WHAT ARE THE CHALLENGES TO MAINTAINING A REGULAR SCHEDULE OF SINK DISINFECTION?
J. Darrel Hicks
Owner at Safe, Clean and Disinfected
January 23, 2025
The traditional sink trap, especially in healthcare facilities, may seem like a simple and effective solution. However, the sink trap becomes a health trap.
That is because sink drains, and P-traps are typically the refuge of opportunistic pathogens that thrive in moist environments. These Healthcare-Associated Infection (HAI) producing pathogens include:
Pseudomonas aeruginosa: This gram-negative bacterium is highly adaptable and often found in hospital sink drains. It is known for its antibiotic resistance and ability to form biofilms.
Klebsiella pneumoniae: Another gram-negative bacterium frequently isolated from sink drains, especially in healthcare settings. It can cause various infections and is often resistant to multiple antibiotics.
Escherichia coli (E. coli): While many strains are harmless, some can cause infections. E. coli is commonly found in sink drains due to its prevalence in human and animal intestines.
Acinetobacter baumannii: This opportunistic pathogen is often found in hospital environments, including sink drains. It is known for its ability to survive on dry surfaces and resist many antibiotics.
Stenotrophomonas maltophilia: This environmental bacterium is frequently isolated from sink drains and can cause infections in immunocompromised patients.
Serratia marcescens: Known for its distinctive red pigmentation, this bacterium is often found in bathrooms and can cause various infections.
Enterobacter species: These gram-negative bacteria are common in sink drains and can cause opportunistic infections, especially in healthcare settings.
Legionella species: While more commonly associated with water systems, Legionella can also be found in sink drains and pose a risk for respiratory infections.
Non-tuberculous mycobacteria (NTM): These environmental bacteria can colonize sink drains and potentially cause infections, especially in immuno-compromised individuals.
These bacteria are problematic in healthcare settings where they can contribute to healthcare-associated infections, especially among immunocompromised patients. Regular and effective sink drain disinfection is crucial to control these potential pathogens.
Why don’t we just remove sinks near patients?
Terminating outbreaks and reducing colonization of gram-negative bacteria are clear benefits when implementing sink-less patient care. These challenges need to be addressed before healthcare providers consider the implementation of water-free strategies. These challenges include:
· ‘Water-free’ is a confusing term which can be a barrier.
· Risk from water and wastewater systems are not appropriately risk assessed in terms of risk to vulnerable patients.
· Surveillance methods lack sensitivity.
· Standard infection prevention and control (IPC) precautions are designed to be ‘catch all’ so lack effectiveness in preventing water and wastewater transmission events.
· Concerns of risk to patient safety when removing clinical hand wash basins.
· An increase in skin related conditions (associated with increased alcohol-based sanitizers.
If sinks remain near patients, how do we address their disinfection?
There is a need for effective strategies to reduce sink drain colonization. Pouring disinfectants into sinks has only a modest, transient effect because the disinfectants flow rapidly down the drain, providing inadequate contact time and poor penetration into areas harboring biofilm-associated organisms.
In response to outbreaks linked to sinks, it has been recommended that facilities consider disinfection of sink drains using an EPA-registered disinfectant with claims against biofilms in consultation with state or local public health departments. To be effective, daily application may be required to achieve a rapid and consistent reduction in colonization. This is labor-intensive and expensive.
The main challenges in maintaining a regular disinfection schedule for sink drains include:
1. Biofilm resistance: Bacteria in drains form protective biofilms that are difficult for disinfectants to penetrate, reducing the effectiveness of cleaning efforts.
2. Rapid bacterial regrowth: Even after successful disinfection, opportunistic pathogens typically reappear in drains within a few days, necessitating frequent, expensive treatments.
3. Insufficient contact time: Many liquid disinfectants do not remain in contact with drain surfaces long enough to effectively kill bacteria, limiting their impact.
4. Variability in effectiveness: Different disinfection methods and products show varying degrees of success, making it challenging to establish a universally effective protocol.
5. Lack of standardized guidelines: There is currently no widespread systematic strategy to identify, track, and prevent drain-related HAIs, complicating efforts to establish consistent disinfection schedules.
Balancing frequency and practicality: While daily application of disinfectants may be most effective, finding a balance between efficacy, cost-effectiveness, and ease of application is challenging.
Potential infrastructure damage: Repeated use of certain disinfectants or methods may have long-term effects on sink infrastructure, requiring careful consideration of product selection and application frequency.
INNOVATION IS NOT ON THE HORIZON; IT’S ALREADY HERE
The WHO predicts 50 million deaths due to antimicrobial resistance (AMR) by 2050. Disease prevention is always better than a cure, especially as we are running out of options for the cure (antibiotics)! If there are no new antibiotics on the horizon, we need to prevent the bacteria from reaching the patient. The looming global AMR crisis and the current strategy of antimicrobial stewardship and development of new antibiotics is oblivious to the built environment.
Innovation is already here, reshaping infection prevention as part of the built environment.
The BEST-IN-CLASS CAD Biofilm Eliminator is the ReSet265 Sink
When it comes to preventing biofilm from the p-trap to the sink drain, the ReSet265 sink is the only Continuously Active Disinfection (CAD) available on the market. As such, it is far superior to foaming disinfectants and it is here now (not in the future). In my professional opinion, the ReSet265 sink is the only “set it and forget it” infection prevention solution for wastewater management in hospital sinks.
CURVED SURFACE
For the first time 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.
EXHAUST-NEGATIVE PRESSURE
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 germicidal ultra-violet lights have been introduced 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.
SO, WHAT’S NEXT?
1. Contact Us-we would love to answer any questions you have and provide custom pricing for your specific needs.
2. Schedule an Installation-After placing an order, our sinks are ready to be installed by a plumbing company of your choice.
3. Start Saving Lives-7% does not seem like a big number. But when it happens in the ICU and adds an additional 26 days to their length of stay: that is HUGE. Twenty-four (40%) patients with Pseudomonas Aeruginosa-HAI died within 30 days of infection; PA-HAI was deemed to have caused death in two (3.3%) and contributed to death in and an additional 20 (33%).
In an ICU the daily cost of being treated for an HAI is $10,000. Adding 26 days to his/her length of stay would be $260,000 for one patient. A single hospital had 72 PA-HAI patients x $260,000 = $18,720,000. That is enough money to buy and install 3,120 ReSet265 sinks.
"In conclusion, based on this study, >7% of PA-HAI in ICUs may be attributable to sink drains, though sampling limitations may have led to underestimation of risk. With increasing antimicrobial resistance, attention to sink drains may still be an under-recognized source of bacteria causing HAIs."
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 Tom Hicks (402) 981-6365
