Sinks located in newly constructed ICU rooms contaminated quickly
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Key takeaways:
- Nearly 300 CRO isolates were recovered in sinks, with the most common species being Enterobacter cloacae and Pseudomonas aeruginosa.
- Half of sinks in the study had newly acquired colonization within a year.
After the construction of two ICUs, researchers found that contamination with carbapenem-resistant organisms of the in-room sinks happened quickly.
“The exact sources and onset of sink contamination by carbapenem-resistant organisms (CROs) remain largely unclear. Given the infrequency with which new inpatient units are built, we were presented with a unique chance to investigate CRO contamination from a clean baseline,” Bobby G. Warren, MPS, clinical research coordinator at the Duke Center for Antimicrobial Stewardship and Infection Prevention, told Healio.
“Our prospective observational study aimed to examine how and when CRO contamination occurred, as well as the extent and regularity of such contamination, in handwashing sinks located within two ICUs of a recently established hospital tower,” he said.
For the study, Warren and colleagues determined the timing, rate and frequency of CRO contamination of in-room sinks of two ICUs in a newly constructed hospital bed tower.
According to the study, the patients in unit A were moved to unit B in the same bed tower. After the move, microbiological samples were taken every 4 weeks from three location of each of the study sinks — the top of the bowl, the drain cover and the p-trap.
The primary outcome was sink conversion events (SCEs) which consisted of CRO contamination of a sink in which CRO had not previously been detected.
In total, 2,814 patients were admitted to study units. Sink samples were collected 22 times between September 2020 and June 2022, generating 1,638 environmental cultures (780 from unit A and 858 from unit B).
The first samples from unit A were collected approximately 60 days after the unit was opened to patients, and of the 26 sinks, four were already contaminated with CRO and three were contaminated with carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) upon initial evaluation, while all samples in unit B were obtained before patients were admitted to this unit and none grew CRO or CP-CRE at baseline.
Overall, 35 SCEs were observed, with nine sinks (41%) in unit A becoming contaminated with CRO by month 10, and all 26 sinks were contaminated in unit B by month 7. Researchers said that despite “infrequent identification of patients with CRE colonization” in the two study units, more than 50% of the study sinks had newly acquired CP-CRE colonization within a year of the new unit opening. Among sinks with an identified SCE, the median time to SCE following unit opening was 109 days.
Additionally, researchers found that a total of 299 CRO isolates were recovered, with the most common species being Enterobacter cloacae (51%) and Pseudomonas aeruginosa (34%).
“Our results, paired with growing literature, support in-room hospital sinks as an important reservoir of CRO, and they emphasize the need for infection prevention strategies to mitigate contamination of surfaces from sinks (eg, splash guards) as well as the development of novel strategies to eliminate CRO from sinks,” Warren concluded.
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