Down The Drain

J. Darrel Hicks, November 19, 2022

Sometimes we think that we know all there is to know, but real growth comes from realizing that you only know what you know, regardless of your experience. Are you in the trap of thinking you know all there is to know, including what will be your next source of wisdom, understanding, knowledge, and new ideas?

For instance, all you know about a hospital sink is what you can observe in 10 seconds. Is it clean or dirty? Does the tap work with running hot and cold water? Is the drain free running or slow?

The literature is replete with articles and studies in infection prevention annals extolling the virtues of various environmental hygiene products, processes, and programs. There are far fewer articles and studies in those same annals discussing sinks as a source of potentially deadly organisms.Perhaps you didn’t know that sinks have been implicated in the spread of dangerous bacteria that could lead to Hospital-associated Infections (HAIs).

In a devilish case of unintended consequences, sinks have been linked to a number of outbreaks of serious infections in hospitals from Baltimore to Shanghai and many places in between in recent years. In one notable case, a hospital in the Netherlands took sinks out of the patient rooms in its intensive care unit in a bid to slow the spread of bacteria. (It worked.)

A patient’s #1 Fear of being admitted to a hospital is GERMS. Hospital-associated infections are a serious problem, and you might not know the real toll of lives affected by Multiple Drug-Resistant Organisms (MDROs).

UNDER-REPORTED DEATH TOLL DUE TO HOSPITAL-ASSOCIATED INFECTIONS

Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them. The Centers for Disease Control and Prevention (CDC), the go-to national public health monitor, and state health departments lack the political, legal, and financial wherewithal to impose rigorous surveillance.

Here are the facts regarding hospital-associated infections (HAIs) in America. In 2019 (the most recent year with data), there were 36,242,000 admissions to U.S. hospitals. A conservative standard HAI rate in a hospital is 7% (of admitted patients will get an HAI during their stay). But there are hospitals with an HAI rate of 10% or more.

Doing the math, 7% of 36.2 million admissions=2.5 million patients get an HAI while 10% of 36.2 million admissions=3.6 million patients get an HAI while hospitalized.

If the mortality rate for 2.5 million patients is 10%, 250,000 Americans die of HAIs. If the same mortality rate of 10% is applied to 3.6 million HAIs, the number of patient deaths us360,000. This would place deaths due to HAIs as the #3 on the causes of death in the U.S. just behind heart disease and cancer.

This estimated deaths due to HAIs is considerably higher than the 99,000 that the Centers for Disease Prevention and Control (CDC) reports on their website and is cited by many reputable papers.

Drug-resistant infections are left off death certificates for several reasons. Doctors and other clinicians get little training in how to fill out the forms. Some don’t want to wait the several days it can take for laboratory confirmation of an infection. And an infection’s role in a patient’s death may be obscured by other serious medical conditions.

There’s also a powerful incentive not to mention a hospital-associated infection: Counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage.

ENVIORNMENTAL CONTAMINATION CONTRIBUTES TO HAIs

Although microbiologically contaminated air, water, and fomites can serve as vehicles of transmission, demonstrating their contribution to HAIs and disease is difficult.

For an infection to ensue, there has to be a sufficient quantity of a virulent pathogenic organism on surfaces in the environment that is transmitted through the correct portal of entry into a susceptible host. The wider use of more aggressive modalities of treatments, such as stem cell or solid organ transplantation and new chemotherapeutic and immunomodulatory agents, has increased the population of immunocompromised patients at risk of acquiring opportunistic HAIsresulting from environmental contamination with nosocomial pathogens.

WATER-BASED CONTAMINATION

Guidelines for health care facility design mandate that sinks be placed in acute care facilities to promote hand hygiene and protect patients from hospital-acquired infections. By virtue of the fact that these sinks need to be in close proximity to the point of care places them in the “patient hot zone.” That zone is often the most contaminated real estate in the patient’s room.

The other problem is that sinks, particularly the pipes that drain them, are ideal places for bacteria to proliferate. The bugs form what are known as biofilms – colonies where they gang together and attach to the surface. These water-dwelling bacteria especially like p-traps, the U-shaped bend in pipes that drain the contents of a sink.

Getting rid of biofilms once they form is, well, pretty much impossible. There are cleaning tricks hospitals try, but even those generally only lower the bacterial count for a while.

“Once you have the biofilms in there, short of ripping the sinks and the piping out, it’s impossible to get rid of. And, in fact, even if you do that, it frequently comes back,” said Dr. Alex Kallen, a medical officer in the Center for Disease Control and Prevention’s division of health care quality promotion.

