DO NOT REMOVE HOSPITAL SINKS UNTIL YOU READ THIS

by J. Darrel Hicks

An internet search on the topic of “Problems with Hospital Sinks” makes known the current

thinking of many infection preventionists. When outbreaks of ESKAPE organisms have

occurred in intensive care units, the IPs have often traced the source to the sinks in patient

rooms. Their solution to the problem: REMOVE THE SINK AND THE PROBLEM GOES

AWAY. Or, COVER THE SINK WITH A TRASH BAG AND THE PROBLEM GOES AWAY. Or,

HAVE HOUSEKEEPING OR MAINTENANCE POUR BLEACH DOWN THE DRAIN AND THE

PROBLEM GOES AWAY.

ESKAPE is an acronym comprising the scientific names of six highly virulent and antibiotic

resistant bacterial pathogens including: Enterococcus faecium, Staphylococcus aureus,

Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and

Enterobacter spp.

The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the

treatment options for serious infections, increased the burden of disease, and increased death

rates and is a global problem.

THE DIRTY TRUTH ABOUT HOSPITAL SINKS

There is a compelling number of scientific studies implicating poorly designed sinks in the

patient-care environment. These poorly designed sinks are part of an entire system of

outdated premise plumbing that is a superhighway for ESKAPE pathogens in a hospital.

Since the advent of indoor plumbing, the positive impact on health and sanitation has been

monumental, no doubt. However, since the discovery of the p-trap nearly 200 years ago, very

little has been done to build upon that original design.

Sinks, particularly the pipes that drain them, are ideal places for ESKAPE bacteria to

proliferate. The “bugs” form what are known as biofilms OR colonies where they gang together

and attach to the surface of pipes below the sink drain.

Biofilm-The Unseen Threat

 90% of harmful bacteria live in biofilm (according to the CDC and NIH).

 Viruses hide in Biofilm--Biofilms provide viruses a means to live without a host--These

viruses can seriously impact a patient’s health.

 Biofilm is a major challenge for cleaning--Biofilm “houses and protects ESKAPE

bacteria” along with MRSA, Salmonella, C-diff et al.

 Biofilm is a protective “Iron Man” shield that bacteria produce that make them highly

resistant to disinfectants.

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 short period of time.

DON’T FEED THE BIOFILM

Aside from patient specimens being poured down sinks, as nurses take care of 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 standpipe

or tailpipe to the strainer at approximately an INCH per day. In a real-world setting the

movement of bacteria inside the tailpipe is restricted to 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 ESKAPE

bacteria in the tailpipe at an accelerated rate to the room-side of the sink drain. Once there, the

biofilm will continue spreading into the sink bowl. This high concentration of potentially

pathogenic and/or antibiotic-resistant microorganisms in proximity to immune-compromised

patients and healthcare personnel reinforces the risk that sinks pose as reservoirs for

healthcare-associated pathogens.

SINK DRAIN TREATMENTS DON’T WORK

The problem with relying on sink drain treatment is one or all of three things:

1. The chemical poured down the drain is corrosive (especially to plumbing that is 20 or

more years old).

2. Neither 98% of liquid disinfectants attain contact time on the walls of pipes to kill

bacteria nor do they kill the pathogens in biofilm due to its thick matrix that is nearly

impossible to crack. Biofilms can be 1500 times less susceptible to disinfectants.

3. Depending on hospital employees (either EVS or Maintenance) to use the right EPA

registered product to kill biofilm in patient rooms on a frequent basis is “dead on arrival.”

How do you know the service was performed per hospital protocols?

SHOULD SINKS BE REMOVED IN FAVOR OF ABHS?

In 1850, Dr. Ignaz Semmelweis saved many lives with three simple words; Wash Your Hands.

The 2001 edition of the FGI Healthcare Facility Guidelines was the first time the Facility

Guidelines Institute included the requirement in new construction that a handwashing station

be provided in the patient room in addition to a sink in the toilet room.

The intention was that positioning a handwashing sink station near the entrance of the room

would provide unobstructed access for use by healthcare personnel and others and encourage

hand hygiene compliance, a top protocol for protecting patients and staff from potentially

deadly germs. Subsequent research has indicated that patients preferred seeing staff wash

their hands. Historically, hand washing compliance by staff between seeing patients was low at

many institutions.

A year later, the Centers for Disease Control and Prevention (CDC) revised its collective hand

hygiene guidelines to recognize the efficacy of ABHS products as a secondary sanitizing

solution if soap and water were not available or if time saving was important. Afterwards,

Alcohol-Based Hand Sanitizer use proliferated at the entry to patient rooms and throughout the

hospital.

However, it is important to keep in mind that the efficacy of ABHS depends on the type of

alcohol, the quantity applied, the technique used, and the consistency of use. There are also

situations where these products are not ideal, for example, in preventing the spread of certain

alcohol-resistant infections (i.e. Candida auris, C. diff, Norovirus and Cryptosporidium), or

when hands are significantly soiled and the bacterial load is too high.

A cautionary note: AHBS contains a minimum of 60-70% alcohol which is highly

flammable. Authorities Having Jurisdiction (AHJ) (i.e., state, city, county,

municipal or fire districts) may restrict the volume of flammable materials within

a hospital smoke compartment. Work with your Facilities Director to ensure the

volume of wall dispensers and the Housekeeping Closet storage of clean supplies

does not exceed your AHJ’s guidelines.

ELIMINATE THE PROBLEM, NOT THE ABILITY TO PERFORM

HANDWASHING

To this point the problem of the splash zone has not been mentioned. The design of most sinks

does not prevent the stream of water from the faucet hitting the bottom of the bowl. Don’t have

the gooseneck (faucet) stream 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.

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.

THE IMPACT OF CONTINUOUSLY ACTIVE DISINFECTION

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.

Recent innovations in infection prevention and control include continuously active disinfection

that kills microbes and prevents the growth of harmful biofilms on surfaces in real time. These

discoveries are game changers in sink design.

CALL TO ACTION

I make it a point to work with the best, educate the haters and step over those who do not have

it in them to do what it takes to protect patients and our community.

I call it "willful blindness." It is a refusal to look at the evidence that runs contrary to what you

believe to be true; it is outside your box. If you find evidence that refutes your beliefs about the

sinks’ role in causing or contributing to HAIs in your hospital you would be compelled to do

something about it.

If you don't have it in you to do what it takes to protect patients, customers, and your

community then I'm not going to change your mind.

But, if you have grasped the issues surrounding sinks in hospitals, you 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 prevent the sink from being the source of ESKAPE

pathogens .

Let me challenge you to:

1. Do your own Infection Prevention Risk Assessment;

2. Complete the CONTACT FORM for more information;

3. Buy a sink, install it, and

4. Follow the SHS roadmap for your own 4-week study.

If your facility stakeholders are convinced that the ReSet265 sink will prevent sinks from being

the source of HAIs in your hospital, Tom Hicks will help you with a 2-3 year replacement

program as you install ReSet265 sinks in your critical care units and where your most

vulnerable patients receive care (eg. Emergency Department, Oncology Unit, NICU, Surgical

Intensive Care Unit, Medical Intensive Care Unit, Transplant Unit, Burn Unit, Scrub sinks in the

OR, etc.)