Infection Control & Hospital Epidemiology (2018), 39, 1254–1256 doi:10.1017/ice.2018.192
Concise Communication
A novel sink drain cover prevents dispersal of microorganisms from contaminated sink drains
Scott H. Livingston BS1,2, Jennifer L. Cadnum BS2, Scott Gestrich MD2, Annette L. Jencson BS, CIC2 and Curtis J. Donskey MD1,3
1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio and 3Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Abstract
In hospital sinks, a novel plastic drain cover was effective in preventing dispersal of gram-negative bacilli and fluorescent gel associated with splattering of flowing water. Our findings suggest that the sink drain covers could provide a simple means to reduce dissemination of pathogens from contaminated sinks.
(Received 9 May 2018; accepted 17 July 2018; electronically published August 30, 2018)
Sinks in healthcare facilities are an important reservoir for dissemination of multidrug-resistant gram-negative bacilli.1–5 Unfortunately, addressing sink contamination is challenging because sink drains provide a favorable environment for pathogen colonization and biofilm formation, but they are not amenable to cleaning and disinfection. For example, sinks in healthcare facil- ities 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. Pouring disinfectants into sink drains has often had only modest efficacy in reducing sink colonization.2,4,6 Given the challenges involved in cleaning and disinfecting
sinks, we hypothesized that providing a simple cover for the sink strainer might be an effective strategy to prevent dispersal of organisms from contaminated sink drains. This approach is similar to a recent intervention in which a reduction in Klebsiella pneumoniae carbapenemase (KPC)-producing organisms were attributed to installation of covers on wastewater hoppers.7 Here, we examined the efficacy of a novel sink drain cover in reducing dispersal of fluorescent gel and colonizing pathogens from sink drains. To assess real-world feasibility of implementing the devices, we also placed the sink drain covers in all sinks in patient rooms of an intensive care unit for 2 weeks.
Methods
A plastic drain cover termed Drain Armor was developed and tested in collaboration with Boehringer Laboratories (Phoenix- ville, PA). The device is a small piece of dome-shaped plastic
Author for correspondence: Curtis J. Donskey, MD, Geriatric Research, Education,
and Clinical Center 1110W, Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106. E-mail:
Curtis.Donskey@
va.gov
Cite this article: Livingston SH. et al. (2018). A novel sink drain cover prevents
dispersal of microorganisms from contaminated sink drains. Infection Control & Hospital Epidemiology 2018, 39, 1254–1256. doi: 10.1017/ice.2018.192
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
designed to cover the sink strainer to prevent dispersal of organisms from contaminated drains while allowing water to flow into the drain (Fig. 1). Three suction cups hold the device in place. The presence of the device should not alter routine cleaning of the sink and adjacent countertop. The device can remain in place during cleaning, and the top surface can be wiped or sprayed with disinfectant when the bowl is cleaned. The device is intended for single use (ie, placed upon admission and discarded upon patient discharge or weekly). Contaminated devices should be removed while wearing gloves. The anticipated cost is ~$5 per device or ~$260 per sink if changed weekly. We used a fluorescent gel (Glow Potion, Brevis, Salt Lake City,
UT) to assess the ability of the sink cover to prevent dispersal from sink drains. We inoculated 1mL of fluorescent gel just below the strainer of sinks in hospital rooms. The sink drain cover was installed, and the water was run for 30 seconds with the device in place. A black light was used to identify sites of dispersal of the fluorescent gel to the bowl and adjacent countertop or other surfaces within 15.25cm (6 inches) of the bowl. The drain cover was removed, and the water was run until there was no evidence of continued dispersal of fluorescent gel. The sink bowl and countertop were cleaned to remove any dispersed marker and another 1mL gel was inoculated. The water was then run for 30 seconds and dispersal was assessed. We also examined the efficacy of the drain cover in preventing
dispersal of colonizing bacteria from sinks in hospital rooms. Prior to testing, the sink bowl and adjacent countertop or other surfaces ≤15.25cm (≤6 inches) from the bowl were disinfected with an improved hydrogen peroxide disinfectant, and surfaces were sampled with BBL Culture Swabs (Becton Dickinson, Franklin Lakes, NJ) premoistened with sterile water to confirm absence of gram-negative bacilli. The countertop or other adja- cent surfaces were cultured again after running the water for 30 seconds both with and without the sink drain cover in place. For a subset of assessments, the sink bowls were cultured. Each bowl and adjacent surfaces were disinfected after each set of
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