{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:23:04Z","timestamp":1789402984436,"version":"build-2803163510"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000601","name":"De Montfort University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000601","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Textile Services Association"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    Hospital-acquired infections (HAIs) and antimicrobial resistance (AMR) are a major public health concern, with the evidence base for the potential role of textiles as fomites in microbial transmission growing. In the UK, domestic laundering machines (DLMs) are commonly used to clean healthcare worker uniforms, raising concerns about their effectiveness in microbial decontamination and role in AMR development. This study aimed to evaluate DLMs\u2019 ability to decontaminate microorganisms and their potential impact on AMR. The performance of six DLMs was assessed using\n                    <jats:italic>Enterococcus faecium<\/jats:italic>\n                    bioindicators under various wash cycles and detergent conditions. Shotgun metagenomics was used to analyse the microbiome and resistome of DLMs. The minimum inhibitory concentrations of domestic detergents were determined for\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    ,\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    , and\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    , and detergent tolerance and antibiotic cross-resistance were assessed. Results showed only 50% (3\/6) of DLMs achieved sufficient decontamination (\u22655 log10 CFU reduction) at 60\u00b0C during full-length cycles, with rapid cycles performing inconsistently. Microbiome analysis revealed the presence of potentially pathogenic bacteria (e.g.,\n                    <jats:italic>Mycobacterium<\/jats:italic>\n                    sp.\n                    <jats:italic>Pseudomonas<\/jats:italic>\n                    sp. and\n                    <jats:italic>Acinetobacter<\/jats:italic>\n                    sp.) and antibiotic resistance genes, including efflux pumps and target modification genes. Detergent tolerance assays showed increased bacterial tolerance to detergents, with cross-resistance to antibiotics observed in\n                    <jats:italic>S. aureus<\/jats:italic>\n                    and\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    , including carbapenem and \u03b2-lactam groups. Whole genome sequencing identified mutations in genes encoding efflux pumps in\n                    <jats:italic>S. aureus<\/jats:italic>\n                    (\n                    <jats:italic>MrgA<\/jats:italic>\n                    ) and\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    (\n                    <jats:italic>AcrB<\/jats:italic>\n                    ) after detergent exposure, which could impact efflux pump function. Findings suggest domestic laundering of healthcare uniforms may be insufficient for decontamination, posing risks for HAI transmission and AMR. Revising laundering guidelines to ensure effective DLM performance, detergent efficacy, and considering alternatives like onsite\/industrial laundering are crucial to enhancing patient safety and controlling AMR in healthcare settings.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0321467","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T14:03:08Z","timestamp":1746799388000},"page":"e0321467","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Domestic laundering of healthcare textiles: Disinfection efficacy and risks of antibiotic resistance transmission"],"prefix":"10.1371","volume":"20","author":[{"given":"Caroline","family":"Cayrou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Silver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0252-4591","authenticated-orcid":true,"given":"Lucy","family":"Owen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9691-1523","authenticated-orcid":true,"given":"Jake","family":"Dunlop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7187-0415","authenticated-orcid":true,"given":"Katie","family":"Laird","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"pone.0321467.ref001","volume-title":"WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobia","author":"Antimicrobial Resistance Division, Impact Initiatives and Research Coordination","year":"2024 May"},{"key":"pone.0321467.ref002","doi-asserted-by":"crossref","first-page":"114006","DOI":"10.1016\/j.ijheh.2022.114006","article-title":"Prevalence of ESKAPE pathogens in the environment: Antibiotic resistance status, community-acquired