Which countries require medical textiles to be washed using hygienic isolation washing machines?

Globally, the safe laundering of medical textiles has long been an essential component of healthcare infection control. Many countries and regions have already enacted legislation or established industry standards requiring healthcare facilities to use hygienic isolation washing machines (also known as double-door or dual-door washers). These requirements are primarily driven by stringent controls on the risk of cross-infection and the promotion of industry best practices. Below is an interpretation of the relevant regulations in various countries and regions:
1. United States
The U.S. Centers for Disease Control and Prevention (CDC), in its "Guidelines for Environmental Infection Control in Healthcare Facilities," explicitly recommends that the laundering of medical textiles be strictly segregated between contaminated and clean areas. Dual-door washing machines, with their physical isolation capabilities, have become critical equipment for this purpose. Moreover, the Association of periOperative Nurses (AORN) and the Occupational Safety and Health Administration (OSHA) also underscore the importance of such equipment. In some states, such as California, the use of dual-door washing machines has already been mandated by law, while other states adhere to industry best practices.
2. European Union countries
The EU’s EN 14065 standard (Risk Analysis and Biocontamination Control for Hygienic Treatment of Textiles, also known as the RABC system) requires that washing processes strictly separate contaminated and clean areas, which has indirectly promoted the adoption of dual-door washing machines. Hospitals in countries such as Germany, France, and the United Kingdom generally adhere to this standard, and some countries have even made its implementation mandatory through local regulations. For example, Germany’s Hospital Hygiene Act explicitly mandates that medical textiles must be washed using isolated equipment to prevent cross-contamination.
3. Canada
Health Canada and CSA standards (such as Z314.23) recommend the use of double-door washing machines when handling infectious textiles and consider them essential equipment. Large public hospitals and private laundry companies in Canada widely adopt such equipment to meet infection-control requirements.
4. Australia and New Zealand
Australian Standard AS/NZS 4146 (Hygiene Management for Laundry Processes) requires that medical textiles be washed with physical separation between contaminated and clean areas; dual-door washing machines are a common solution. Public hospitals and third-party laundry service providers generally adopt this type of equipment.
5. Brazil
Brazil’s medical laundry regulations have been gradually improving in recent years. In the guidelines issued by Brazil’s National Health Surveillance Agency (ANVISA), strict separation between contaminated and clean areas is emphasized throughout the medical textile washing process. Although the use of double-door washing machines is not yet mandatory, the regulations explicitly recommend the use of isolated equipment in high-risk areas—such as hospitals specializing in infectious diseases and operating room textile laundering. Moreover, Brazil’s regulations do not mention the use of tunnel-type washing units; instead, they tend to favor equipment and technologies that can effectively prevent cross-contamination.
6. Other regions
In the Middle East, such as Saudi Arabia and the United Arab Emirates, some countries have adopted European and American standards in newly built hospitals, requiring the use of isolation-type washing machines. In Asia, for instance in Japan and Singapore, although there are no nationwide mandatory regulations, high-end medical institutions and infectious disease hospitals typically proactively adopt dual-door equipment.
Key Summary
• Mandatory requirements for countries: Germany, France (certain regions), the United States (certain states), and Canada (high-risk institutions).
• Recommended national standards: EU member states (EN 14065), Australia, New Zealand, Japan, and others.
• International Trend: Even in countries where it is not mandatory, adopting dual-door washing machines is considered a “best practice” for infection control—particularly when handling surgical dressings and fabrics from isolation wards.
Professional Discussion and Recommendations on the WS/T508 Standard
• Standard lag issue
Currently, some countries and regions have already enacted legislation mandating the use of double-door washing machines in medical institutions; however, the revised version of WS/T508 has yet to reflect this requirement. By contrast, international best practices have already recognized double-door washing machines as a “best practice” for infection control. Yet, the draft revision of WS/T508 still retains the clause “if... is used,” which indirectly encourages the use of products that fail to meet standards. It is recommended that the rationale behind this clause be further substantiated and that it should not contradict the microbiological requirements and indicators.
• Alignment of the standard system
The EN 14065 standard promotes equipment upgrades by implementing rigorous washing procedures that strictly separate contaminated and clean areas. Although WS/T508 does specify zoning requirements in building layouts, it fails to impose clear restrictions on equipment that cannot meet these zoning requirements, thereby undermining the effectiveness of standard implementation. It is recommended that the standard be supplemented with specific requirements for equipment to ensure the effective implementation of zoning provisions.
• Risk prevention and control vulnerabilities
The current standards do not fully reflect specific requirements for measures aimed at reducing infection rates. In particular, for newly built hospitals and socially operated service institutions, if substandard equipment is used—equipment that cannot be easily replaced in the short term—patients may be exposed to fabrics with microbial levels exceeding acceptable limits over the long term, thereby increasing the risk of infection. It is recommended to supplement the standards with relevant scientific evidence and corresponding countermeasures to enhance the risk prevention and control mechanisms.
The above recommendations are intended to enhance the scientific rigor and practical applicability of the standards, and are provided for reference and study by the standard-setting authorities.