A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit

Abstract

Objectives: The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. Methods: A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. Results: Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates 0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate 51%, prevalence of sinks with visible splashes 14%, prevalence of sinks close to the patient's bed 21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016). Discussion: Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.

Re: ‘A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit’ by Valentin et al.

“…Recording factors that may contribute to contamination of clinical areas near to the sinks was also original and interesting, and suggests the implementation of further studies. Overall, the results reported by Valentin et al [1] raise some important questions, and more particularly the variability of the prevalence of sink contamination, the actual risk of transmission from this environmental reservoir to patients, and the usefulness of iterative disinfections.…”

“…We read with great interest the recently published article by Valentin et al [1] investigating the risk associated with contaminated sinks in the intensive care unit.…”

“…Another important issue raised by Valentin et al [1] is the risk of transmission to patients and consequently the usefulness of disinfection. By recording some factors that may contribute to contamination of sinks and clinical areas near the sinks (i.e.…”

“…They also demonstrated that using a daily bleach treatment was associated with a lower sink contamination. However, it is noteworthy that this practice seems not to be consensual among the intensive care units participating to the study, as using bleach was only recorded in 22% of them [1]. Concurrently, in a study comparing the effect of bleach and hydrogen peroxide on a contaminated drain biofilm model, Ledwoch et al [4] found the latter more effective at decreasing colonyforming units in the sink drains.…”

blaVIM in wastewater drains: A hidden circulation of VIM-producing Enterobacterales in the hospital setting?

“…These results raised the high proportion of wastewater drains with carbapenemase genes in both ICUs and other wards, which is concerning, even though the risk of patient contamination from wastewater drains is still a matter of discussion, especially in the context of an outbreak. [4][5][6][7][8] Unexpectedly, bla VIM was detected in 1 of 7 wastewater drains, whereas only 3 VIM-positive patients had been previously identified in our hospital. Importantly, there were no VIM-CPE-positive cultures from wastewater drains with bla VIM .…”