infection and risk to human health","volume":"244","author":"J Denissen","year":"2022","journal-title":"Int J Hyg Environ Health"},{"issue":"9","key":"pone.0321467.ref003","doi-asserted-by":"crossref","first-page":"3330","DOI":"10.3390\/ijerph9093330","article-title":"Hospital textiles, are they a possible vehicle for healthcare-associated infections?","volume":"9","author":"S Fijan","year":"2012","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0321467.ref004","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/jam.13485","article-title":"The effect of low-temperature laundering and detergents on the survival of Escherichia coli and Staphylococcus aureus on textiles used in healthcare uniforms","volume":"123","author":"K Riley","year":"2017","journal-title":"J Appl Microbiol"},{"issue":"2","key":"pone.0321467.ref005","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1053\/jhin.2001.1127","article-title":"Carbapenem-resistant Acinetobacter and role of curtains in an outbreak in intensive care units","volume":"50","author":"I Das","year":"2002","journal-title":"J Hosp Infect"},{"issue":"4","key":"pone.0321467.ref006","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jhin.2012.04.022","article-title":"Hot and steamy: outbreak of Bacillus cereus in Singapore associated with construction work and laundry practices","volume":"81","author":"MND Balm","year":"2012","journal-title":"J Hosp Infect"},{"issue":"5","key":"pone.0321467.ref007","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.ajic.2021.12.017","article-title":"Health care worker knowledge and attitudes towards uniform laundering during the COVID-19 pandemic","volume":"50","author":"L Owen","year":"2022","journal-title":"Am J Infect Control"},{"key":"pone.0321467.ref008","unstructured":"National Health Service (NHS). Uniforms and workwear: guidance for NHS employers. London: NHS. 2020."},{"issue":"2","key":"pone.0321467.ref009","doi-asserted-by":"crossref","first-page":"123","DOI":"10.5650\/jos.ess15168","article-title":"Effects of Water Hardness on Textile Detergency Performance in Aqueous Cleaning Systems","volume":"65","author":"K Gotoh","year":"2016","journal-title":"J Oleo Sci"},{"issue":"12","key":"pone.0321467.ref010","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1086\/668441","article-title":"Gordonia bronchialis sternal wound infection in 3 patients following open heart surgery: intraoperative transmission from a healthcare worker","volume":"33","author":"SN Wright","year":"2012","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"22","key":"pone.0321467.ref011","doi-asserted-by":"crossref","first-page":"e01435-19","DOI":"10.1128\/AEM.01435-19","article-title":"The Washing Machine as a Reservoir for Transmission of Extended-Spectrum-Beta-Lactamase (CTX-M-15)-Producing Klebsiella oxytoca ST201 to Newborns","volume":"85","author":"RM Schmithausen","year":"2019","journal-title":"Appl Environ Microbiol"},{"issue":"8","key":"pone.0321467.ref012","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1080\/08927014.2010.524297","article-title":"Biofilms isolated from washing machines from three continents and their tolerance to a standard detergent","volume":"26","author":"J Gattlen","year":"2010","journal-title":"Biofouling"},{"issue":"6","key":"pone.0321467.ref013","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3139\/113.110394","article-title":"Characterization of Microbial Communities in Household Washing Machines","volume":"52","author":"ID Nix","year":"2015","journal-title":"Tenside Surfactants Detergents"},{"issue":"1","key":"pone.0321467.ref014","doi-asserted-by":"crossref","first-page":"30","DOI":"10.3390\/microorganisms8010030","article-title":"Influence of Sampling Site and other Environmental Factors on the Bacterial Community Composition of Domestic Washing Machines","volume":"8","author":"S Jacksch","year":"2019","journal-title":"Microorganisms"},{"issue":"6","key":"pone.0321467.ref015","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.3390\/microorganisms12061112","article-title":"Assessing antibiotic-resistant genes in university dormitory washing machines","volume":"12","author":"W Chen","year":"2024","journal-title":"Microorganisms"},{"issue":"23","key":"pone.0321467.ref016","doi-asserted-by":"crossref","first-page":"e02062-20","DOI":"10.1128\/AEM.02062-20","article-title":"The Household Resistome: Frequency of \u03b2-Lactamases, Class 1 Integrons, and Antibiotic-Resistant Bacteria in the Domestic Environment and Their Reduction during Automated Dishwashing and Laundering","volume":"86","author":"L Schages","year":"2020","journal-title":"Appl