Transfer of microorganisms to and from textiles in healthcare settings: a systematic review

Objective: Microbial contamination of textiles in healthcare settings is common and hypothesized to contribute to pathogen transfer. This systematic literature review aims to summarize the current evidence on microorganism transfer to and from textiles in healthcare and on factors that influence transfer. Design: Systematic literature review. Methods: Cochrane, Medline/Ovid, EMBASE, and Web of Science were searched. Studies were included if the transfer experiment involved textiles as origin material or destination material, the transfer mechanism was described accurately, and transfer events were quantifiable. Results on transfer and factors associated with transfer were extracted. Results: We included 21 studies with 490 transfer experiments. Considerable heterogeneity in all relevant study variables resulted in a very broad range of reported transfer proportions, from less than 1% to up to 100%. Cotton was the most frequently studied textile (13 studies) while was the most frequent pathogen of interest (13 studies). Highest transfer proportions (85-100%) were reported in transfer experiments from solid surfaces to textiles by wiping. Very low transfer proportions (0.01-2.5%) were reported in transfer experiments from textiles to textiles by pressure. Moisture and friction were associated with higher transfer. Conclusions: This study highlights the wide range of microbial transfer quantity from and to textiles in healthcare, depending on transfer mechanism, moisture, and other factors. The findings can inform the design of infection prevention and control (IPC) practices in healthcare.