Washing machines should be further investigated as possible sites for horizontal gene transfer (ESBL genes) and cross-contamination with clinically important Gram-negative strains. Particularly in the health care sector, the knowledge of possible (re-)contamination of laundry (patients’ clothes and staff uniforms) with multidrug-resistant Gram-negative bacteria could help to prevent and to control nosocomial infections. This report describes an outbreak with a single strain of a multidrug-resistant bacterium (Klebsiella oxytoca sequence type 201) in a neonatal intensive care unit that was terminated only when the washing machine was removed. In addition, the study implies that changes in washing machine design and processing are required to prevent accumulation of residual water where microbial growth can occur and contaminate clothes.

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Microbial control is important to prevent nosocomial infections. Cold atmospheric plasma (CAP) is studied as an alternative disinfectant for dry surfaces. Bacterial endospores including Clostridium difficile and vegetative bacteria including Enterococcus faecium are treated on carriers, considering European testing standards. CAP reduces the spore load (106 cfu) by at least 3 log10 as required, independent from the bioburden (≤10 min treatments). Only a 2 log10 reduction is achieved with vegetative bacteria due to multilayer formation resulting from a higher required load (108 cfu). However, densities <10−7 cfu cm−2 enable disinfection by CAP. Elemental mapping identified other influencing burden. Overall, this study demonstrates possibilities and limitations of CAP treatment for disinfecting purposes.

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