Environ Microbiol"},{"issue":"1","key":"pone.0321467.ref017","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1038\/s42003-023-04601-y","article-title":"Intermittent antibiotic treatment of bacterial biofilms favors the rapid evolution of resistance","volume":"6","author":"M Usui","year":"2023","journal-title":"Commun Biol"},{"key":"pone.0321467.ref018","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1128\/9781555819804.ch6","volume-title":"Resistance of Bacteria to Biocides. In: Schwarz S, Cavaco LM, Shen J, editors. Antimicrobial Resistance in Bacteria from Livestock and Companion Animals","author":"J Maillard","year":"2018"},{"issue":"8","key":"pone.0321467.ref019","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.3390\/microorganisms11082000","article-title":"Current Understanding of Potential Linkages between Biocide Tolerance and Antibiotic Cross-Resistance","volume":"11","author":"K Coombs","year":"2023","journal-title":"Microorganisms"},{"issue":"2","key":"pone.0321467.ref020","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1111\/jam.15564","article-title":"Priming with biocides: A pathway to antibiotic resistance?","volume":"133","author":"P Adkin","year":"2022","journal-title":"J Appl Microbiol"},{"issue":"12","key":"pone.0321467.ref021","doi-asserted-by":"crossref","first-page":"44","DOI":"10.7324\/JAPS.2018.81206","article-title":"Correlation between resistance of Pseudomonas aeruginosa to benzalkonium chloride and expression of efflux pump genes","volume":"8","author":"M Osman","year":"2018","journal-title":"J Appl Pharm Sci"},{"issue":"1","key":"pone.0321467.ref022","doi-asserted-by":"crossref","first-page":"194","DOI":"10.3390\/applmicrobiol4010014","article-title":"Development of a standardised international protocol for evaluation of the disinfection efficacy of healthcare laundry wash processes","volume":"4","author":"L Owen","year":"2024","journal-title":"Applied Microbiology"},{"issue":"2","key":"pone.0321467.ref023","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/S0195-6701(03)00240-8","article-title":"Development of bacterial resistance to several biocides and effects on antibiotic susceptibility","volume":"55","author":"SE Walsh","year":"2003","journal-title":"J Hosp Infect"},{"key":"pone.0321467.ref024","year":"2024"},{"key":"pone.0321467.ref025","author":"European Committee on Antimicrobial Susceptibility Testing"},{"issue":"11","key":"pone.0321467.ref026","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1086\/662183","article-title":"Effectiveness of low-temperature domestic laundry on the decontamination of healthcare workers\u2019 uniforms","volume":"32","author":"N Lakdawala","year":"2011","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"1","key":"pone.0321467.ref027","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jhin.2005.06.002","article-title":"Laundering of hospital staff uniforms at home","volume":"62","author":"SN Patel","year":"2006","journal-title":"J Hosp Infect"},{"issue":"16","key":"pone.0321467.ref028","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.3390\/foods12162981","article-title":"The Effect of Water Hardness and pH on the Efficacy of Peracetic Acid and Sodium Hypochlorite against SARS-CoV-2 on Food-Contact Surfaces","volume":"12","author":"JN Morris","year":"2023","journal-title":"Foods"},{"issue":"2","key":"pone.0321467.ref029","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.foodcont.2013.01.044","article-title":"Effects of water hardness and pH on efficacy of chlorine-based sanitizers for inactivating Escherichia coli O157:H7 and Listeria monocytogenes","volume":"32","author":"P Pangloli","year":"2013","journal-title":"Food Control"},{"issue":"8","key":"pone.0321467.ref030","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.cmi.2019.04.013","article-title":"Management of carbapenem-resistant Enterobacteriaceae infections","volume":"25","author":"E Durante-Mangoni","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"pone.0321467.ref031","doi-asserted-by":"crossref","first-page":"80","DOI":"10.3389\/fmicb.2019.00080","article-title":"Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Update on Therapeutic Options","volume":"10","author":"C Sheu","year":"2019","journal-title":"Front Microbiol"},{"issue":"2","key":"pone.0321467.ref032","doi-asserted-by":"crossref","DOI":"10.1128\/microbiolspec.GPP3-0057-2018","article-title":"Antibiotic Resistance and the MRSA Problem","volume":"7","author":"M Vestergaard","year":"2019","journal-title":"Microbiol