He said it’s not entirely clear how much of a risk biofilm in hospital sinks pose. These bacterial colonies are generally — though not always — found in the pipes leading awayfrom sinks, so people using the sinks shouldn’t, in theory, have contact with them.

SINKS IN THE “PATIENT HOT ZONE”

“The thing about the sinks is that they’re the cornerstone of infection control policy. … All of the [hospital] guidelines in the developed world talk about having sinks — the ratio of sinks per beds and where they are and that sort of thing,” said Dr. Michael Gardam, director of infection control at University Health Network, an institution comprising four Toronto hospitals.

Gardam has firsthand experience with an outbreak caused by a sink. It was a bad one. Three dozen patients in intensive care contracted a drug-resistance bacteria; an investigation after the fact said five died because of the infection.

Figuring out how the patients were getting infected took sleuthing, but eventually suspicion fell on some sinks in the ICU. They had gooseneck faucets that directed water straight down into the drain. The pressure created a back splash, with tiny droplets of bacteria-laced water spraying onto nearby porous surfaces where medical staff prepared tubing and other equipment used in patient care.

Gardam ordered staff to stop using the sinks, going so far as encasing them in garbage bags. There were no new cases after that.

The hospital subsequently made a number of changes, which have been adopted elsewhere as well, Gardam said.

“Some of the stuff we’ve learned … is: Don’t have the gooseneck (faucet) drain directly into the drain; have it drain off the side of the bowl. Don’t allow it to splash. Make sure it’s deep enough that it can’t splash on you and splash on your clothing. Make sure that the stuff around [the sinks] is waterproof.”

DOWN THE DRAIN IS OUT OF SIGHT

Exacerbating the problem is the fact that biofilms that develop in hospital sinks may house really bad bugs – bacteria that are resistant to key antibiotics. That’s because sinks aren’t just used to wash hands. Staff sometimes use them to dispose of patient specimens – urine, for instance – or to drain the dregs of an intravenous bag of antibiotics.

Quote from a patient, “The nurse asked me to pee and to set the specimen cup on the back of the sink when I was done. The nurse then came in checked my urine with the dipstick and then dumped my urine down the sink drain in the restroom. This was the only sink in the room, also used for handwashing. Is this a safe practice?”

“It’s just like: How do you use your kitchen sink? You dump your disgusting stuff down there and then you wash your hands,” said Dr. Trish Perl, an infection control expert who is chief of infectious diseases at the University of Texas Southwestern Medical Center in Dallas.

Hospitals should have clean sinks — for hands — and dirty sinks, for disposing of patient specimens. But some health care workers would argue it’s safer to tip a specimen into the nearest sink rather than walk down a hallway with something that might spill.

There does seem to be at least anecdotal evidence that if you discard patient specimens down sinks, then you can contaminate the drains with the things that are in those specimens — which, if they’re in the hospital, are more likely to be multidrug resistant organisms.

Aside from body fluids being poured down sinks, as nurses take care of their patients, they have been known to empty IV bags down the sink drain as routine practice. Those IV bags might contain nutrient-rich liquids such as tube-feeding leftovers.

When nutrients are added to the sewer system, the organisms rapidly grow up the tailpipe to the strainer at approximately an inch per day. In a real-world setting, motility of bacteria inside the tailpipe is restricted to relatively sporadic and brief wetting events in which swimming is an opportunity to colonize new surfaces. It is assumed that once established, the biofilm promotes the upward growth of GFP-expressing E. coli in the tailpipe at an accelerated rate. The nutrient regimen ultimately promotes colonization of items commonly disposed of in hospital sinks (intravenous fluids, feeding supplements, and leftover beverages).

Also, bedside practitioners might have to “waste” narcotics down the drain. The Environmental Protection Agency strongly discourages pouring or flushing pharmaceuticals down the drain in any setting, including at health care facilities, because they may enter and pass-through water treatment systems and contaminate the water supply.

As part of its rule for managing hazardous waste pharmaceuticals, the EPA has banned the “sewering” (or pouring down the drain or toilet) of hazardous waste pharmaceuticals at health care facilities.

However, this rule applies only to drugs considered hazardous waste, such as toxic chemotherapy drugs. Most pharmaceuticals do not fall into this category.

“P” STANDS FOR PROBLEM

Thomas Crapper founded Thomas Crapper & Co in London, a plumbing equipment company. Crapper improved the S-bend trap in 1880. An S-shaped trap is also known as an S-bend. It was invented by Alexander Cumming in 1775 but became known as the U-bend following the introduction of the U-shaped trap by Crapper in 1880.

