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

Hajar, Zeina; Mana, Thriveen Sankar Chittoor; Cadnum, Jennifer L.; Donskey, Curtis J.

doi:10.1017/ice.2019.25

Cited by 22 publications

(14 citation statements)

References 9 publications

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“…Similarly, slower drainage was found to be associated with a higher microbiological burden and drain positivity for contamination [33]. In addition, the presence of a drainage cover was shown to reduce contamination of countertops and healthcare worker (HCW)s' gowns in a study by Hajar et al [34]. In the absence of a drain cover, 11% of countertops, 9% of gowns, and 6% of hands after hand washing demonstrated contamination with Gram-negative organisms compared to the contamination of 1% of countertops, 2% of gowns and 0% of hands with drainage cover.…”

Section: Non-outbreak Reportsmentioning

confidence: 97%

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

Chia

Sengupta

Kukreja

et al. 2020

Antimicrob Resist Infect Control

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Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.

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Section: Non-outbreak Reportsmentioning

confidence: 97%

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

Chia

Sengupta

Kukreja

et al. 2020

Antimicrob Resist Infect Control

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“…The formation of biofilms, which are refractory to disinfection and facilitate long-term persistence of bacteria, poses an additional concern [41]. As well as acting as a reservoir, sinks are points of direct pathogen dispersal when they are used as bacteria escape by droplets and aerosols [42][43][44][45], and bacteria can also be carried on airflows within plumbing systems even between different floors of a building [46]. Furthermore, due to the realistic nature of sinks being used as an occasional point of disposal of patient material, pharmaceuticals and/or disinfectants, their resident bacteria are exposed to a wide variety of chemical substances.…”

Section: Introductionmentioning

confidence: 99%

Hospital sink traps as a potential source of the emerging multidrug-resistant pathogen Cupriavidus pauculus: characterization and draft genome sequence of strain MF1

Butler

Kelly

Muddiman

et al. 2022

Journal of Medical Microbiology

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Introduction. Cupriavidus pauculus is historically found in soil and water but has more recently been reported to cause human infection and death. Hospital sink traps can serve as a niche for bacterial persistence and a platform for horizontal gene transfer, with evidence of dissemination of pathogens in hospital plumbing systems driving nosocomial infection. Gap Statement. This paper presents the first C. pauculus strain isolated from a hospital sink trap. There are only six genome assemblies available on NCBI for C. pauculus ; two of these are PacBio/Illumina hybrids. This paper presents the first ONT/Illumina hybrid assembly, with five contigs. The other assemblies available consist of 37, 38, 111 and 227 contigs. This paper also presents data on biofilm formation and lethal dose in Galleria mellonella; there is little published information describing these aspects of virulence. Aim. The aims were to identify the isolate found in a hospital sink trap, characterize its genome, and assess whether it could pose a risk to human health. Methodology. The genome was sequenced, and a hybrid assembly of short and long reads produced. Antimicrobial susceptibility was determined by the broth microdilution method. Virulence was assessed by measuring in vitro biofilm formation compared to Pseudomonas aeruginosa and in vivo lethality in Galleria mellonella larvae. Results. The isolate was confirmed to be a strain of C. pauculus , with a 6.8 Mb genome consisting of 6468 coding sequences and an overall G+C content of 63.9 mol%. The genome was found to contain 12 antibiotic resistance genes, 8 virulence factor genes and 33 metal resistance genes. The isolate can be categorized as resistant to meropenem, amoxicillin, amikacin, gentamicin and colistin, but susceptible to cefotaxime, cefepime, imipenem and ciprofloxacin. Clear biofilm formation was seen in all conditions over 72 h and exceeded that of P. aeruginosa when measured at 37 °C in R2A broth. Lethality in G. mellonella larvae over 48 h was relatively low. Conclusion. The appearance of a multidrug-resistant strain of C. pauculus in a known pathogen reservoir within a clinical setting should be considered concerning. Further work should be completed to compare biofilm formation and in vivo virulence between clinical and environmental strains, to determine how easily environmental strains may establish human infection. Infection control teams and clinicians should be aware of the emerging nature of this pathogen and further work is needed to minimize the impact of contaminated hospital plumbing systems on patient outcomes.

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“…The hospital water environment has been recognized as a reservoir of harmful pathogens. Sinks and taps can be a transmission source of dangerous bacteria, including carbapenem-resistant Enterobacteriaceae (CRE) [1], multidrug-resistant Gram-negative bacilli [2] and extendedspectrum b-lactamase (ESBL)-producing Enterobacterales [3].…”

Section: Introductionmentioning

confidence: 99%

It's a trap! The development of a versatile drain biofilm model and its susceptibility to disinfection

Ledwoch

Robertson

Lauran

et al. 2020

Journal of Hospital Infection

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Background: Pathogens in drain biofilms pose a significant risk for hospital-acquired infection. However, the evidence of product effectiveness in controlling drain biofilm and pathogen dissemination are scarce. A novel in-vitro biofilm model was developed to address the need for a robust, reproduceable and simple testing methodology for disinfection efficacy against a complex drain biofilm. Methods: Identical complex drain biofilms were established simultaneously over 8 days, mimicking a sink trap. Reproducibility of their composition was confirmed by nextgeneration sequencing. The efficacy of sodium hypochlorite 1000 ppm (NaOCl), sodium dichloroisocyanurate 1000 ppm (NaDCC), non-ionic surfactant (NIS) and peracetic acid 4000 ppm (PAA) was explored, simulating normal sink usage conditions. Bacterial viability and recovery following a series of 15-min treatments were measured in three distinct parts of the drain. Results: The drain biofilm consisted of 119 mixed species of Gram-positive and -negative bacteria. NaOCl produced a >4 log 10 reduction in viability in the drain front section alone, while PAA achieved a >4 log 10 reduction in viability in all of the drain sections following three 15-min doses and prevented biofilm regrowth for >4 days. NIS and NaDCC failed to control the biofilm in any drain sections. Conclusions: Drains are one source of microbial pathogens in healthcare settings. Microbial biofilms are notoriously difficult to eradicate with conventional chemical biocidal products. The development of this reproducible in-vitro drain biofilm model enabled understanding of the impact of biocidal products on biofilm spatial composition and viability in different parts of the drain.

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

Cited by 22 publications

References 9 publications

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

Hospital sink traps as a potential source of the emerging multidrug-resistant pathogen Cupriavidus pauculus: characterization and draft genome sequence of strain MF1

It's a trap! The development of a versatile drain biofilm model and its susceptibility to disinfection

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