Background: Skin infections have profound impacts on health and wellbeing. A range of interrelated pathogens cause itch, irritation and skin trauma. This can lead to bacterial infections and serious post-infectious consequences including ARF and RHD. An integrated approach to managing skin pathogens is needed. Washing clothes and bedding is assumed to be an effective intervention. However, to date there has been no synthesis of evidence for the survival of skin pathogens on household fabrics, nor the value of washing/laundering to control them.
Methods: We conducted a systematic review of the survival/transmission of skin pathogens via fabric fomites and effective laundering specifications such as temperature, duration and detergents. Seven key skin pathogens were included: Streptococcus pyogenes [Strep A], Staphylococcus aureus, scabies, head and body lice, tinea, bed bugs, and molluscum contagiosum.
Results: Fabric fomite survival was evident for all seven pathogens. There was more, higher quality evidence for S. aureus, tinea and scabies compared to other pathogens. Specifications for effective laundering were available for some pathogens. We have synthesized our findings to identify evidence-gaps for transmission of skin pathogens via fabric fomites and provide recommendations to achieve comprehensive laundering guidance.
Conclusion: A range of interrelated skin pathogens and post-infection complications may be addressed by improving capacity to wash clothing and bedding. Consolidated laundering guidelines are needed to support families, laundry service providers and clinics. This work will contribute to reducing the burden of skin infections and complications, particularly in regional and remote Aboriginal and Torres Strait Islander communities.