The U-bend could not jam, so, unlike the S-bend, it did not need an overflow. In the United States, traps are commonly referred to as P-traps. It is the addition of a 90-degree fitting on the outlet side of a U-bend, thereby creating a P-like shape (oriented horizontally).

P-traps have been in use for 140 years and are common under every hospital sink with very few exceptions and are typically installed just downstream from the sink drain with the purpose of preventing odorous gases from entering the built environment from the wastewater system.

Opportunistic Premise Plumbing Pathogens (OPPPs) really like the warm, wet, and dark environment in the P-trap. ThePROBLEM-trap also happens to be an excellent incubator for microorganisms that live in the sink, wastewater, and premise plumbing environments.

The retained water in a sink P-trap is present to provide a water barrier to prevent off-gassing of sewer smell, but it may inadvertently provide favorable conditions for pathogenic and opportunistic antibiotic-resistant microorganisms to survive and develop resilient biofilms.

Periodic water use and flushing of waste fluid down sink alongside warmer indoor temperatures and pipes being a relatively protected environment favors formation of biofilms. The body of water in P-traps also allows for periodic stagnation, further promoting bacterial growth and biofilm formation.

Previous studies have highlighted the importance of sinks and their traps as a source in nosocomial outbreaks (Cholley et al., 2008; Gillespie et al., 2000; Lowe et al., 2012). Sink traps harbored opportunistic and antimicrobial-resistant bacteria, which were not easily controlled or removed (Hota et al., 2009; StjärneAspelund et al., 2016). An experimental study showed how biofilms can extend from the P-trap to basin, and upon addition of faucet water, microorganisms can be splashed to the surrounding area (Kotay et al., 2017).

More recently, a study was released detailing the formation of biofilms in an in vitro drain biofilm model (Ledwoch et al., 2020). This further demonstrated the establishment of a rigid thick layer of embedded cells within eight days in a P-trap-simulated environment.

Additionally, upon disinfection, the back sections of the trap were not controlled by Sodium Hypochlorite disinfection, and within days post treatment, the biofilm had recovered. This finding is similar to other studies where biofilms recovered within seven days after treatment with bleach or foaming products (Buchan et al., 2019; Jones et al., 2020).

These studies were again hospital associated as they treated sinks found in patient rooms. Ledwoch’s et al. model provides a reproducible and simple testing methodology for investigating trap formation and disinfection, but it does not represent complex biofilms formed over years of in situ sinks. The culture-based methods that were used to quantify target organisms of interest (Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and opportunistic plumbing pathogens capable of growth on a cefotaxime containing medium) yielded more informative results.

No matter how well the drain cover is disinfected by EVS, just inches away lies the problem. The drain cover is the point at which the concentration of target organisms sharply increased from almost undetectable above the drain cover to ≥106 CFU/cm2 in some samples below the drain cover.

This high concentration of potentially pathogenic and/or antibiotic resistant microorganisms in proximity to patients and healthcare personnel reinforces the risk that sinks pose as reservoirs for healthcare-associated pathogens.

SUPERBUGS IN BIOFILM COATING OF DRAINPIPES

Published literature reviews provide evidence that sink, shower and other wastewater drains in healthcare settings have been associated with outbreaks, particularly among the most vulnerable patient populations in neonatal and adult intensive care units, burn units, transplant units and hematology/oncology units. 

These outbreaks are difficult to recognize and manage because long intervals of time may pass between cases, and the number of cases at any given time is low. Once an outbreak is identified, it can be challenging to eliminate one of the increasingly recognized sources – bacteria growing in biofilms in drains.  

Biofilms are slimy coatings on wet surfaces that harbor complex microbial communities. Research has revealed that hospital superbugs could migrate upward through drainpipes in biofilms toward the sink strainer.

Having colonized the P-shaped water trap in the plumbing under sinks, the biofilms were found to grow toward the sink strainer at a rate of about one inch per day. Once in the sink strainer area, the superbugs then could be dispersed into the near-sink environment by the impact of streaming water from the faucet. Could slowly “creeping” biofilms be spreading?

Bacteria grows in the opposite direction of water flow.  Independent lab tests, performed on hospital sites, have proven that water and bacteria frequently get caught in the sink’s plumbing trap and becomes a primordial soup, or biofilm that facilitates the growth of more bacteria out of the trap itself.  

