A multicenter investigation to characterize the risk for pathogen transmission from healthcare facility sinks

Abstract

In 4 hospitals, we demonstrated frequent dispersal of fluorescent tracer and fluoroquinolone-resistant gram-negative bacilli from sink drains to sink bowls and to surfaces outside the bowl. Fluorescent tracer dispersal correlated inversely with the depth of the sink bowl. Modifications in sink design could substantially reduce the risk for pathogen dissemination.

Effectiveness of foam disinfectants in reducing sink-drain gram-negative bacterial colonization

“…9,10 Moreover, organisms colonizing sink drains can be dispersed from beneath the strainer to the sink bowl, and countertop, and to patients or personnel by splashing of flowing water. [11][12][13] Unfortunately, addressing sink contamination is challenging because sink drains are not amenable to cleaning and disinfection. 14 For example, sinks in healthcare facilities typically have fixed, narrow strainer holes that do not permit access by brushes that could be used to remove bioburden prior to application of disinfectants.…”

Dispersal of gram-negative bacilli from contaminated sink drains to cover gowns and hands during hand washing

“…However, similar dispersal of gram-negative bacilli has been demonstrated in sinks in 4 hospitals. 10 The sink drain cover was only tested for 1 hand-washing episode per sink. However, we previously implemented the devices for a 2-week period in an intensive care unit and demonstrated that organisms in the sink bowl can be dispersed by flowing water.…”

Water as a source for colonization and infection with multidrug-resistant pathogens: Focus on sinks

“…Of these characteristics, only sink bowl depth was associated with dispersion of the gel outside the bowl, with dispersion occurring in nearly half of sinks with depth ≤19 cm and rarely when depth exceeded 24 cm. 8 Additionally, there are important dynamics between water flow rate and pathogen dispersion that may not be fully mediated by sink design and must be balanced with functionality and the risks of low-flow states.…”

“…At our institution, we documented transmission of KPC-producing Citrobacter freundii from a colonized in-room sink P trap and drain to the sink edge during routine use of the sink (Lewis and Smith, unpublished data). Factors including sink design, water flow rates 8 and degree of drain colonization all influence the degree of pathogen transmission from sink drains.…”

“…, 2 Recently, hospital-building wastewater systems including sinks and drains have received more attention as potential sources of transmission of multidrug-resistant gram-negative bacilli 3 7 In this issue of Infection Control and Hospital Epidemiology , 2 studies by Dr Curtis Donskey’s research group add to our understanding of the importance of sink drains as reservoirs of pathogens and describe potential interventions to reduce contamination of surfaces surrounding sinks 8 9 This commentary focuses on the growing body of evidence linking sinks to HAIs and discusses strategies to mitigate the risk of transmission of pathogens from sinks to patients.…”