Infection Control & Hospital Epidemiology (2019), 40,460–462 doi:10.1017/ice.2019.25
Concise Communication
Dispersal of gram-negative bacilli from contaminated sink drains to cover gowns and hands during hand washing
Zeina Hajar MD1, Thriveen Sankar Chittoor Mana MNO, MS2, Jennifer L. Cadnum BS2 and Curtis J. Donskey MD3,4 1Department of Medicine, Infectious Diseases Division, University Hospitals Cleveland Medical Center, Cleveland, Ohio, 2Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, 3Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio and 4Case Western Reserve University School of Medicine, Cleveland, Ohio
Abstract
We demonstrated that hand washing resulted in frequent dispersal of gram-negative bacilli from colonized sink drains in hospitals to cover gowns and hands. A plastic drain cover reduced but did not eliminate the risk for contamination. This mechanism of dispersal could result in contamination of healthcare personnel and patients.
(Received 29 October 2018; accepted 24 January 2019)
Sinks in healthcare facilities are an important reservoir for dissemination of multidrug-resistant gram-negative bacilli and Candida spp.1–7 It has been demonstrated that colonizing micro- organisms and fluorescent markers can be dispersed as far as 0.8 to 1 m from sink drains.3,4 Such dispersal may result in spread to patients through contamination of equipment or supplies in close proximity to the sink. In addition, patients or personnel might acquire organisms on hands or clothing after contact with contaminated countertops. Given the potential for dispersal from sink drains, it is plausible
that direct contamination of personnel or patients could occur dur- ing hand washing. However, previous reports have not investigated this mechanism of transmission. Therefore, we examined the potential for dispersal from contaminated sink drains to hands and clothing during hand washing. Because a plastic drain cover reduced dispersal from sinks to countertops,8 we tested whether the device would reduce dispersal to hands and clothing.
Methods
The study was conducted on 7 hospital wards, including 2 intensive care units and 5 medical-surgical units, during a 2-month period. In total, 10–20 automated patient room sinks were studied on each ward during the daytime when patients were not in the room. Prior to testing, the sink bowl and adjacent countertop or other surfaces ≤15.2 cm (≤6 inches) from the bowl were disinfected with a com- mercial hydrogen peroxide disinfectant and surfaces were sampled with BBL culture swabs (Becton Dickinson, Franklin Lakes, NJ) premoistened with Dey-Engley neutralizing medium to confirm the absence of gram-negative bacilli. A standardized test protocol was used to examine the potential for dispersal from the sink drain to clothing and hands during hand
Author for correspondence: Curtis J. Donskey, Email:
Curtis.Donskey@
va.gov Cite this article: Hajar Z, et al. (2019). Dispersal of gram-negative bacilli from
contaminated sink drains to cover gowns and hands during hand washing. Infection Control & Hospital Epidemiology, 40: 460–462,
https://doi.org/10.1017/ice.2019.25
washing. Research personnel donned a clean cover gown (Safety Plus Polyethylene Gown, TIDI Products, Neenah, WI); the gown was worn as a surrogate for clothing that would allow visualization of sites of water splattering. Multiple cultures of the clean gowns were negative for gram-negative bacilli. After donning the gown, hand hygiene was performed using alcohol-based hand sanitizer. The anterior and posterior surfaces of the hands and fingers were imprinted onto replicate organism detection and counting (RODAC) plates containing MacConkey agar (Hardy Diagnostics, Irving, TX) to confirm the absence of gram-negative bacilli. Hands were then washed for 15 seconds and patted dry with a paper towel. After hand washing, RODAC plates containing MacConkey agar were used to sample both hands and a 10 × 10-cmarea on the ante- rior surface of the cover gown over the abdomen, including areas with visible evidence of water splattering. Figure 1 provides an illus- tration of personnel performing hand washing and shows visible water splattered onto the cover gown. We used BBL culture swabs premoistened with Dey-Engley neutralizer to sample the countertop or other areas <15.2 cm (<6 inches) from the sink bowl. Immediately after completion of the initial assessment, the bowl
and adjacent surfaces of the sink were again disinfected using the hydrogen peroxide disinfectant, and a plastic drain cover (Drain Armor, Boehringer Laboratories, Phoenixville, PA) was applied.8 Thesametest protocolwas then followedwith the drain cover in place. After completion of the assessments of dispersal, swabs were
used to sample the proximal sink drain to a depth of 2.5cm(1 inch) below the strainer. These swabs were plated onto MacConkey agar using a 4-quadrant streak method. Sinks that did not have growth of gram-negative bacilli from the drain swab were excluded from the analysis of dispersal. All culture plates were incubated at 37°C for 24 hours. The numbers of colonies of gram-negative bacilli recovered from gowns and hands were counted. Selected colonies from gowns and hands and from sink drains of the rooms where dispersal to gowns and hands occurred were subjected to identifi- cation using standard microbiologic methods and matrix-assisted
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
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