IT’S A TRAP! DON’T FALL FOR HOPITAL DRAIN SOLUTIONS THAT ARE DEPENDENT ON A BUSY PERSON!
Since the advent of indoor plumbing, the 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 bacteria to proliferate. The “bugs” form what are known as biofilms-colonies where they gang together and attach to the inner surface of pipes below the sink drain.
Hospital wastewater plumbing systems are large, complex waterworks with low-flow areas that produce stagnation and biofilm formation. The water in a hospital is designed never to freeze, with average water temperatures in the 70s – and this labyrinth of pipes provides warm, dark, moist areas that are perfect breeding grounds for bacteria inside biofilm.
Sink waste traps and drains are a reservoir for carbapenem-resistant Enterobacteriaceae (CPE) in hospitals. Once established, CPE contamination might not be confined to a single sink and could spread through wastewater plumbing. Outbreaks of carbapenem-resistant organisms were found more commonly in ICUs and immunocompromised patients. However, the acquisition of infection from sink drains may be more widespread in in-patients than previously thought.
The results of a study published March 28, 2024 titled, “Epidemiology of Healthcare-Associated Pseudomonas aeruginosa in Intensive Care Units: Are Sink Drains to Blame?” stated: “Over ten months, 72 Pseudomonas aeruginosa (PA)-HAI occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median 26 vs 3 days uninfected, p<0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAI. Four patients with five PA-HAI (6.9%) had closely related isolates previously recovered from their room/bedspace sinks.”
Pathogens in drain biofilms pose a significant risk for hospital-acquired infection. However, the evidence of product effectiveness in controlling drain biofilm and pathogen dissemination is scarce. Microbial biofilms are notoriously impossible to eradicate with conventional chemical biocidal products. The development of a reproducible, in-vitro biofilm in a sink drain model enabled understanding of the impact of biocidal products on biofilm spatial composition and viability in different parts of the drain and it’s not good.
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 pathogens in a hospital.
DO WE NEED ONE MORE STUDY TO INFORM US THAT HOSPITAL SINK DRAIN BIOFILM “MAY BE THE CAUSE OF HAIs”??
Biofilm-The Unseen Threat
90% of harmful bacteria (“bad actors) live in biofilm (according to the CDC and NIH)
Not only do these “bad actors” replicate exponentially in an 8-hour period, but they also share their antimicrobial resistance with harmless bacteria in the biofilm.
Viruses hide in Biofilm, too--Biofilms provide viruses a means to live without a host--These viruses can seriously affect human health.
Biofilm is a major challenge for cleaning--Biofilm “provides a life raft for the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) which are the leading cause of nosocomial infections throughout the world.
Getting rid of biofilms once they form is, well, pretty much impossible.
HERE COMES THE FOAM
The Society for Healthcare Epidemiology, in combination with the Infectious Diseases Society of America, the Association for Professionals in Infection Control & Epidemiology, the American Hospital Association and The Joint Commission, issued new guidance for preventing healthcare-associated infections through hand hygiene. The guidelines included a recommendation to disinfect sink drains using an EPA-registered disinfectant with kill claims against bacteria in biofilm.
There are cleaning tricks hospitals try, but even foaming disinfectants generally only lower the bacterial count for a short period of time and must be applied every day or every 3 days depending on the product. Most do not destroy the “life raft” so the survivors reappear stronger than ever.
Here is a list of questions or points one must consider before implementing foaming disinfectant sprays for sinks, toilets, floor, and shower drains.
Have stakeholders in the facility done an infection prevention risk-assessment to ascertain which sinks are most likely to place patients at risk of ESKAPE pathogens in biofilm? Is there a written policy/protocol for treating sink drains with a foaming EPA-registered product that kills bacteria in sink drains?
Within unionized hospitals, which trade will be performing this task? The most likely job category/trade would be a Maintenance technician. With benefits and hourly wages, how much will it cost for a Maintenance tech to treat all patient room sinks, toilets, floor and shower drains receive treatment every 3 days? Then multiply that by 122 (365 ÷ 3) Is one person enough? Depending on the number of patient rooms, you might need 4 or 5 personnel to do nothing but foaming. Whether union employees are used or non-union, the cost could be tens of thousands of dollars for labor alone just to foam drains.
· Must the introduction of these added EPA-registered disinfectants into the municipal sewer system and eventually into the waterways be non-toxic to fish and plants? Should it be approved by the sewer authorities having jurisdiction?
