Rethinking Linens: Experts Highlight a Missing Piece of Infection Prevention

During a recent Infection Control Today^® (ICT^®) roundtable, experts from microbiology, clinical medicine, and the healthcare linen industry came together to examine a frequently neglected contributor to health care-associated infections (HAIs): textiles. Although linens, gowns, and other fabrics come into contact with every patient on every shift, they remain largely absent from infection prevention conversations. The panelists argued that this must change.

Maggie Thiemann, MD, an academic hospitalist with 2 decades of clinical experience, noted that linens are rarely discussed at the executive level. “Linens are not a major part of the discussion right now for a couple of reasons,” she said. “It seems to suffer from the ‘if it ain’t broke, don’t fix it’ situation. Unless your linens are disintegrating or turning green, it is really not on the radar.”

Michael Schmidt, PhD, professor of microbiology and immunology at the Medical University of South Carolina, framed the problem within the broader challenge of HAIs. “Let’s just start out with the dirty little secret about health care, and that is (HAIs),” he said. “These are infections patients acquire while they are under the care of skilled professionals.” Schmidt explained that microbes move through the built environment with ease. “Everyone who has been in a hospital knows those gowns do not cover everything,” he said. “Consequently, the microbes are coming into contact with us.”

He also addressed why textiles have been underestimated. “It is a hard problem to solve,” he said. “Every patient is different. Every patient’s comorbidity is different. You need so many patients in your study to understand whether or not the linen you are introducing as the intervention will have the effect you are trying to understand.”

Eddie Lafeaux, CEO and cofounder of Westport Linen Services, brought the perspective of someone who daily handles the operational realities of health care textiles. With 35 years in the health care linen industry, he understands firsthand how textiles move through facilities. Lafeaux highlighted that bed sheets, gowns, and scrubs all act as surfaces with high potential for contamination, especially in acute and postacute environments.

Thiemann emphasized that innovation is needed, but adoption requires leadership. Embedded antimicrobial textiles and copper-infused fabrics are promising, but widespread implementation will not happen without champions. “It is going to take a very innovative leader,” she said. “Somebody who has the authority and the foresight to make such an innovative decision and switch the process.”

Schmidt agreed. “You need somebody in a position of power that has courage,” he said. He underscored the stakes with stark numbers. “About 687,000 patients will acquire an HAI in the US this year,” he said. “Seventy-two thousand of those individuals will end up dead.”

When asked where textiles pose the highest risk, Thiemann pointed to high acuity, high-turnover environments. “Hospitals, nursing homes, rehab facilities, anywhere there is a dense population of patients with high turnover,” she said. “It is a 6-lane highway of contamination.”

The panelists concluded that textiles must become a meaningful part of infection prevention bundles. As Schmidt put it, “All of us contribute to the system of coming up with a better solution for our patients.”