How frequently should sink drains be disinfected?

Ramos-Castañeda, Jorge A.; Faron, Matthew L.; Hyke, Joshua; Bell-Key, Dominique; Buchan, Blake W.; Nanchal, Rahul; Pintar, Paula; Graham, Mary Beth; Huerta, Susan; Muñoz-Price, L. Silvia

doi:10.1017/ice.2019.316

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…Because CP-CRPA persists in the environment, particularly in biofilms formed in premise plumbing ( 5 ), plumbing within room X was sampled; CP-CRPA isolates from samples collected from one sink were genetically similar to the clinical isolates. Addition of the disinfectant to the sink drain cleaning schedule appeared to be successful in eliminating CP-CRPA; however, optimal frequency of drain disinfection for disrupting CP-CRPA biofilm formation remains to be established, with findings from some studies suggesting that repeated application of disinfectant every 3–7 days could be effective in reducing gram-negative bacterial loads ( 6 , 7 ).…”

Section: Discussionmentioning

confidence: 99%

Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit — Idaho, 2021–2022

Cahill¹,

Jaworski²,

Harcy³

et al. 2023

MMWR Morb. Mortal. Wkly. Rep.

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Treatment of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) infections is challenging because of antibiotic resistance. CP-CRPA infections are highly transmissible in health care settings because they can spread from person to person and from environmental sources such as sink drains and toilets. During September 2021-January 2022, an Idaho hospital (hospital A) isolated CP-CRPA from sputum of two patients who stayed in the same intensive care unit (ICU) room (room X), 4 months apart. Both isolates had active-on-imipenem metallo-beta-lactamase (IMP) carbapenemase gene type 84 (bla IMP-84 ) and were characterized as multilocus sequence type 235 (ST235). A health care-associated infections team from the Idaho Division of Public Health visited hospital A during March 21-22, 2022, to discuss the cluster investigation with hospital A staff members and to collect environmental samples. CP-CRPA ST235 with bla IMP-84 was isolated from swab samples of one sink in room X, suggesting it was the likely environmental source of transmission. Recommended prevention and control measures included application of drain biofilm disinfectant, screening of future patients who stay in room X (e.g., the next 10 occupants) upon reopening, and continuing submission of carbapenemresistant P. aeruginosa (CRPA) isolates to public health laboratories. Repeat environmental sampling did not detect any CRPA. As of December 2022, no additional CP-CRPA isolates had been reported by hospital A. Collaboration between health care facilities and public health agencies, including testing of CRPA isolates for carbapenemase genes and implementation of sink hygiene interventions, was critical in the identification of and response to this CP-CRPA cluster in a health care setting.

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Section: Discussionmentioning

confidence: 99%

Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit — Idaho, 2021–2022

Cahill¹,

Jaworski²,

Harcy³

et al. 2023

MMWR Morb. Mortal. Wkly. Rep.

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“…5,15 Several publications have suggested that foam disinfectants containing hydrogen peroxide may be more effective than bleach for sink drain disinfection. [28][29][30] Prospective evaluation is warranted to assess their effect on sink-to-patient transmission. Currently, the only effective means to prevent sink-to-patient MDRO transmission may be structural aspects (eg, eliminating sinks that are not necessary) together with education to address the infectious risks of sinks and prevention of their misuse (no flushing of any substance into the sink and sole use for hand washing).…”

Section: Discussionmentioning

confidence: 99%

Sink-traps are a major source for carbapenemase-producing Enterobacteriaceae transmission

