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in reducing pathogens within and distal to the P-trap. Finally, it is not clear how well daily instillation of tryptic soy broth mimics real-world exposure of sinks to nutrients. In a recent study, nutrient-rich solutions (eg, intravenous fluids) were frequently poured down sink drains.10
Acknowledgments. Franke Kindred loaned the sink used for testing but did not provide input on study design or data analysis and did not review the manuscript.
Financial support. This work was supported by the Department of Veterans Affairs.
Conflicts of interest. C.J.D. has received research funding from Clorox, EcoLab, GOJO, Pfizer, Avery Dennison, and Boehringer Laboratories. All other authors report no potential conflicts.
References
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Fig. 1. Efficacy of intermittent flushes with ozonated water on the concentration of Pseudomonas aeruginosa (A) and Candida auris (B) in the strainer, the P-trap, and distal to the P-trap of a colonized sink.
was present at a lower concentration in the strainer than at the other sites. After beginning ozonated water disinfection, both pathogens were reduced to undetectable levels in the strainer within 2 days. In the P-trap, the concentration of both pathogens decreased gradually, and both were undetectable or were present at low concentrations after 10 days. In contrast, both pathogens continued to be detected in relatively high concentrations distal to the P-trap. Our findings demonstrate that repeated exposure to ozonated
water is effective in reducing P. aeruginosa and C. auris in colonized sinks. The pathogens were reduced to an undetectable level in the strainer, suggesting that ozonated water could be useful to reduce the risk for transmission from colonized sinks. The ability to provide an automated, programmable flush with a disinfecting solution is an important feature of the sink if the goal is long-term maintenance of sink disinfection. Our study has some limitations. We examined the impact of
ozonated water in a single sink design for a 2-week period with 2 pathogens. We assessed the impact of relatively low ozone con- centrations. Higher ozone concentrations might be more effective
4. Jencson AL, Cadnum JL, Piedrahita C, Donskey CJ. Hospital sinks are a potential nosocomial source of Candida infections. Clin Infect Dis 2017;65:1954–1955.
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6. César J, Sumita TC, Junqueira JC, Jorge AO, do Rego MA. Antimicrobial effects of ozonated water on the sanitization of dental instruments contaminated with E. coli, S. aureus, C. albicans, or the spores of B. atrophaeus. J Infect Publ Health 2012;5:269–74.
7. Cadnum JL, Shaikh AA, Piedrahita CT, et al. Effectiveness of disinfectants against Candida auris and other Candida species. Infect Control Hosp Epidemiol 2017;38:1240–1243.
8. ASTM International, designation E2197: Standard quantitative disk carrier test method for determining bactericidal, virucidal, fungicidal, mycobactericidal, and sporicidal activities of chemicals, 2011.
9. US Environmental Protection Agency Office of Pesticide Programs. EPA MLB SOP MB-35-00: OECD Quantitative method for evaluating the efficacy of liquid antimicrobials against Candida auris on hard, non- porous surfaces. Environmental Protection Agency website. https://www.
epa.gov/pesticide-registration/interim-guidance-efficacy-evaluation-products- claims-against-candida-auris-0. Accessed March 21, 2017.
10. Grabowski M, Lobo JM, Gunnell B, Enfield K, Carpenter R, Barnes L, Mathers AJ. Characterizations of handwashing sink activities in a single hospital medical intensive care unit. J Hosp Infect 2018. pii: S0195-6701 (18)30263-9.
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