Colonization of strainers or drains reported in studies was perhaps a result of ascending biofilm growth from the P-trap to the strainer or introduction through contaminated fluids.When nutrients are added to the sink system, the organisms rapidly grow up the tailpipe to the strainer at approximately an inch per day. In a real-world setting, motility of bacteria inside the tailpipe is restricted to relatively sporadic and brief wetting events in which swimming is an opportunity to colonize new surfaces. It is assumed that once established, the biofilm promotes the upward growth of GFP-expressing E. coli in the tailpipe at an accelerated rate.GFP stands for green fluorescent protein. GFP is a fluorescent protein that can be expressed in vivo. If GFP is exposed to light, it emits a green, fluorescent signal. This property has had an enormous impact on cell biology by enabling the imaging of almost any protein, in transcription studies by working as a reporter gene, and in biochemical applications.

This was confirmed by an investigation undertaken by the National Institutes of Health into where germs live in hospitals after an outbreak of antibiotic-resistant infections killed 11 patients at the Clinical Center in 2011-2012. Published in 2013 in Clinical Infectious Diseases, the study revealed that bacteria and several forms of antibiotic resistant ‘super bugs’ were living in the plumbing and scrubbed out sink drains.

SINKS DON’T STAND ALONE; THEY ARE PART OF A SYSTEM

We all know how an infection can spread through the body’s circulatory system; hospitals have a very similar system. Human body waste in the form of liquids and solids flows by gravity out of the building and into the municipal sewer system via the pipes in the walls and floors of a hospital. Also, vent pipes to the building roof vent the gases created by human waste in sewer pipes to the outdoors.

This sewage systemcarrying body waste from Soiled Utility room hoppers, sinks,floor drains and toilets is also a Superhighway for the pathogenic organisms mentioned above.

We all know instinctively that toilets harbor pathogens. That’s why we take sensible precautions such as thoroughly washing our hands after using the toilet and regularly treating bathroom surfaces with efficacious products, such as chlorine-based disinfectants. Hospital toilets are particularly challenging because of the compromised health of patients who use them. Understanding how hospital superbugs cross-contaminate surfaces in the ICU can go a long way toward developing best practices and engineering safeguards to help prevent potentially deadly exposures.Healthcare facilities can have large complex water systems that promote growth of pathogenic organisms if not properly maintained. For this reason, the Centers for Medicare & Medicaid Services (CMS) and CDC consider it essential that hospitals and nursing homes have a water management program that is effective in limiting Legionella and other opportunistic pathogens of premise plumbing from growing and spreading in their facility.

A healthcare water management program identifies both hazardous conditions and corrective actions that can minimize the growth and spread of waterborne pathogens. Programs such as Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings: A Practical Guide to Implementing Industry Standards 13.2 are designed, implemented, and regularly reviewed by multidisciplinary teams that include facility managers, infection prevention professionals, clinicians, and administrators.

Water management programs should carefully assess their facility’s premise plumbing. This includes examining factors such as: the age and overall design of the system; additions, renovations and other modifications; water age (i.e. how long water might be held in the piping system); and assuring that there are no ‘dead ends’ where water can stagnate.

Hospital wastewater plumbing systems are large, complex waterworks with low-flow areas that produce stagnation and biofilm formation. The water in a hospital is designed never to freeze, with average water temperatures in the 70s – and this labyrinth of pipes provides dark moist areas that are perfect breeding grounds for bacteria.

Sink waste traps and drains are a reservoir for carbapenem-resistant Enterobacteriaceae (CPE) in hospitals. Once established, CPE contamination might not be confined to a single sink and could spread through wastewater plumbing. Outbreaks of carbapenem-resistant organisms were found more commonly in ICUs and immunocompromised patients. However, the acquisition of infection from sink drains may be more widespread in in-patients than previously thought.

There has been more investigation about microbiologic dynamics of infectious viral particles such as those of severe acute respiratory syndrome (SARS) and Ebola viruses through premise plumbing systems. However, the microbiology, sustainability, and dynamics might be very different, although the backflow and inoculation issues could have some parallels when comparing viruses to bacteria. As Enterobacteriaceae can either multiply or remain viable for long periods of time in biofilms coating the interior of P-traps and the connected plumbing, it may not be sustainable to target any intervention limited to a single isolated sink as a source of a particular pathogen.

Finally, when focusing “downstream,” water management programs should consider the various pathways that might lead to patients becoming exposed to waterborne pathogens, in relation to ingestion, diet, hygiene, and clinical care.