Regev-Yochay,

Margalit,

Smollan

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: We studied the extent of carbapenemase-producing Enterobacteriaceae (CPE) sink contamination and transmission to patients in a nonoutbreak setting. Methods: During 2017–2019, 592 patient-room sinks were sampled in 34 departments. Patient weekly rectal swab CPE surveillance was universally performed. Repeated sink sampling was conducted in 9 departments. Isolates from patients and sinks were characterized using pulsed-field gel electrophoresis (PFGE), and pairs of high resemblance were sequenced by Oxford Nanopore and Illumina. Hybrid assembly was used to fully assemble plasmids, which are shared between paired isolates. Results: In total, 144 (24%) of 592 CPE-contaminated sinks were detected in 25 of 34 departments. Repeated sampling (n = 7,123) revealed that 52%–100% were contaminated at least once during the sampling period. Persistent contamination for >1 year by a dominant strain was common. During the study period, 318 patients acquired CPE. The most common species were Klebsiella pneumoniae, Escherichia coli, and Enterobacter spp. In 127 (40%) patients, a contaminated sink was the suspected source of CPE acquisition. For 20 cases with an identical sink-patient strain, temporal relation suggested sink-to-patient transmission. Hybrid assembly of specific sink-patient isolates revealed that shared plasmids were structurally identical, and SNP differences between shared pairs, along with signatures for potential recombination events, suggests recent sharing of the plasmids. Conclusions: CPE-contaminated sinks are an important source of transmission to patients. Although traditionally person-to-person transmission has been considered the main route of CPE transmission, these data suggest a change in paradigm that may influence strategies of preventing CPE dissemination.

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“…Various disinfectants have been tested with limited success in decreasing the bacterial load in drains, such as chlorine [ 35 ], steam [ 16 ], acetic acid [ 36 , 37 ], ozonated water [ 34 ] and hydrogen peroxide [ 38 – 40 ]. However, if a single treatment is carried out, OPs typically reappear in the drain a few days later [ 16 , 33 , 38 , 41 ]. Therefore, establishing a recurrent cleaning and disinfection routine is essential to prevent the resurgence of OPs in sink drains after an outbreak.…”

Section: Introductionmentioning

confidence: 99%

Disinfection of sink drains to reduce a source of three opportunistic pathogens, during Serratia marcescens clusters in a neonatal intensive care unit

Bourdin,

Benoit,

Prévost

et al. 2024

PLoS ONE

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Objective Evaluate the effects of five disinfection methods on bacterial concentrations in hospital sink drains, focusing on three opportunistic pathogens (OPs): Serratia marcescens, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Design Over two years, three sampling campaigns were conducted in a neonatal intensive care unit (NICU). Samples from 19 sink drains were taken at three time points: before, during, and after disinfection. Bacterial concentration was measured using culture-based and flow cytometry methods. High-throughput short sequence typing was performed to identify the three OPs and assess S. marcescens persistence after disinfection at the genotypic level. Setting This study was conducted in a pediatric hospitals NICU in Montréal, Canada, which is divided in an intensive and intermediate care side, with individual rooms equipped with a sink. Interventions Five treatments were compared: self-disinfecting drains, chlorine disinfection, boiling water disinfection, hot tap water flushing, and steam disinfection. Results This study highlights significant differences in the effectiveness of disinfection methods. Chlorine treatment proved ineffective in reducing bacterial concentration, including the three OPs. In contrast, all other drain interventions resulted in an immediate reduction in culturable bacteria (4–8 log) and intact cells (2–3 log). Thermal methods, particularly boiling water and steam treatments, exhibited superior effectiveness in reducing bacterial loads, including OPs. However, in drains with well-established bacterial biofilms, clonal strains of S. marcescens recolonized the drains after heat treatments. Conclusions Our study supports thermal disinfection (>80°C) for pathogen reduction in drains but highlights the need for additional trials and the implementation of specific measures to limit biofilm formation.

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How frequently should sink drains be disinfected?

Abstract: Previously, we showed that disinfection of sink drains is effective at decreasing bacterial loads. Here, we report our evaluation of the ideal frequency of sink-drain disinfection and our comparison of 2 different hydrogen peroxide disinfectants.

Cited by 6 publications

References 6 publications

Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit — Idaho, 2021–2022

Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit — Idaho, 2021–2022

Sink-traps are a major source for carbapenemase-producing Enterobacteriaceae transmission

Disinfection of sink drains to reduce a source of three opportunistic pathogens, during Serratia marcescens clusters in a neonatal intensive care unit

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