Infection Control & Hospital Epidemiology (2018), 39, 1467–1469 doi:10.1017/ice.2018.191
Concise Communication
A multicenter investigation to characterize the risk for pathogen transmission from healthcare facility sinks
Scott A. Gestrich MD1, Annette L. Jencson BS, CIC1, Jennifer L. Cadnum BS1, Scott H. Livingston BS1,2, Brigid M. Wilson PhD3 and Curtis J. Donskey MD2,3
1Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, 2Case Western Reserve University School of Medicine, Cleveland, Ohio and 3Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Abstract
In 4 hospitals, we demonstrated frequent dispersal of fluorescent tracer and fluoroquinolone-resistant gram-negative bacilli from sink drains to sink bowls and to surfaces outside the bowl. Fluorescent tracer dispersal correlated inversely with the depth of the sink bowl. Modifications in sink design could substantially reduce the risk for pathogen dissemination.
(Received 9 May 2018; accepted 17 July 2018)
In recent years, numerous outbreaks have been attributed to contaminated sinks.1–3 Organisms colonizing sink drains can be dispersed from the strainer to the sink bowl and countertop by splattering of flowing water.4,5 Outbreaks have usually involved gram-negative bacilli such as Pseudomonas spp and carbapenem- resistant Enterobacteriaceae.1,2 However, sink drains may also be an underappreciated reservoir of Candida spp.6,7 Sink design may play a key role in determining the risk for
dispersal of colonizing microorganisms. For example, placement of the faucet such that water flows directly onto the drain may increase the risk for organism dispersal.2,4 However, there is limited information on the design of sinks currently used in hospitals and on their propensity to disperse pathogens. Here, we conducted a multicenter study to better characterize the risk for transmission from hospital sinks and to identify factors associated with pathogen dispersal.
Methods Setting
The study was conducted in 4 acute-care hospitals in northeastern Ohio: a Veterans Affairs hospital, a community hospital, and 2 academic teaching hospitals. For each facility, the sink bowls and countertops in patient rooms were cleaned with a hospital- approved disinfectant after each patient discharge. The study procedures were approved by the infection prevention programs at each facility. Approval from the institutional review board was not obtained because as there was no interaction with patients or personnel.
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: Gestrich S. et al. (2018). A multicenter investigation to characterize
the risk for pathogen transmission from healthcare facility sinks. Infection Control & Hospital Epidemiology 2018, 39, 1467–1469. doi: 10.1017/ice.2018.191
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. Dispersal of gram-negative bacilli from colonized sink drains
For each hospital, we cultured a convenience sample of up to 50 sinks in occupied patient rooms or personnel work areas. Before sink operation, the entire sink bowl and the adjacent countertop or other surfaces ≤15.25 cm (≤6 inches) from the bowl were sampled with separate Rayon swabs (BBL Culture Swabs, Becton Dickinson, Franklin Lakes, NJ) premoistened with sterile water. The sink bowl and adjacent surfaces were then disinfected with a commercial improved hydrogen peroxide disinfectant. Addi- tional cultures were collected 10 minutes after disinfection and again after the hot- and cold-water faucets were run for 30 sec- onds; the rate of flow was adjusted to be consistent with a rate typically used for hand hygiene. After the evaluation of dispersal of gram-negative bacilli, swabs inserted through an opening of the strainer were used to sample the proximal sink drain to a depth of 2.5cm (1 inch) below the strainer. The swabs were plated onto MacConkey agar (Hardy Diagnostics) containing ciprofloxacin 1 mg/L and incubated at 37°C for 24 hours. For a subset of 20 sinks, we filtered 50mL of water from the faucet and cultured the filter.
Sink design features associated with dispersal of fluorescent gel from sink drains
For a subset of sinks, we examined dispersal of a fluorescent gel from the sink drain to identify sink characteristics associated with dispersal. For this assessment, 1mL of a commercial fluorescent gel (Glitterbug Potion, Brevis Corporation, Salt Lake City, UT) was inoculated on the outer surfaces of the drain pipes just below the sink strainer with a pipette tip. The water was run for 30 seconds, and a black light was used to assess dispersal to any surfaces outside the bowl. Prior to the assessment, the sink bowl and countertop were cleaned and the black light was used to identify and remove any artifact that might yield false-positive fluorescence readings.
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