Keep Floors Safe: Say No to Absorbent Woven Textiles

Safety, efficiency, and infection prevention are top priorities in every health care area, such as sterile processing departments, operating rooms, labor and delivery suites, and other invasive units. Yet, a risky practice often seen and reported to persist today is using woven textiles, such as towels and blankets, as improvised absorbents for fluid spills on the floor. These common spills include, but are not limited to, fluids that may be contaminated with blood and body fluids. Although often viewed as a time and convenience option, utilizing a woven textile in this manner introduces potential safety and infection risks to the entire facility.

This paper will examine the clinical, regulatory, and operational risks associated with the use and misuse of woven textiles when trying to contain and absorb fluids on the floor or other horizontal surfaces. We will also outline evidence-based alternatives that help support patient and staff safety while offering organizations a safer method of complying with the Occupational Safety and Health Administration (OSHA) bloodborne pathogen standards, as well as other state and local regulations and guidelines.

1. Hazard Identification

Commonly used reusable woven textiles (eg, towels, blankets, sheets) are not engineered, manufactured, or intended to effectively absorb, retain, or isolate blood, body fluids, or other potentially infectious material (OPIM) liquids on the floor. The CDC health care–associated infections (HAIs) recommendations call for the use of “absorbent (paper) towels, cloths, or absorbent granules (if available) that are spread over the spill to solidify the blood and body fluid.” CDC further recommends disposing of these materials as infectious waste.¹ The Association of periOperative Registered Nurses (AORN) goes a step further and recommends the application of “an EPA-registered disinfectant that is effective against bloodborne pathogens (eg, human immunodeficiency virus, hepatitis B virus) to the spill.”²

Whenever a health care facility declines to use single-use, disposable absorbent materials, as the CDC and others recommend, and uses reusable woven textiles to absorb these fluids on the floor, the staff may assume that these materials will effectively absorb and trap the fluids. Unfortunately, woven textiles lack the fluid-resistant properties required in

clinical environments and can wick and spread liquids across surfaces. Although woven textiles may initially appear to contain fluids, these reusable wovens will readily release fluids when moved or compressed.^3,4 This wicking and redistribution of fluids common with reusable woven textiles can inadvertently increase the contamination zone, spread pathogens, and expose health care workers, including laundry workers, to unnecessary risk from exposure to potentially infectious and/or hazardous materials. It is well recognized that moisture in textiles or fabrics can foster microbial growth and has been implicated in HAIs.^5,6

This concern is especially relevant in high-risk areas such as sterile processing departments, operating rooms, labor and delivery suites, and other critical care areas, where compromised environmental hygiene can and has led to reports of serious HAIs. Improper fluid containment threatens infection control efforts and may undermine institutional safety protocols and other regulatory requirements.^2,7

2. Woven Textiles: Limited Efficacy Compared With Engineered Materials

Commonly used health care woven textiles are not designed, nor intended, to trap and lock in hazardous fluids, including blood and OPIM. Purpose-built single-use absorbent materials, on the other hand, are designed to fit specific applications and are intended to contain fluid within engineered absorbent layers. In the health care setting, the use of fluid-impervious backing and sealed edges, if included in the purpose-built single-use absorbent materials’ design, helps prevent fluid redistribution and minimize the potential exposure risks encountered when discarding in the appropriate waste receptacle. These advanced absorbent materials are designed based on several factors, including, but not limited to, fluid dynamics and absorbency science, to provide consistent containment, which is not achievable with woven textiles.

In contrast, common woven textiles, such as blankets and towels, lack a fluid barrier and rely solely on natural absorption capacity, which varies significantly with material composition, blends, weight, and other factors. The absorbency of woven textiles can quickly be exceeded during the cleanup of even minor spills. The result is a high probability of spread and seepage when moved, compromising surface decontamination and delaying area readiness for reuse.⁸

3. Regulatory Misalignment and Lack of Best Practice Recognition

The use of woven textiles for cleanup and/or containment of spills, such as blood or body fluids, is not endorsed by any recommending body or regulatory agency, such as OSHA or The Joint Commission. Recommending bodies such as AORN and the Association for the Advancement of Medical Instrumentation advocate using engineered, validated cleaning and absorbent products. The absence of recognition for woven textiles in this context reflects their unsuitability for infection control and occupational safety.

