Impact of sink design on bacterial transmission from hospital sink drains to the surrounding sink environment tested using a fluorescent marker

Pirzadian, Jannette; Souhoka, Tessa; Herweijer, Milee; Heel, Liesbeth van; Wamel, Willem J. B. van; Goossens, Richard; Severin, Juliëtte A.; Vos, Margreet C.

doi:10.1016/j.jhin.2022.04.017

Cited by 13 publications

(5 citation statements)

References 10 publications

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“…In other outbreak investigations, it was also proposed that reviewing cleaning protocols, educating staff on proper waste disposal, and instructing staff to report problems with sink drainage may all help avoid contamination of the outer sink environment [12,30]. Additionally, we previously observed that other factors, such as faucet position relative to the drain and dripping from the faucet, influenced the incidence and distance that dispersed droplets could be found from the drain; even in these cases, drain plugs significantly reduced dispersal to the outer sink environment [31].…”

Section: Plos Onementioning

confidence: 97%

Limiting spread of VIM-positive Pseudomonas aeruginosa from colonized sink drains in a tertiary care hospital: A before-and-after study

et al. 2023

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Background In healthcare environments, sinks are being increasingly recognized as reservoirs for multidrug-resistant Gram-negative bacteria. In our hospital, carbapenemase-producing, Verona Integron-encoded Metallo-beta-lactamase (VIM)-positive Pseudomonas aeruginosa (VIM-PA) was detected at low endemicity in patients, and environmental culturing revealed that sink drains were primary reservoirs. Therefore, an intervention was initiated in several wards to install sink drain plugs as physical barriers against splashing to prevent transmission of VIM-PA from drain reservoirs to the surrounding sink environment. Aim To assess the efficacy of the intervention on limiting spread of VIM-PA. Methods Swabs were taken from inner sink environments (i.e. drains), and outer sink environments (i.e. wash basins, faucet aerators, and countertops) twice before and three times after the intervention. Siphon water and drain wells were also sampled before and at the moment of the intervention, respectively. All samples were screened for VIM-PA, and isolates were typed with multiple-locus variable-number tandem repeat analysis (MLVA). Results There was a significant reduction in VIM-PA positivity in both inner (P-value <0.001) and outer (P-value 0.001) sink environments after the intervention. However, VIM-PA recolonization was observed in the inner sink environments of patient rooms, and also in rooms exclusive to healthcare personnel, over time. Surfaces in the outer sink environment were rarely positive for VIM-PA after the intervention. MLVA revealed three genetic clusters, with one found in all wards and room types during the study period. Conclusions Drain plugs are a simple and effective infection prevention and control measure to contain spread of VIM-PA from drain reservoirs.

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Section: Plos Onementioning

confidence: 97%

Limiting spread of VIM-positive Pseudomonas aeruginosa from colonized sink drains in a tertiary care hospital: A before-and-after study

et al. 2023

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“…Failing to control biofilm regrowth will lead to sink contamination and the potential spread of pathogens from water splashing. Physical measures to reduce splashing exist as well as sink design to prevent placing items on the sink ledge [ 127 ], whilst common sense would refrain to place sink < 2 m from patient’s bed or sterile preparation area.…”

Section: Impact Of Biofilms For Infection Prevention and Controlmentioning

confidence: 99%

How biofilm changes our understanding of cleaning and disinfection

Maillard,

Centeleghe

2023

Antimicrob Resist Infect Control

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Biofilms are ubiquitous in healthcare settings. By nature, biofilms are less susceptible to antimicrobials and are associated with healthcare-associated infections (HAI). Resistance of biofilm to antimicrobials is multifactorial with the presence of a matrix composed of extracellular polymeric substances and eDNA, being a major contributing factor. The usual multispecies composition of environmental biofilms can also impact on antimicrobial efficacy. In healthcare settings, two main types of biofilms are present: hydrated biofilms, for example, in drains and parts of some medical devices and equipment, and environmental dry biofilms (DSB) on surfaces and possibly in medical devices. Biofilms act as a reservoir for pathogens including multi-drug resistant organisms and their elimination requires different approaches. The control of hydrated (drain) biofilms should be informed by a reduction or elimination of microbial bioburden together with measuring biofilm regrowth time. The control of DSB should be measured by a combination of a reduction or elimination in microbial bioburden on surfaces together with a decrease in bacterial transfer post-intervention. Failure to control biofilms increases the risk for HAI, but biofilms are not solely responsible for disinfection failure or shortcoming. The limited number of standardised biofilm efficacy tests is a hindrance for end users and manufacturers, whilst in Europe there are no approved standard protocols. Education of stakeholders about biofilms and ad hoc efficacy tests, often academic in nature, is thus paramount, to achieve a better control of biofilms in healthcare settings.

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“…Hota et al [41] discussed the reasons for an outbreak of infection by Pseudomonas aeruginosa in patients admitted to the intensive care unit of a tertiary hospital, pointing to the formation of biofilm in sink drains as the main cause. Tests using a commercial fluorescent marker have shown that when the sink was used for hand washing, the contents of the drain splashed out at least 1 m from the sink, especially in washbasins with relatively shallow depths, between 140 mm and 150 mm [42].…”

Section: The Washbasins Problemmentioning

confidence: 99%

Methodology for Risk Assessment of SARS-CoV-2 Virus Transmission in Hospital Buildings

da Cunha,

Willcox,

da Costa

et al. 2023

Safety

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Considering the impact of COVID-19 on hospital facilities and the relevance of risk management and occupational health and safety within this context, this study introduces a method to assess the SARS-CoV-2 virus transmission risk in a toilet. The proposed method is based on a risk tripod involving environmental, human, and transmission factors. For this, risk assessment methodologies were applied, such as Failure Modes and Effects Analysis (FMEA), Ergonomic Work Analysis (EWA), which allowed the identification of risk indicators, and Fault Tree Analysis (FTA), which allowed the identification of transmission routes of COVID-19 in toilets. Subsequently, the Analytic Hierarchy Process (AHP) was used to find each transmission route weighting for calculating the Risk Score. The results indicated that the design of sanitary equipment, with an emphasis on washbasins and toilets, especially in health or large circulation establishments, is of paramount importance in the dissemination of pathogens. Safe habits and the use of protective gear must be continuously encouraged, but greater attention must be paid to technical and engineering issues. Furthermore, the developed method proved to be an applicable tool to identify the main sources of risk and prioritize the implementation of control measures.

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Impact of sink design on bacterial transmission from hospital sink drains to the surrounding sink environment tested using a fluorescent marker

Cited by 13 publications

References 10 publications

Limiting spread of VIM-positive Pseudomonas aeruginosa from colonized sink drains in a tertiary care hospital: A before-and-after study

Limiting spread of VIM-positive Pseudomonas aeruginosa from colonized sink drains in a tertiary care hospital: A before-and-after study

How biofilm changes our understanding of cleaning and disinfection

Methodology for Risk Assessment of SARS-CoV-2 Virus Transmission in Hospital Buildings

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