A reservoir of bacteria: sink drains next to toilets in patient rooms may harbor dangerous organisms


February 4, 2019 Arlington, Va.,

Sinks situated next to patient toilets in hospital rooms may be reservoirs for Klebsiella pneumoniae carbapenemase (KPC), increasing the risk of dangerous germ transmission, according to new research published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology.

The study found a high prevalence of KPC positivity in sink drains located next to toilets. Of the samples tested, 87.0 percent of patient sinks next to toilets tested positive for KPC – in stark comparison to the 21.7 percent of sink drains located closer to the entry door of the room.

Klebsiella is a type of bacteria that can cause a number of healthcare associated infections, such as pneumonia, bloodstream infections, wound infections, or surgical site infections. Increasingly, Klebsiella bacteria have developed antimicrobial resistance, most recently to the class of antibiotics known as carbapenems.

In four of five rooms in which the entry-door sink tested positive, the sink near the toilet was also positive, suggesting a potential source for cross-contamination within the same room.

Researchers in Milwaukee, Wisconsin performed the study in the medical intensive care unit (MICU) of a 600-bed Wisconsin hospital. The MICU did not have any documented interactions with KPC-producing organisms within the past year.

“This study, if validated, could have major implications for infection control,” agree study authors, Blake Buchan, PhD, and Silvia Munoz-Price, MD, PhD. “If sinks next to toilets are indeed a reservoir for KPC, additional interventions – such as modified hand hygiene practices and sink disinfection protocols – may be needed to stem the risk of transmission among healthcare providers and patients alike.”

This is the first study to directly examine the relevance of sink proximity to toilets in patient rooms. The researchers point out that while it is not clear how contamination occurs, it is plausible that biofilms growing in pipes shared between toilets and sinks or that flushing generates contaminated drops that reach the sink drains.

“The results of this study demonstrate the importance of remaining vigilant to potential areas of cross-contamination,” said 2019 APIC President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. “Maintaining a strong understanding of environmental risks is critical to protecting patient safety, and this is yet another example of how germs can lurk in often the most unexpected of places.”

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Notes for editors
The article is “The relevance of sink proximity to toilets on the detection of Klebsiella pneumoniae carbapenemase inside sink drains,” by Blake W. Buchan, Marty Beth Graham, Jill Lindmair-Snell, Jennifer Arvan, Nathan A. Ledeboer, Rahul Nanchal, and L. Silvia Munoz-Price (https://doi.org/10.1016/j.ajic.2018.06.021). It appears in the American Journal of Infection Control, Volume 47, Issue 1 (January 2019) published by Elsevier and is openly available.

The study is funded by the Agency for Healthcare Research and Quality (R01HS024723, PI Shang).

About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control
covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJICis the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL. www.ajicjournal.org

About APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

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