Keeping health care linens clean: Underrecognized hazards and critical control points to avoid contamination of laundered health care textiles


      • Microbes, particularly molds, on linens pose risks to specific patient populations.
      • Suboptimal handling of cleaned health care textiles may result in contamination.
      • Contamination could occur at the laundry or health care facility.
      • This report includes checklists to assess laundry and health care facilities.
      Outbreaks of health care-associated infections, particularly invasive mold infections, have been linked to environmental contamination of laundered health care textiles. Contamination may occur at the laundry or health care facility. This report highlights underrecognized hazards, control points, and actions that infection preventionists can take to help decrease the potential for patient exposure to contaminated health care textiles. Infection preventionists can use the checklists included in this report to assess laundry and health care facility management of laundered health care textiles.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sehulster LM.
        Healthcare laundry and textiles in the United States: review and commentary on contemporary infection prevention issues.
        Infect Control Hospital Epidemiol. 2015; 36: 1073-1088
      1. Association for the Advancement of Medical Instrumentation (AAMI). Processing of Reusable Surgical Textiles For Use in Health Care Facilities. ANSI/AAMI ST65:2008 (R2018). Arlington, VA.

      2. American Society of Heating, Refrigerating, and Air-Conditioning Engineers. ANSI/ASHRAE/ASHE Standard 170-2021. Ventilation of Health Care Facilities. 2021.

      3. Sehulster L, Chinn RY. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) MMWR. Recommendations Rep.: Morbidity Mortal Wkly report. Recommendations reports 2003; 52(Rr-10): 1-42.

        • Sundermann AJ
        • Clancy CJ
        • Pasculle AW
        • et al.
        How clean is the linen at my hospital? The mucorales on unclean linen discovery study of large United States transplant and cancer centers.
        Clin Infect Dis. 2018; 68: 850-853
        • Duffy J
        • Harris J
        • Gade L
        • et al.
        Mucormycosis outbreak associated with hospital linens.
        Pediatr Infect Dis J. 2014; 33: 472-476
        • Cheng VCC
        • Chen JHK
        • Wong SCY
        • et al.
        Hospital outbreak of pulmonary and cutaneous zygomycosis due to contaminated linen items from substandard laundry.
        Clin Infect Dis. 2016; 62: 714-721
        • Teal LJ
        • Schultz KM
        • Weber DJ
        • et al.
        Invasive cutaneous rhizopus infections in an immunocompromised patient population associated with hospital laundry carts.
        Infect Control Hosp Epidemiol. 2016; 37: 1251-1253
      4. Code of Federal Regulations. 482.12 Condition of participation: Governing body. Accessed: October 19, 2021.

      5. United States Food and Drug Administration. HACCP Principles & Application Guidelines, National Advisory Committee on Microbiological Criteria for Foods, Adopted August 14, 1997, Silver Spring, MD. Accessed: December 8, 2021.

        • Ibrahim AS
        • Spellberg B
        • Walsh TJ
        • Kontoyiannis DP
        Pathogenesis of mucormycosis.
        Clin Infect Dis. 2012; 54: S16-S22
      6. Association for Linen Management. Education and Training. Access date: January 10, 2022.

        • Hartnett KP
        • Jackson BR
        • Perkins KM
        • et al.
        A guide to investigating suspected outbreaks of mucormycosis in healthcare.
        J Fungi (Basel, Switzerland). 2019; 5: 69
      7. CDC. Reduce Risk from Water. Accessed January 1, 2022.

      8. Association for Linen Management. Advancing excellence in the textile care industry through education, certification, and best practices. Accessed January 11, 2022.

        • Harpaz R
        • Dahl RM
        • Dooling KL.
        Prevalence of immunosuppression among US Adults, 2013.
        JAMA. 2016; 316: 2547-2548