CAN A BETTER SINK DESIGN SAVE LIVES? AN INTERVIEW WITH TOM HICKS

Tom’s Profile: Tom is a Registered Architect with over 25 years of experience in Healthcare Architecture at HDR, INC., with 21 of those years in Medical Equipment Planning. He spent 18 years as Director of the Group and retired as an SVP in 2016.

Projects ranged from single department remodels to large replacement facilities in over 30 states, Canada, Mexico, the Middle East, and the Caribbean. Tom holds 2 Healthcare related U.S. patents.

Background of the Problem of Sinks as a Source of Pathogenic Organisms:

Since the advent of modern-day plumbing, the positive impact on human health has been monumental. However, since the invention of the p-trap nearly 250 years ago, very little has been done to build upon that original design.

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 a 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 until they rebound.

Interview:

Me: I’m on the phone with Tom Hicks, the Chief Opportunity Officer (COO) of Safe Health Solutions, LLC.

Good morning, Tom, thanks for taking time to tell me the story behind the hospital sink you’ve developed. "Necessity is the mother of invention" is a well-known proverb that suggests that the primary driving force behind human invention and innovation is the need to address practical problems or fulfill essential needs. When faced with challenges or limitations, people are motivated to find solutions and create new things to overcome those obstacles. Tell me about your invention.

Tom: Thank you, Darrel for this chance to talk about how the sink was developed.

I really had no desire, intentions, or thoughts of continuing my "work" in retirement. Some volunteering here and there, mostly at church, but nothing related to my 25 plus years of healthcare design and construction experience. 

My years of being involved in and then managing HDR's Medical Equipment Planning Group led to the eventual steps of the sink. Fast forward to about 2011. With that expertise I was tabbed to find potential medical uses for aqueous ozone by HDR. Relations between HDR leadership and the owners of the aqueous ozone company led to an investment and a push for HDR to find an application for hospitals. 

I had become very aware of HAIs over my years with HDR, but it had really not been top of mind as something I could impact in any significant way. My department would make sure Sterile Processing had a proper flow of instruments for processing or an OR had a flow of staff and equipment that promoted best practices. But finding an application for aqueous ozone was out of my lane. 

Me: To be clear, aqueous ozone is a sanitizer and deodorizer, not a disinfectant. It’s an important distinction. What was your success in finding a fit for hospital use? 

Tom: As I became more involved with the aqueous ozone company I started to become more and more aware of and educated on hygiene and issues related to HAI's. I found out that the chemistry in aqueous ozone was very limited. Long story short aqueous ozone was not going to be the solution we thought it would be. 

Here’s where the story gets interesting. I had the aqueous ozone spigot in the kitchen of our home and a friend/member of our Bible Study started asking questions.

Those questions led to the introduction to his daughter, Dr. Amy Mathers, at the University of Virginia. She was battling an outbreak of a particularly nasty antibiotic- resistant HAI that she had narrowed down to being hosted within the waste plumbing. She didn't know how the “bug” was getting to the patient, but the plumbing was the only place it was being found. Also, she was beginning to connect the dots to previous patients in some of those same rooms. Further investigation traced movement through the waste plumbing pathways, as well. 

I pulled together the aqueous ozone company and Greg Koll, at the time an HDR Mechanical Engineer and still Mechanical Engineer extraordinaire. Greg is the President/CEO of SHS. 

We headed to Virginia to see what we might be able to do. We, mostly Greg, started theorizing on causes and effects as to the “why, what and where” plumbing was at fault. We surmised that decades of adopting low flow water saving faucets was likely causing less mechanical action on biofilms and therefore pathogens. 

Me: Let me interrupt you for a second, Tom. This is fascinating information that I have never heard of. I’ve read stories about sinks being taken out of intensive care units but did not know that biofilm might be the culprit. 

Tom: Yes, 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 a surface. These water-dwelling bacteria especially like p-traps, the U-shaped bend in pipes that drain the contents of a sink. I think there was an oversight or lack of awareness that these drains are not necessarily a one way street. They are part of premise plumbing that connects shower drains, sink drains, toilets, and hoppers in soiled utility rooms.

Me: There are close to 2.5 million patients affected by hospital-associated infections. If I do the math correctly, that could lead to 250,000 deaths! I know there are many contributing factors to these astonishing facts, but can sinks play a role in saving lives? 

Tom: Those are some serious statistics, Darrel. Each one of those affected by HAIs are a person, not a number. Greg and I felt compelled to find a solution to a sink’s contribution to ANY deaths.  Some of the stuff we learned is: Because different types of bacteria may contaminate the same drain, drains can serve as sites where antibiotic resistant genes are transferred between bacterial species.

Patients may be exposed to organisms in drains when water splashes from the drain. Splashes may occur when water flow hits the contaminated drain cover or when a toilet or hopper is flushed. Splashes can lead to dissemination of MDRO-containing droplets, which in turn may contaminate the local environment or the skin of nearby healthcare personnel and patients.

This led to lots of concepts and a base design. We were positive it would work and discussions of forming a company and filing for a patent soon followed. 

Me: I know your time is valuable. I have one last question before we go. Why have you spent money and time on this project? Shouldn’t you be enjoying your grandkids and travelling? 

Tom: My “why” for staying with it through some ups (and many downs) has been the POTENTIAL for saving lives. Not many of us are blessed with the opportunity to have a broad, significant impact on the human condition. My 25 years of participating in the design of new healthcare facilities was very rewarding, especially children's hospitals.  

Successfully resetting the standard in sink design and use is a Big Deal. Every component in buildings has gone through countless iterations and improvements since the P-Trap.....but nothing has basically changed with sinks. We are not even proposing to change the P-trap. It does and will continue to serve a great purpose. 

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 HOSPITAL SINKS. 

The ReSet265 sink creates the Ante Space/Kill Zone, whatever one wants to call it, between the occupied space and the known pathogens. Out of sight, out of mind does not change the FACTS, that we are inches away from visible biofilm and pathogens. 

At SHS, we may not save 10s of thousands of lives, but every patient who doesn’t get a sink-related infection is the “accident that didn’t happen.” It is our hope that the concept is extended to senior-care facilities, jails, prisons, schools, and to all public restrooms. The financial rewards to me and my family are possible, but the potential impact on humanity is priceless. 

Me: Well said, Tom. I want to thank you again for granting me this interview. I know it will help readers understand the “why” behind SHS. Do you have anything you’d like to say in closing? 

Tom: Now that your readers have a grasp of the issues surrounding sinks in hospitals, they need to take the next step to discover the only patented complete solution that addresses the splash zone and biofilm. The ReSet265 sink is ADA compliant and combines multiple layers of smart technologies working in unison to become an Engineering Control that separates the sewer from the patientcare environment.

And thank you Darrel for the opportunity to tell the story behind the invention that has the possibility of preventing HAIs and saving lives.