Sink drains, plumbing pose risk for MDRO spread in hospitals
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Key takeaways:
- Rigorous disinfection efforts and improved sink hygiene may prevent MDRO spread in hospitals.
- Efforts require a cross-department, cross-agency collaboration to be effective.
Biofilms that form in sink drains and plumbing can host multidrug resistant organisms, but cross-department efforts to sanitize them can limit their spread, according to a study.
Multidrug resistant organisms (MDROs) are highly transmissible from person to person in health care facilities and hospitals, and can populate environmental sources like sinks and surfaces, according to the study published in MMWR.
Over the last decade, researchers have tracked the spread of MRDOs in hospital sinks, sink drains and in plumbing, which have the potential to spread to other surfaces in the surrounding area.
Although technologies to prevent hospital-acquired infections such as an ultraviolet C light device for disinfecting surfaces have been developed, implementation of rigorous disinfection regimens for sinks and surrounding surfaces in the ICU and patient rooms are often needed to prevent MDRO infections.
“Treatment of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) infections is challenging because of antibiotic resistance,” Megan E. Cahill, PhD, MPhil, Epidemic Intelligence Service Officer with the CDC, and colleagues wrote in the study. “CP-CRPA infections are highly transmissible in health care settings because they can spread from person to person and from environmental sources such as sink drains and toilets.”
The authors report that between September 2021 and January 2022, an Idaho hospital identified CP-CRPA from sputum in two patients who stayed in the same ICU room 4 months apart. In the months between the two patients, 16 other patients stayed in the same room for a median of 3.5 days (range = 1 to 12 days), with no CP-CRPA detected in sputum cultured from five of the patients.
In March 2022, the Idaho Division of Public Health (IDPH) investigated the identified cluster of cases and collected environmental samples, finding CP-CRPA in one sink in the ICU room, including in biofilms formed in the drain, p-trap and counter. P. aeruginosa was also found in a water sample from one of seven toilet bowls.
Although no patients had been treated in the room after the second patient tested positive for CP-CRPA, the room was closed based on IDPH recommendations to disinfect for biofilms, add splash guards to reduce counter contamination from the drain, disinfect all ICU sink drains weekly, introduce new sink hygiene practices and continue to screen patients in the closed room once reopened.
“Collaboration between health care facilities and public health agencies, including testing of CRPA isolates for carbapenemase genes and implementation of sink hygiene interventions, was critical to the identification and response to this CP-CRPA cluster in a health care setting,” the authors wrote.
Cahill and colleagues note that there was no evidence of person-to-person transmission, and it is likely that the single sink is the “likely environmental source of CP-CRPA” but add that both patients in the cluster also received prolonged mechanical ventilation — which they said suggests shorter stays and lack of mechanical ventilation may also reduce transmission risk.
“Multifaceted interventions, including sink hygiene practices, engineering controls and administrative controls, are critical to limiting MDRO spread in health care settings,” they wrote.
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