TJC HOSPITAL INFECTION PREVENTION AND CONTROL (IC)CHAPTER EP REQUIRES YOUR ATTENTION

by J. Darrel Hicks

Effective July 1, 2024 The Joint Commission has a revised Infection Prevention and

Control Chapter IC.04.01.01 that includes this EP:

“Communication and collaboration with all components of the hospital involved in

infection prevention and control activities, including but not limited to the antibiotic

stewardship program, sterile processing department, and the water management

program.”

Infection preventionists are not subject matter experts when it comes to the daily

workings of a facility’s plumbing and water processes. But they are crucial in helping

determine risks associated with contamination or subpar maintenance to patient

outcomes and helping determine the potential source of an outbreak associated with

water systems. Collaboration with facilities, environmental services, bioengineering

departments, and hospital leadership is essential to a successful program.

Water is a prime environment for bacterial growth, which can contribute to the

contamination of surfaces and create reservoirs for pathogens. As health care becomes

more complex, water remains a key source to consider when investigating unusual

clusters of health care–associated infections like CRE (Carbapenem-resistant

Enterococci). In fact, sink drains should be one of the usual suspects in any outbreak

investigation.

Be Ready to Embrace the Future of Sink Design

Outbreaks of hospital sink-related infections involve a diverse spectrum of

microorganisms (e.g., gram negative pathogens). They can be attributed to defects in

sink design and hospital wastewater systems that promote the formation and dispersion

of biofilm.

Emphasis should be placed on optimizing best practices in sink design and placement

to prevent infections. Hospitals should consider developing a rational surveillance and

prevention strategy based on the current design and state of their sinks.

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.

Be Ready to Embrace the Continuously Active Disinfectant of Sink Drains

Recent innovations in infection control include continuously active disinfectants (CADs)

that kill microbes and prevent the growth of harmful biofilms on surfaces over time.

These discoveries are game changers in the field of infection prevention.

Existing drain disinfection chemistries and technologies are not effective at killing

bacteria in drains and they depend on employees who actually perform the service. 

Efforts to disinfect drains have included complete replacement of the sink or its

components, installing self-cleaning traps, disinfection with processed steam, enhanced

manual cleaning, descaling of pipes, and disinfection with chlorine-based solutions or

other liquid disinfectants. 

It’s important to note that liquid disinfectants do not come in contact with the surface of

the drain long enough to meet the contact time needed to kill the bacteria.

Numerous studies have found traditional cleaning methods in health care environments

to be suboptimal and have called for protocol improvements with the consideration of

passive, automated antimicrobial interventions. (Dancer, 2014; Reynolds, Sexton,

Garavito, Anderson, & Ivaska, 2021)

ReSet265 is the first sink to introduce the use of germicidal ultra-violet lights within the

negatively pressurized chamber (ante room) to kill bacteria located within the drain trap

before they have a chance to contaminate the sink basin used by patients or hospital

staff.

ReSet265 is the first sink to ever incorporate exhaust through the basin into a negative

pressure air chamber (ante room) above the sink trap.

For another FIRST, the innovative design of the ReSet265 sink uses one or more

sanitizing agent injectors at various locations throughout the open cavity and/or into the

exhaust port to help clean the surfaces of the open cavity and the exhaust port.

CALL TO ACTION

Infection Preventionists: You are crucial in helping determine risks associated with

contamination or subpar maintenance while helping determine the potential source of

an outbreak associated with water systems. Collaboration with facilities, environmental

services, bioengineering departments, and hospital leadership is essential to a

successful program.

The new Joint Commission IC Chapter IC.04.01.01 is intended to prevent the risk of

healthcare-associated infections. Biofilm in sink drains and P-traps can be the “genius

villain protagonist that hides in plain sight.” Just read “A Case of Serial Transmission of

NDM-1 Klebsiella pneumoniae Tied to a Hospital Sink Drain.”

Now that you have a grasp of 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 separate the sewer from the care

environment.

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

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

If your in-house convinces the facility stakeholders 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, Transplant Unit, Burn Unit, Scrub sinks in the OR, etc.).