INFECTION PREVENTION AND CONTROL
a 90-degree bend and incorporated an antimicrobial substance. TDs could be fitted to other types of sinks, provided there was space for them, and enough vertical drop between the sink outlet and the waste pipe to which the trap is joined. The TDs tested in the above studies were made up from bought-in bends that were joined together. A more cost-effective approach would be to bend the Tuba Drains out of copper tube. Most bending machines are not able to do that in a single part, so the plan is to make two parts and solder them together inside an external sleeve in the middle of the Tuba Drain. It will be important to ensure that the solder joint is a neat, accurate one, that doesn’t create a lump in the lumen, or a dip due to an unfilled gap between the pipes. We are currently working on producing the bent Tuba Drain. The approach should be working in the next two months, so we should be able to mass produce them by this September. The Tuba Drain is a simple, cost-effective, low- maintenance approach for preventing the ascent of bacteria from traps to sinks. It should be incorporated in new hospitals, and – where possible – added to existing sink drains in old hospitals. Not all resistance is transferred in hospitals, and it will also have a role in care homes, airports, railway stations, and hotels. Ultimately it may be used as standard drainage of every sink. Great Ormond Street Hospital has applied for a UK patent, and may extend that globally. If Tuba Drains are introduced globally, along with other measures to limit environmental spread, and further efforts are made to decolonise the guts of people who are carriers of resistant bacteria (already demonstrated to be effective against Vancomycin-resistant Enterococcus), I can see no reason why we should not reverse the rise of antibiotic resistance, but it will require the will, effort, and investment, of those controlling health services. The WHO estimated that bacterial AMR was directly responsible for 1.27 million global deaths in 2019, and contributed to 4.95 million deaths.5
The World Bank estimates that AMR could result
in US$ 1 tn in additional healthcare costs by 2050, and US$ 1 tn to US$ 3.4 tn gross domestic product (GDP) losses per year by 2030.6 likely to be worthwhile.
A bit of investment and effort is
References 1 The Silent Pandemic: Antimicrobial Resistance and the Need for Better Hospital Design. Healthcare Infection Society, 18 June 2025. https://tinyurl. com/4znf5yvn
2 Kizny Gordon A, Mathers A, Cheong E, Gottlieb T, Kotay S, Walker A et al. The Hospital Water Environment as a Reservoir for Carbapenem-Resistant Organisms Causing Hospital- Acquired Infections-A Systematic Review of the Literature. Clin Infect Dis 2017; 64(10):1435-1444.
3 Kotay SM, Donlan RM, Ganim C, Barry K, Christensen BE, Mathers AJ. Droplet- Rather than Aerosol-Mediated Dispersion Is the Primary Mechanism of Bacterial Transmission from Contaminated Hand- Washing Sink Traps. Appl Environ Microbiol 2019; 85(2): 1997-18.
4 Harris S, Njogu G, Galbraith R, Galbraith J, Hastick S, Storey N et al. A ‘Tuba Drain’ incorporated in sink drains reduces counts of antibiotic- resistant bacterial species at the plughole: a blinded, randomized trial in 36 sinks in a hospital outpatient department with a low prevalence of sink colonization by antibiotic-resistant species. J Hosp Infect 2025; Jan: 155:123-129. Epub 2024 Nov 6. PMID: 39515476.
5 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 2022; 399: 629-655.
6 Drug-Resistant Infections: A Threat to Our Economic Future. World Bank Group, March 2017.
https://tinyurl.com/4f9ujh5k
A view of the Tuba Drain from above.
August 2025 Health Estate Journal 43
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