INFECTION CONTROL
conducted in a hospital outpatient setting compared sinks fitted with the device to matched controls with standard plumbing. Target organisms included clinically relevant gram-negative species associated with healthcare environments, such as Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and members of the Enterobacterales group. Sinks incorporating the modified drainage pathway
showed significantly lower counts of these organisms at the sink outlet over time, supporting the interpretation that the device limits movement of bacteria from trap reservoirs toward the basin interface. Laboratory testing performed prior to clinical installation demonstrated a related mechanism. When bacteria were introduced into trap fluid, splashes reached the upper waste pipe in standard configurations but were not detected at equivalent locations when the modified drainage pathway was present. This finding supports the view that the primary effect arises from prevention of upward splash transmission from the trap. From an infection prevention perspective, the significance of this approach lies in its focus on interrupting transmission rather than attempting complete eradication of microorganisms within the drainage system. Given the difficulty of permanently decontaminating trap
environments, physical isolation of the reservoir from the sink outlet represents a structurally based control strategy. By reducing the movement of gram-negative bacteria from trap water to areas of direct clinical interaction, this intervention addresses a defined environmental pathway associated with contamination risk. In practical terms, these modifications represent an engineered intervention targeted at a recognised, specific weakness in conventional sink design. It acts by increasing separation between microbial reservoirs and the clinical environment, directly altering fluid behaviour that drives splash generation, and creating conditions less favourable for biofilm persistence in the upper drainage pathway.
Sustainability As a mechanical intervention, this type of solution operates without any power, automated dosing system, or complex requiring any ongoing maintenance, thereby reducing energy demand and operational resource consumption. Its structural function is continuous and independent of user behaviour. Copper is durable and fully recyclable, supporting long service life and responsible material use. These features position the system as an infrastructure- based infection control measure that supports environmental management, resource efficiency, and long-term clinical resilience. There is also a focus on the sustainable use of carbapenems, which is essential to preserving their clinical effectiveness over the long term. Carbapenems are often reserved for severe infections and for organisms that cannot be treated with other therapies. Their value depends not only on their availability, but on how carefully they are used. Sustainability in this context means protecting their effectiveness so they remain reliable treatment options for future patients. Careful prescribing is fundamental. Carbapenems
should be used only when clearly justified by clinical need, supported where possible by microbiological evidence. Early diagnostic testing and rapid identification of the infecting organism allow treatment to be directed more precisely. This reduces unnecessary exposure and limits the selection pressure that encourages resistant strains to emerge. To maintain a sustainable use policy for carbapenem
Moist plumbing environments provide highly favourable ecological conditions for the persistence and amplification of gram-negative bacteria. Drains, sinks, and basins function not simply as passive waste pathways but as active microbial reservoirs capable of sustaining complex, structured communities over prolonged periods.
prescribing, there needs to be a reduction in the requirement of use. This is turn can be managed by reducing the type of events requiring the use of such therapies by reducing the number of gram-negative bacteria outbreaks.
Preventing infection: a critical element of sustainable practice Effective hygiene, environmental control, and safe management of water and drainage systems reduce the incidence of healthcare associated infection. When fewer infections occur, the need for advanced antibiotics such as carbapenems is reduced. Sustainable carbapenem use extends beyond prescribing alone. It involves coordinated clinical decision making, effective infection prevention, and responsible management of healthcare environments, all aimed at preserving the effectiveness of these essential medicines for the future.
Bibliography n World Health Organization: Global antibiotic resistance
surveillance report 2025
www.who.int/publications/i/ item/9789240116337
n The Journal of Hospital Infection – Tuba Drain technology.
www.sciencedirect.com/science/article/abs/pii/ S0195670124003621
n Aerosol-based exposure to opportunistic pathogens originating from hospital sink drains.
www.sciencedirect.com/science/ article/abs/pii/S0196655325007011
n Resistance profiles of carbapenemase-producing Enterobacterales in a large centre in England: are we already losing cefiderocol?
https://academic.oup.com/jac/ article/80/1/59/7879525
n ECDC – Rapid risk assessment – Carbapenem-resistant Enterobacterales – third update.
www.ecdc.europa.eu/en/ publications-data/carbapenem-resistant-enterobacterales- rapid-risk-assessment-third-update
n American Society for Microbiology - A Large, Refractory Nosocomial Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Escherichia coli Demonstrates Carbapenemase Gene Outbreaks Involving Sink Sites Require Novel Approaches to Infection Control.
https://journals.asm. org/doi/10.1128/aac.01689-18
n Cost of Nosocomial Outbreak Caused by NDM-1–Containing Klebsiella pneumoniae in the Netherlands, October 2015–January 2016.
https://www.researchgate.net/ publication/319424548_Cost_of_Nosocomial_Outbreak_ Caused_by_NDM-1-Containing_Klebsiella_pneumoniae_in_ the_Netherlands_October_2015-January_2016
Paul Owen
Paul Owen is the global business unit manager – healthcare & life sciences at Mueller Europe where he heads up the international sales & marketing strategies for infection prevention solutions. Mueller Europe specialises in environmental solutions that reduce transmission risk from multidrug- resistant gram-negative bacteria. Paul works closely with estates, microbiologists, IPC and contractors to deliver infection prevention within built environment, measurable improvements in patient safety, and cost reductions in the NHS and wider Healthcare markets.
June 2026 Health Estate Journal 35
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