BACKGROUND: Healthcare laundry-related infection is rare, and pulmonary zygomycosis due to contaminated hospital linens has never been reported. METHODS: We reported an outbreak investigation of zygomycosis in a university-affiliated teaching hospital. Air samplers, sponge swabs and Replicate Organism Detection and Counting (RODAC) contact plates were used for environmental sampling. The fungal isolates from clinical and environmental samples were identified by morphology, MALDI-TOF MS, and ITS1-5.8S-ITS2 rRNA gene cluster sequencing. RESULTS: From 2 June 2015 to 18 July 2015, 6 immunosuppressed patients developed pulmonary (n = 4) and/or cutaneous (n = 3) infection by a spore-forming mold, Rhizopus microsporus, through direct inhalation and skin contact of contaminated linen items supplied by a designated laundry. Seventy (27.8%) of 252 freshly laundered clothing and 15 (3.4%) of 443 nonclothing laundered linen items (pillow case, bed sheet, draw sheet) were contaminated by R. microsporus, which was significantly higher than those from other hospital laundries (0%, n = 451; P < .001) supplying linen to hospitals with no cases of zygomycosis reported during the same period. The fungal isolates from patients and linens were phylogenetically related. In sum, 61% of environmental samples and 100% of air samples at the designated laundry were also positive for zygomycetes, suggesting heavy environmental contamination. RODAC contact plates revealed mean total viable bacteria counts of freshly laundered items (1028 ± 611 CFU/100 cm(2)) far exceeded the "hygienically clean" standard of 20 CFU/100 cm(2) set by the US healthcare textile certification requirement. CONCLUSIONS: Suboptimal conditions of washing, drying, and storage contributed to the massive linen contamination and the outbreak of zygomycosis.
BACKGROUND: Healthcare laundry-related infection is rare, and pulmonary zygomycosis due to contaminated hospital linens has never been reported. METHODS: We reported an outbreak investigation of zygomycosis in a university-affiliated teaching hospital. Air samplers, sponge swabs and Replicate Organism Detection and Counting (RODAC) contact plates were used for environmental sampling. The fungal isolates from clinical and environmental samples were identified by morphology, MALDI-TOF MS, and ITS1-5.8S-ITS2 rRNA gene cluster sequencing. RESULTS: From 2 June 2015 to 18 July 2015, 6 immunosuppressed patients developed pulmonary (n = 4) and/or cutaneous (n = 3) infection by a spore-forming mold, Rhizopus microsporus, through direct inhalation and skin contact of contaminated linen items supplied by a designated laundry. Seventy (27.8%) of 252 freshly laundered clothing and 15 (3.4%) of 443 nonclothing laundered linen items (pillow case, bed sheet, draw sheet) were contaminated by R. microsporus, which was significantly higher than those from other hospital laundries (0%, n = 451; P < .001) supplying linen to hospitals with no cases of zygomycosis reported during the same period. The fungal isolates from patients and linens were phylogenetically related. In sum, 61% of environmental samples and 100% of air samples at the designated laundry were also positive for zygomycetes, suggesting heavy environmental contamination. RODAC contact plates revealed mean total viable bacteria counts of freshly laundered items (1028 ± 611 CFU/100 cm(2)) far exceeded the "hygienically clean" standard of 20 CFU/100 cm(2) set by the US healthcare textile certification requirement. CONCLUSIONS: Suboptimal conditions of washing, drying, and storage contributed to the massive linen contamination and the outbreak of zygomycosis.
Authors: Vincent C C Cheng; Hong Chen; Shuk-Ching Wong; Jonathan H K Chen; Wing-Chun Ng; Simon Y C So; Tuen-Ching Chan; Sally C Y Wong; Pak-Leung Ho; Lona Mody; Felix H W Chan; Andrew T Y Wong; Kwok-Yung Yuen Journal: Infect Control Hosp Epidemiol Date: 2018-02-27 Impact factor: 3.254
Authors: Alexander J Sundermann; Cornelius J Clancy; A William Pasculle; Guojun Liu; Richard B Cumbie; Eileen Driscoll; Ashley Ayres; Lisa Donahue; Steven A Pergam; Lilian Abbo; David R Andes; Pranatharthi Chandrasekar; Alison L Galdys; Kimberly E Hanson; Kieren A Marr; Jeanmarie Mayer; Seema Mehta; Michele I Morris; John Perfect; Sanjay G Revankar; Becky Smith; Sankar Swaminathan; George R Thompson; Merin Varghese; Jose Vazquez; Estella Whimbey; John R Wingard; M Hong Nguyen Journal: Clin Infect Dis Date: 2019-02-15 Impact factor: 9.079
Authors: Shobini Sivagnanam; Dhruba J Sengupta; Daniel Hoogestraat; Rupali Jain; Zach Stednick; David N Fredricks; Paul Hendrie; Estella Whimbey; Sara T Podczervinski; Elizabeth M Krantz; Jeffrey S Duchin; Steven A Pergam Journal: Antimicrob Resist Infect Control Date: 2017-12-06 Impact factor: 4.887
Authors: Vincent C C Cheng; Siddharth Sridhar; Shuk-Ching Wong; Sally C Y Wong; Jasper F W Chan; Cyril C Y Yip; Chi-Hung Chau; Timmy W K Au; Yu-Yan Hwang; Carol S W Yau; Janice Y C Lo; Cheuk-Kwong Lee; Kwok-Yung Yuen Journal: Emerg Infect Dis Date: 2018-01-17 Impact factor: 6.883
Authors: Kathleen P Hartnett; Brendan R Jackson; Kiran M Perkins; Janet Glowicz; Janna L Kerins; Stephanie R Black; Shawn R Lockhart; Bryan E Christensen; Karlyn D Beer Journal: J Fungi (Basel) Date: 2019-07-24