Infection prevention What is down a sink?


Dr. Mark Garvey highlighted the risks of infection transmission from the environment, including hospital sinks, as part of the Tiny Bradley Lecture, in a presentation titled: ‘Scoping out the IPC landscape’. Dr. Mark Garvey, a Consultant Clinical Scientist, Clinical Director of IPC, and Director of the Hospital Infection Research Laboratory, highlighted some examples of serious transmissions that have occurred – including incidents involving transmission of Hepatitis C in a renal healthcare setting8


and waterborne


Pseudomonas aeruginosa in a haematology unit.9 Transmission of infection from trays used


for IV prep was identified as a serious concern in both incidents. In the haematology unit, blue IV trays were found in a sink which had no filter. This sink was proven to be a source of Pseudomonas aeruginosa, which led to three patients experiencing central line infections on the unit. Therefore, we need to think carefully about how these pieces of equipment are cleaned and decontaminated, and the risks posed by sinks, he warned. Dr. Mark Garvey went on to highlight the


patients”, Dr. Michael Weinbren warned. He also highlighted daily practices in hospitals which represent a risk – such as filling water jugs by standing them in the sink, so the jug is in contact with the wastewater drain. This can lead to infection transmission. To overcome this risk, specially designed water dispensers can be introduced that ensure there is no contact with the sink or wastewater drain. Ultimately, he pointed out that if you cannot see the risk, you cannot mitigate the risk. A risk- based approach is essential. However, while we are good at recognising that patients have an infection, we are not so good at tracing this back to the water/wastewater systems.


findings of further research which looked at Pseudomonas aeruginosa infection in augmented care. This project examined the molecular ecology and transmission dynamics in four large UK hospitals.10


Over a 16-week period, all water outlets in the augmented care units were sampled for P


. aeruginosa and clinical isolates were


collected. They found that 20-30% of the water outlets tested positive for P


. aeruginosa. The


samples were genome sequenced, and patient isolates examined from previous months. As a result, they found that 60% of the isolates taken from patients, who had experienced a P


. aeruginosa infection, matched the water


isolates. In another paper, ‘efforts to engineer out


P


. aeruginosa’ included new tap outlets and point-of-use filters; as well as holistic measures, such as a revised tap cleaning method and appropriate disposal of patient wastewater. These engineering and holistic interventions resulted in a 50% reduction in the number of P. aeruginosa clinical patient isolates over a year.11


“I think it would be fair to say that if we were


able to track back every transmission event to the source, the design of the built environment would be completely different in our buildings in relation to water/wastewater,” commented Dr. Michael Weinbren.


Reducing water outlets in a new build hospital Pat Cattini, a Past President of the IPS, and Corporate Director of Infection Prevention and Control at University Hospitals Sussex, highlighted a project underway at the Trust to reduce water outlets in the design of a new cancer centre, being built as part of the New


Dr. Mark Garvey further presented a slide titled:


‘What is down a sink?’, featuring graphic photos of biofilms and contamination, as well as positive samples cultured from sinks – including CPE. He also presented some revealing research on the extent of the ‘sink splash zone’.12


This study


involved placing paper towels on the floor around the splash zone of the sink. They ran the tap to see how far it would splash and found that it splashed up to 2 metres in distance – demonstrating the risks of transmission to patients and contamination of medical equipment. “When you look at what is around a sink on an


ITU, you will find IV trolleys and the patient’s bed – what is down that sink and what is splashing about can easily get on the patient. Water has a major role to play in infection control,” Dr. Mark Garvey commented. He concluded by highlighting the paper by


Hopman et al, which involved the removal of sinks from patient rooms and the introduction of ‘water-free patient care’, on an ICU, which resulted in a significant reduction of colonisation with MDR Gram-negative bacteria.7


Hospitals Programme. The new cancer centre, once completed, will


centralise the Trust’s non-surgical haematology and oncology services, and the accommodation will be in single rooms with an ensuite. However, the initial planned design would have meant significant exposure of this vulnerable patient group to water outlets (4-5 outlets if following the Health Building Note [HBN] – which includes a clinical handwash basin, toilet, shower, and patient wash basin). Pat Cattini pointed to a growing body of


research that highlights the potential infection risks associated with exposure to water outlets, including research by Mark Garvey et al, which was presented earlier in the conference.6


This


study looked at the ‘splash zone’ around water outlets, highlighting the potential infection risks (particularly from Pseudomonas aeruginosa) associated with water outlets on an ICU. Joost Hopman et al ‘s study also reported a


reduced rate of intensive care unit acquired gram-negative bacilli after the removal of sinks and the introduction of ‘water-free’ patient care.7


She also highlighted the retrospective


analysis of 552 ICUs, by Fucini et al, which found that sinks in patient rooms in ICUs are associated with higher rates of hospital- acquired infection.4 “I was concerned about the vulnerable cancer patients that will be going into our new unit,”


36 www.clinicalservicesjournal.com I March 2025


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