A water management program is particularly important for patient populations whose ‘immune system might be compromised as a result of an underlying condition (e.g., cancer patients, premature infants) or in relation to invasive procedures such as surgery or the use of medical devices.

CONTAMINATION OF THE SINK AND SURROUNDING SURFACES

Data from different dispersal experiments suggest that although P-traps can act as the source or the reservoir of pathogens, the physical presence of the organism in the sink bowl or colonization of the strainer is necessary for the dispersal to occur. Many of the studies used swab samples, which likely sampled the strainer rather than P-trap water.

Once the strainer was colonized, the water from the faucet resulted in GFP-expressing E. coli dispersion in the bowl and to the surrounding surfaces of up to 30 in. The range of dispersal recorded in this study was comparable to that reported earlier.

Greater dispersal near the faucet may be attributed to the specific designs of the sink bowl and faucet in this study, which determine the contact angle of water impact. This is an important finding since many sinks in hospitals are similar in design, with faucet handles representing a high-touch surface for the sink users. It can also be concluded from the dispersion experiments that secondary and successive dispersals would likely increase the degree and the scope of dispersion.

Sinks and faucets tested at the University of Michigan Health System revealed slime and biofilm. Credit: A picture containing toilet, light

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BEGIN BY RAISING AWARENESS OF THE ISSUE

There are many studies documenting the antibiotic properties of different types of room finishes:  paint, flooring, carpet, handrails and have taken rigorous measures to sanitize these surfaces.  Unfortunately, many hospitals have not invested the same number of resources testing their plumbing systems.  They may suspect there is an issue but may not know how to address the problem.  They may also fall victim to the ‘out of sight – out of mind” response.  Healthcare Mechanical Engineering Specialists (HMES) experts can be a valuable resource in helping to educate a facility staff on how to address potential infection and bacteria posed by plumbing fixtures.

DON’T UNDERESTIMATE THE IMPACT OF PROXIMITY

One of the easiest solutions to implement, according to a 2013 French study published in the Journal of Hospital Infection, is measuring the “splash” radius from each sink in the patient room and making sure nothing is in close proximity.  For example, assure that a patient’s toothbrush is not in the splash zone of the restroom. Include a ledge on a perpendicular or opposite wall and instruct patients and their family members not to place their personal belonging near the sink. 

Similarly, measure the “splash” radius of the caregiver’s hand washing sink and make sure the paper tower dispenser and glove boxes are not within three feet of the sink, well out of the water’s splash zone.  Specify paper towel dispensers that are completely enclosed and dispense towels with a wave of a hand to ensure no cross contamination. 

Consider installing a standalone hand washing sink rather than a sink mounted in a countertop, as the countertop is frequently used as a staging area for sterile materials.  Creating a physical separation between the sink and counter will reduce any contamination from splashing water.

If you can’t change the room configuration, consider new care protocols

Perhaps a facility leader can’t change where a sink is located but can alter what is done around the sink.  For example, consider giving patients a new hospital-supplied toothbrush each day that can be disposed of after one use.  That will reduce any infection or contamination from the sink or toilet.  Train caregivers not to use countertops adjacent to handwashing sinks as sterile prep areas.  Encourage them to use single use carts, making sure they do not “park” them next to the handwashing sink and make sure they are sterilized after each use.   Ask your patients and their families to keep the bathroom door closed while flushing and when not being used.

HELPING TO PREVENT INFECTION THROUGH ENGINEERING AND DESIGN

With advances in modern medicine, hospitals are able to treat and cure people that are sicker than ever before, which means they are more immunosuppressed than ever, so they are more susceptible to infection.  Cancer patients are particularly vulnerable to even small amounts of bacteria.  As part of experienced HMES experts’ education process with hospitals, such project team experts review the engineering systems and design of their most intensive care environments and recommend suggestions to enhance infection control and reduce potential for cross contamination.  This review includes how the nursing staff uses the different surfaces and equipment in high-risk environments.  Suggestions included changing sink types and moving the patient bed away from the hand washing zone.  In another instance, HMES project team experts observed that in some patient rooms, the hand washing sinks were connected back-to-back with the wrong trap arm fittings, providing a more direct path of contamination of sinks on the opposite side of the wall.  A simple and cost-effective intervention was to offset the traps which significantly reduced cross contamination between rooms.

INVESTIGATE NEW TECHNOLOGIES AND FIXTURES

In OSHA (Occupational Safety and Hazards Act) standards, there is a hierarchy of controls to reduce the risk of exposure to hospital staff. OSHA is more concerned about employee’s safety than patient’s safety.