Spectr"},{"issue":"6","key":"pone.0321467.ref033","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1093\/jac\/dki372","article-title":"Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA)","volume":"56","author":"DFJ Brown","year":"2005","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"pone.0321467.ref034","doi-asserted-by":"crossref","first-page":"dlaa114","DOI":"10.1093\/jacamr\/dlaa114","article-title":"Treatment of methicillin-resistant Staphylococcus aureus (MRSA): updated guidelines from the UK","volume":"3","author":"NM Brown","year":"2021","journal-title":"JAC Antimicrob Resist"},{"key":"pone.0321467.ref035","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.2147\/DDDT.S164515","article-title":"Linezolid: a review of its properties, function, and use in critical care","volume":"12","author":"SMR Hashemian","year":"2018","journal-title":"Drug Des Devel Ther"},{"issue":"3","key":"pone.0321467.ref036","doi-asserted-by":"crossref","first-page":"e01892-18","DOI":"10.1128\/AAC.01892-18","article-title":"Biocide Exposure Induces Changes in Susceptibility, Pathogenicity, and Biofilm Formation in Uropathogenic Escherichia coli","volume":"63","author":"EL Henly","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"issue":"4","key":"pone.0321467.ref037","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3390\/antibiotics7040110","article-title":"Biocidal Agents Used for Disinfection Can Enhance Antibiotic Resistance in Gram-Negative Species","volume":"7","author":"G Kampf","year":"2018","journal-title":"Antibiotics (Basel)"},{"key":"pone.0321467.ref038","doi-asserted-by":"crossref","first-page":"640923","DOI":"10.3389\/fmicb.2021.640923","article-title":"Biocide-induced emergence of antibiotic resistance in Escherichia coli","volume":"12","author":"B Pereira","year":"2021","journal-title":"Frontiers in Microbiology"},{"issue":"6","key":"pone.0321467.ref039","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1111\/jam.12647","article-title":"Impact of wash cycle time, temperature and detergent formulation on the hygiene effectiveness of domestic laundering","volume":"117","author":"M Honisch","year":"2014","journal-title":"J Appl Microbiol"},{"key":"pone.0321467.ref040","article-title":"Preventing the spread of infectious diseases in the European Union - targeted hygiene as a framework for sustainable hygiene","author":"S Bloomfield","year":"2010","journal-title":"International Scientific Forum On Home Hygiene"},{"key":"pone.0321467.ref041","doi-asserted-by":"crossref","first-page":"710","DOI":"10.3389\/fgene.2018.00710","article-title":"Genetic Diversity of norA, Coding for a Main Efflux Pump of Staphylococcus aureus","volume":"9","author":"SS Costa","year":"2019","journal-title":"Front Genet"},{"issue":"1","key":"pone.0321467.ref042","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1128\/AAC.49.1.161-169.2005","article-title":"Effect of promoter region mutations and mgrA overexpression on transcription of norA, which encodes a Staphylococcus aureus multidrug efflux transporter","volume":"49","author":"GW Kaatz","year":"2005","journal-title":"Antimicrob Agents Chemother"},{"issue":"1","key":"pone.0321467.ref043","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1128\/AAC.00715-09","article-title":"Klebsiella pneumoniae AcrAB efflux pump contributes to antimicrobial resistance and virulence","volume":"54","author":"E Padilla","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"pone.0321467.ref044","doi-asserted-by":"crossref","first-page":"103901","DOI":"10.1016\/j.resmic.2021.103901","article-title":"Analysis of AcrB in Klebsiella pneumoniae reveals natural variants promoting enhanced multidrug resistance","volume":"173","author":"Y Li","year":"2022","journal-title":"Res Microbiol"},{"issue":"1","key":"pone.0321467.ref045","first-page":"1000159","article-title":"Antimicrobial compounds of plant origin as efflux pump inhibitors: New avenues for controlling multidrug resistant pathogens","volume":"4","author":"M Rao","year":"2018","journal-title":"J Antimicrob Agents"},{"key":"pone.0321467.ref046","article-title":"Textiles - Laundry processed textiles - Biocontamination control system","author":"British Standards Institute","year":"2016","journal-title":"London: BSI"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321467","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T14:03:23Z","timestamp":1746799403000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321467"}},"subtitle":[],"editor":[{"given":"Guadalupe Virginia","family":"Nev\u00e1rez-Moorill\u00f3n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,30]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0321467","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,30]]}}}