Furthermore, attempts to standardize spill cleanup procedures using linens are inherently flawed, as variation in size, weave, and saturation capacity leads to inconsistent outcomes. Without validated absorbency or barrier performance, woven textiles cannot be reliably incorporated into institutional policies or quality improvement initiatives.^2,6

4. Operational Inefficiencies: Increased Turnover Time

When spills are managed with woven textiles, facilities may face longer room turnover times due to the need for repeated cleaning and disinfection. Woven textiles not only fail to contain fluids fully but can also readily release them onto surfaces when they drip, requiring secondary cleaning steps. Fabric-based materials (eg, woven textiles) can absorb fluids but may still allow leakage, which often necessitates additional cleaning and disinfection, causing workflow delays and reducing operational efficiency.⁹ This can delay room availability and disrupt surgical schedules, especially in high-volume settings, while increasing labor needs.

Increased downtime between cases can lead to scheduling bottlenecks, frustrated staff, and reduced patient throughput. By contrast, using engineered absorbents can help accelerate room or area cleanup while ensuring more complete fluid capture and improved readiness for disinfection.

5. Workplace Safety and Slips, Trips, and Falls

OSHA regulations require health care employers to eliminate recognized workplace hazards, including slip, trip, and fall (STF) risks. Fluids incompletely absorbed or released from saturated linens can create slick surfaces that are difficult to detect and may result in injury. STF events are among the most frequently reported injuries in health care and lead to lost work time, increased insurance costs, and potential litigation.

Penalties for failing to correct STF hazards can be substantial. OSHA citations may range from $16,550 to over $165,000 per violation for repeat offenses. More importantly, such incidents compromise staff safety and morale while exposing the institution to reputational and financial harm.^10,11

6. Biohazard Management and Disposal Requirements

Once exposed to blood or OPIM, reusable linens must be treated as contaminated medical waste. If improperly handled, they risk spreading pathogens to other departments or areas. Reprocessing contaminated linens without proper handling protocols violates OSHA standards and increases exposure risks to laundry workers and clinical staff.

Proper handling of any contaminated linen is critical to preventing the potential for secondary transmission events.⁷ Many facilities may not be aware that once linens are used for spill cleanup of blood and/or OPIM, they must be placed into red bags or be labeled with biohazardous labels. Laundry personnel must be trained in the procedures used for handling contaminated laundry. This has created significant confusion for health care facilities.^7,12

7. Environmental Misconceptions and True Sustainability

Although reusable materials often appear environmentally friendly, their use for fluid spill cleanup creates hidden environmental and public health costs. Ineffective containment leads to increased use of water and detergents, and the production of infectious wastewater that must be treated. These environmental burdens may exceed the footprint of single-use engineered alternatives.

Moreover, when woven textiles are misused and subsequently discarded as contaminated waste, the original intent of reuse is undermined. By contrast, engineered spill control materials are optimized for safe disposal, reduced handling, and minimal environmental impact.

8. Learning From the Past

Historically, operating rooms relied on woven gowns and drapes, but these materials were eventually phased out due to inadequate barrier protection and inconsistent fluid resistance. After extensive evaluation, the US health care system transitioned to engineered materials that provide more reliable infection prevention, staff protection, and patient safety.^13,14

Today, most woven textiles are limited to noncritical applications like hand drying. Applying the same evidence-based standards to floor spill management is a logical progression. Just as engineered surgical drapes replaced linens for better outcomes, purpose-built absorbents should also replace linens in managing floor fluids.

Conclusion: Prioritizing Safety, Adherence, and Outcomes

Using woven textiles to manage fluid spills is an outdated and unsafe practice. These materials are ill-suited for fluid containment, introduce the potential for cross-contamination risks, extend room turnover time, and conflict with several infection control standards. Regulatory bodies, industry guidelines, and historical lessons all point toward adopting absorbent engineered materials as the modern standard method to help control fluid spills on the floors of health care facilities.

To protect staff and patients and ensure consistent, compliant operations, health care organizations should abandon legacy practices in favor of a proven, purpose-built solution. Choosing the right tools—starting from the floor up—is essential to sustaining a culture of safety and excellence.

References

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10. Walking-working surfaces and personal protective equipment (fall protection systems). 29 CFR §1910 (2016). https://www.federalregister.gov/documents/2016/11/18/2016-24557/walking-working-surfaces-and-personal-protective-equipment-fall-protection-systems
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