The Journal of hospital infection · 2026
Transmission of dry surface biofilm via and through cotton bedsheets: implications for hospital infection control.
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Chowdhury D, Tahir S, Legge M, Wang M, Deva A K, Vickery K, Hu H
Аннотация
BACKGROUND: Dry-surface biofilms (DSBs) have been found to persist on hospital beds and pillows.
AIM: This study aimed to investigate whether cotton bedsheets prevent transmission of DSB-related pathogens to patients.
METHODS: Staphylococcus aureus DSB was cultured on polycarbonate coupons. DSB transmission was simulated via 150- or 250-thread/in2 cotton bedsheets directly onto surfaces, or through cotton sheets onto hands and then onto surfaces, both before and after neutral detergent treatment by colony-forming unit (cfu) counts. Quantitative real-time polymerase chain reaction (qPCR) and scanning electron microscopy (SEM) were used to evaluate bacterial biofilm contamination on hospital mattresses and pillow covers.
FINDINGS: Lab simulations: Bacterial transfer counts (cfu) differed significantly across all experimental conditions. Specifically, bacterial transmission was significantly higher for cotton sheets with a thread count of 150 threads/in2 than in those with a count of 250 threads/in2 (P < 0.001). Additionally, transmission was significantly greater for wet sheets (post detergent treatment) than for dry sheets (P < 0.001) and significantly higher for direct touch than for contact through the sheets (P < 0.001). CLINICAL SAMPLES: qPCR detected 1.1×105±6.8×104 bacteria/cm2 on mattress covers and 7.5±3.7×104 bacteria/cm2 on pillow covers; SEM directly visualized DSB embedded in surface pits of mattress covers, confirming real-world clinical contamination.
CONCLUSION: Cotton bedsheets show high transmissibility for DSB, especially when wet. DSB can persist on mattresses and could be transmitted through bedsheets, highlighting the need for rigorous cleaning, frequent sheet changes, and higher-thread-count sheets to reduce pathogen transmission and hospital-acquired infections.
AIM: This study aimed to investigate whether cotton bedsheets prevent transmission of DSB-related pathogens to patients.
METHODS: Staphylococcus aureus DSB was cultured on polycarbonate coupons. DSB transmission was simulated via 150- or 250-thread/in2 cotton bedsheets directly onto surfaces, or through cotton sheets onto hands and then onto surfaces, both before and after neutral detergent treatment by colony-forming unit (cfu) counts. Quantitative real-time polymerase chain reaction (qPCR) and scanning electron microscopy (SEM) were used to evaluate bacterial biofilm contamination on hospital mattresses and pillow covers.
FINDINGS: Lab simulations: Bacterial transfer counts (cfu) differed significantly across all experimental conditions. Specifically, bacterial transmission was significantly higher for cotton sheets with a thread count of 150 threads/in2 than in those with a count of 250 threads/in2 (P < 0.001). Additionally, transmission was significantly greater for wet sheets (post detergent treatment) than for dry sheets (P < 0.001) and significantly higher for direct touch than for contact through the sheets (P < 0.001). CLINICAL SAMPLES: qPCR detected 1.1×105±6.8×104 bacteria/cm2 on mattress covers and 7.5±3.7×104 bacteria/cm2 on pillow covers; SEM directly visualized DSB embedded in surface pits of mattress covers, confirming real-world clinical contamination.
CONCLUSION: Cotton bedsheets show high transmissibility for DSB, especially when wet. DSB can persist on mattresses and could be transmitted through bedsheets, highlighting the need for rigorous cleaning, frequent sheet changes, and higher-thread-count sheets to reduce pathogen transmission and hospital-acquired infections.