Hospital wastewater plumbing systems are large, complex waterworks with low-flow areas that produce stagnation and biofilm formation. The water in a hospital is designed never to freeze, with average water temperatures in the 70s – and this labyrinth of pipes provides dark moist areas that are perfect breeding grounds for bacteria. Therefore, the ELIMINATION of the problem has to be done BEFORE the hospital is built.

There are NO SUBSTITUTIONS FOR THE BUILT environment of a hospital’s plumbing system.

 The next option is ENGINEERING CONTROLS. As more and more hospitals become aware of the potential for bacteria and “super bug” contamination from their plumbing systems, the industry is responding by developing new fixtures and systems that reduce or eliminate the potential of infection.  These include implementing UV lights, low-splash sinks, and exhaust in fixtures, as well as automatic injection of sanitizing agents. 

Of course, these more sophisticated fixtures’ planning, design and installation require infrastructure to support their associated strategies. Electrical and exhaust connections, along with new piping systems and other central systems, bolster the different strategies that are designed to reduce infection in the care environment. Reimagining an entire system from the ground up can drive up construction costs, but in the end reduce the overall costs of healthcare.

Existing drain disinfection chemistries and technologies are not effective at killing bacteria in drains and they depend on employees who actually perform the service.  Efforts to disinfect drains have included complete replacement of the sink or its components, installing self-cleaning traps, disinfection with processed steam, enhanced manual cleaning, descaling of pipes, and disinfection with chlorine-based solutions or other liquid disinfectants.  It’s important to note that liquid disinfectants do not come in contact with the surface of the drain long enough to meet the contact time needed to kill the bacteria.

The Impact of Continuously Active Disinfection 

Environmental surfaces are frequently contaminated with microbes and contribute to the spread of infectious agents. Despite effective surface disinfectants, maintaining hygienic surfaces is difficult due to commonly touched surfaces that are easily recontaminated.

The emerging compact UVC LEDs with rapidly increasing efficiencies have the potential to alter the technology horizon of UVC disinfection. Such advancements enable their incorporation in confined spaces to inhibit surface colonization on inaccessible surfaces such as those in premise plumbing.

The formation of microbial biofilms on wet and dry surfaces creates additional challenges for contamination control in hospitals and other critical environments, given increased protection from biocides. Survival of some organisms ranges from hours to weeks or more, allowing ample time for transmission to susceptible hosts and repeat contamination of surfaces. Interventions that effectively reduce the persistence of pathogens in the environment are expected to have a direct impact on reduced risks of exposure and infection.

Recent innovations in infection control include continuously active disinfection that kill microbes and prevent the growth of harmful biofilms on surfaces over time. These discoveries are game changers in the field of infection prevention.

Conclusion and significance

Numerous studies have found traditional cleaning methods in hospital sinks and the surfaces surrounding them to be suboptimal and have called for protocol improvements with the consideration of automated antimicrobial interventions.

The formation of “Super Bug-laden” biofilms on wet and dry surfaces creates additional challenges for contamination control in hospitals, food production, and other critical environments, given increased protection from biocides.

Biofilms display higher tolerance to disinfectants, facilitate resistance to environmental stress, and allow embedded microorganisms to share nutrients and metabolic products. This suggests the P-traps of sinks, invented to prevent sewer gases rising from the sink drain into the building, are an ideal environment for proliferation of microbial communities.

Survival of some organisms ranges from hours to weeks or more, allowing ample time for transmission to susceptible hosts and repeat contamination of surfaces. Interventions that effectively reduce the persistence of pathogens in the environment are expected to have a direct impact on reduced risks of exposure and infection.

NOT TAKING ACTION CAN BE COSTLY

Willful blindness-when there’s something to be seen but you will not look; something to discover but you won’t take the time to discover it. With the rise in antibiotic resistant infections, hospitals are looking at all causes and strategies to reduce infection – both caregiver-based and facility-based.  The bad news: the CDC’s 2020 and 2021 National and State Healthcare-Associated Infections Progress Reports showed increases for HAIs and facility types included in the report.

Whether a hospital leader has a 20-year-old building, or is considering a new replacement hospital, consider engaging an experienced “healthcare” engineering design expert to assist with developing solutions that address risk of infection and contamination from plumbing fixtures.   Implementing best practice design and engineering strategies in areas that cannot be sanitized can result in reduced exposure to infection across the entire hospital.