COULD CRE IN SINK BIOFILM BE A THREAT TO HER?
J. Darrel Hicks
Owner at Safe, Clean and Disinfected
February 5, 2025
Sink drains in patient rooms often harbor carbapenem-resistant Enterobacteriaceae (CRE).
The European Center for Disease Prevention and Control (ECDC) published an assessment warning the public that the probability of CRE was spreading in the European Union/European Economic Area (EU/EEA) countries was high. The last update of ECDC’s rapid risk assessment on CRE was published in 2019. ECDC said the epidemiological situation has been deteriorating since then.
“These findings indicate a high probability of further spread of CRE in the EU/EEA, both in hospital settings and in community, a worrying trend since CRE infections are linked to high mortality,” Piotr Kramarz, ECDC chief scientist, said in a statement.
Studies show varying mortality rates ranging from 30%-80% depending on patient factors. One multicenter study found that the 30-day mortality rate for CRE bacteremia was 50.6%.
THE COST OF TREATING A CRE HOSPITAL-ASSOCIATED INFECTION
According to research, the cost of a single Healthcare Associated Infection (HAI) caused by CRE can range from $22,484 to $66,031 for hospitals, with the median cost varying depending on the type of infection and severity, making CRE infections one of the most expensive HAIs to treat due to their high resistance to antibiotics and the cost of a CRE HAI can vary significantly depending on the site of infection, with bloodstream infections generally being the most expensive. often complex management needs.
Key points about the cost of CRE HAIs:
· High direct medical costs:
The high cost is primarily attributed to the need for extended hospital stays, broad-spectrum antibiotics (often with limited availability), extensive diagnostic testing, and intensive supportive care.
· Impact on societal costs:
Beyond direct medical costs, CRE infections can also result in significant societal costs due to lost productivity and disability associated with prolonged illness.
DOWN THE DRAIN
Sink drains in patient rooms often harbor CRE. Multiple studies have found CRE contamination in hospital sink drains, with prevalence rates as high as 64% in some facilities. There is strong evidence suggesting a connection between CRE in sink drains and hospital-associated infections:
CRE can form biofilms in sink drains and grow upwards, reaching the sink strainer.
Water from faucets hitting contaminated sink strainers can splash up to 3 feet away, potentially contaminating surrounding surfaces and patient care items.
In some cases, CRE strains found in sink drains match those isolated from patients in the same room.
To prevent CRE in sinks and reduce associated infections, several measures can be taken:
Improve sink design:
Avoid sinks where water flows directly into the drain.
Ensure proper drainage and avoid leaks or disconnected pipes.
Enhance cleaning and maintenance:
Regularly clean and disinfect sinks, especially those that appear dirty.
Consider periodic treatment of drains with disinfectants, though regrowth can occur within days.
Implement infection control practices:
Provide separate hand hygiene stations away from sinks.
Avoid storing patient care items near sinks.
Enforce strict hand hygiene protocols.
Monitor and surveillance:
Regularly test sink drains for CRE contamination.
Implement CRE screening for high-risk patients.
Address water systems:
Ensure proper water treatment and quality, as piped water was associated with higher CRE prevalence.
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 3,120th 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."
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Or call Tom Hicks (402) 981-6365
