber shedding at an enzyme concentration of 0.5 gram per liter (gpl), treatment temperature of 55°C, 6.5 pH, and a treatment time of 45 minutes. Knitted polyester fabric treated with the optimized enzyme treatment condition showed a significant reduction (p<0.05) in microfiber shedding (count-79.11% and mass-85.68%). The surface changes and the interaction of the enzyme on the fabric were confirmed by hydrolytic activity and FTIR analysis. The optimized treatment on different knit structures and fabric with different grams per square meter (GSM) indicated the versatility of the treatment irrespective of fabric parameters. The repeated laundry process (20 washing cycles) showed that the enzyme-treated samples had a significant level (p<0.05) of reduction in shedding than the control sample. The difference in shedding after 20 washes supports the efficiency and longevity of the enzyme treatment process in reducing microfiber shedding.