· What sort of training and PPE does the person foaming the product need before taking on the task? If a mask is required for PPE, will the presence of the mask make the patient or staff wonder if they need one, also?
· What is the dwell time for the foaming product to kill bacteria in biofilm? How soon can the sink be used by the patient or staff after the product’s dwell time?
· Does the patient need to be out of the room? If the patient stays in the room, the Maintenance Tech must inform them of why the drains need to be treated, how long it will take and what they might see or smell as the sink drains are being cleaned and disinfected.
· Does the foaming product and process cause an offensive odor that patients and staff might complain about? If the patient or a staff member does not want the foaming treatment to be done in their presence due to the odors, what is the plan to get it done in keeping with the facility policy for maintaining sink drains in patientcare areas?
· Does the foam push past any water it meets past the p-trap or does it stop at the p-trap? It seems like once the foam engages the water in the trap it might lose its push, thereby limiting the extent of the foam effectiveness.
· If the foam forces the water out of the trap, water will need to be added back or sewer gases will enter the occupied space until done so. Add that amount of time to the time the Maintenance Tech is in the room waiting on the dwell time of the disinfecting foam.
· One company’s version of a drain foaming device is a $4,000 piece of electric equipment that looks to be the size of a commercial wet/dry vac with a 20’ hose and a nozzle attached. How noisy is it?
· It seems problematic that the process involves sticking the same nozzle into a toilet and then into a sink!
· From an Infection Prevention/Control standpoint, is there any thought or concern about the foaming device picking up contagions from one room/drain and spreading them to the next rooms and to other fixtures?
HERE IS THE BIGGEST QUESTION FOR YOU TO ANSWER BEFORE CHOOSING TO FOAM SINKS, DRAINS AND TOILETS: WOULDN’T IT BE MORE BENEFICIAL AND COST-EFFECTIVE TO AUTOMATE THE DISINFECTION OF SINKS INSTEAD OF DEPLOYING FOAMING DISINFECTANTS?
If a facility isn’t unionized, leadership might choose to require the Environmental Services tech to add foaming the drains to their tasks while cleaning and disinfecting a patient’s room and restroom.
CAUTION: Don’t make the success of your program of killing pathogenic biofilm in sink drains (which has been implicated in the deaths of patients for the past 20 years) dependent on the busiest and lowest paid employee in the hospital…the lady who has to clean and disinfect 18-22 patient rooms and do 5 terminal cleanings along with the Nurse’s Station, the unit kitchen, two offices, the staff lounge, the family waiting room, two public restrooms, and the soiled and clean utility rooms. Those rooms cannot be cleaned and disinfected and those tasks cannot be performed by a robot or automation.
However, eliminating the bacteria in sink drain biofilms can be automated. By preventing the drain biofilm, the sink bowl isn’t contaminated by the untreated drain pipe. Preventing contamination can be automated and done using the only ADA-compliant sink that combines multiple layers of smart technologies working in unison to separate the sewer from the care environment.
INTRODUCING THE SAFE HEALTH SOLUTIONS
ReSET265 SINK’S FEATURES
· CURVED SURFACE-this sink has implemented a curved surface to reduce splash by coordinating and matching the exact location of the surface with the discharge location of the faucet. This design eliminates the splash that contaminates clothing/uniforms and the surfaces up to 36” surrounding the sink.
· EXHAUST-First sink to ever incorporate exhaust through the basin into a negative pressure air chamber (ante room) above the sink trap.
· GERMICIDAL ULTRA-VIOLET LIGHT-First sink to implement continuous automated disinfection by utilizing germicidal ultra-violet lights within the negatively pressurized chamber (ante room) to kill bacteria located within the drain trap and within the ante room before they have a chance to contaminate the sink basin used by patients or hospital staff.
· SANITIZING AGENT-First time a sink using 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.
· SMART CONTROLS-A central control system has been implemented to provide monitoring and control to ensure that the features of the sink are functioning according to their intended design.
Click here to view a short video to see the ReSet265 sink in action.
SO, WHAT’S NEXT
1. Contact Us-We’d love to answer any questions you have and provide custom pricing for your specific needs.
2. Schedule an Install-After placing an order, our sinks are ready to be installed by a plumbing company of your choice.
3. Start Saving Lives-Initial research has shown this sink to be effective at killing and 99% of germs in hospital sink drains while preventing the formation of biofilm that has been implicated in patient morbidity and mortality.
For more information on the pricing of our sinks and a custom solution for your hospital, complete the form and somebody will quickly respond.
Or call (402) 981-6365