Look At Sink Biofilm As The Enemy

Biofilm Superbugs

Imagine that there is a fire in the apartment just below yours. Would not everybody be alerted and start helping their neighbors to stop the fire? You surely know that the fire will reach your own apartment quickly. Ignoring the smoke filling your apartment does not constitute a “plan of action.”

Today with respect to AMR (antimicrobial resistance), the latter seems to be happening. The fire stands for multi-drug resistant organisms (MDRO), namely methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), but especially carbapenemase-producing microorganisms belonging to the Enterobacteriaceae or to non-fermenting gram-negative bacteria, such as Acinetobacter baumannii or Pseudomonas aeruginosa.

One of the major challenges for modern medicine is our ageing society and an increased level of immunocompromised hosts. More invasive and intensive medical interventions will increase the number of healthcare-associated infections (HCAI), which means infection that occurs because of or in concomitance, but in any case, during or after healthcare interventions.

Such infections are usually caused endogenously from microbial components of the patient’s own microbiome. Usually, the microorganisms of the microbiome show a natural resistance against a few antibiotics. Due to selection processes and epidemic transmission of specific clones, microorganisms that have become resistant to multiple antibiotics become part of the patient’s microbiome and can subsequently cause infections that are difficult or even impossible to treat.

We need to focus more on implementation of known infection prevention measures than trying to solve the problem by observing and describing it (i.e., the smoke filling your apartment). However, in addition to medical factors such as antibiotic use, hand hygiene etc., we tend to forget that there are factors behind these factors that have a major influence and are found in the wastewater plumbing of our different healthcare facilities.

• Look at the Wastewater Plumbing as the Source

  • Genomic analysis shows hospital water systems are reservoirs for CPEs.

  • Hospital wastewater often has a high level of CPE, even when CPE in patients is rare. Is this due to ‘silent colonization’ of patients or staff, or contaminated water systems? However, some of the CPEs in these complex ecosystems are not found in humans – it seems that “environmental” Enterobacterales have acquired carbapenemase.

  • Simulated studies provide compelling evidence that there’s a route from contaminated drains back to the patient, through tracking the spread of marked microbes.

  Infection Prevention Strategies for Wastewater

  Despite no slam-dunk epidemiological evidence, all rounds point to the physical environment as the most important modifiable variable in plasmid-mediated transmission. So, what can we do to tackle the watery parts of our hospitals that we know are contaminated with a “microbial soup” including CPE:

  • Perhaps the most fail safe is to go entirely water-free, as has been done in some ICU settings where reductions in antibiotic-resistant Gram-negatives and all HCAIs have been demonstrated. I don’t suggest you do that.

  • To my knowledge, this is the first study to assess both aerosol and P-trap contamination longitudinally, comparing a self-disinfecting sink and trap to a standard sink. This study documents that the sink basin and splash-zone contamination are associated with aerosols from contaminated P-traps, and that self-disinfecting sink and drains can significantly control P-trap contamination and associated aerosols. The results of the study strongly encourage the installation of self-disinfecting sinks, such as the one discussed.

  • Improved design of sinks could help – and, perhaps, introducing the idea of self-disinfecting sinks, with  built-in laminar flow to control aerosolization and UV disinfection strategies for the basin and P-trap is worth investigation.

  o    Existing drain disinfection chemistries and technologies are not effective at killing biofilm bacteria in drains and they depend on employees to actually perform the service. Efforts to disinfect drains have included complete replacement of the sink and 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. These efforts are short-lived at best. 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.

  • Even when sinks or their drains are replaced or existing drains are treated, the biofilms returns within days; the problem continues unfazed. The ReSet265 sink eliminates biofilm with continuous UV disinfection of the drain along with decontamination of P-trap water.

  • Reducing exposure of patients and equipment in the sink splash zone. Sink drains in healthcare have been identified as a source of pathogen transmission including Hospital Associated Infections (HAI's). Shallow sinks with drains in proximity to the faucet discharge are the most problematic. Research has shown pathogens scattered as far a 3 feet in all directions including the uniform, white coat or clothing of people washing their hands. The ReSet265 sink eliminates design issues.

  • More education to improve our use of sinks, so that a little more than 4% of the use of hand hygiene sinks is actually for hand hygiene!

  As the major preventive goal is to prevent infections and maintain optimal antimicrobial treatment, we need to prevent all avoidable HAIs. We especially need to keep the non-avoidable infections at least treatable. This is possible through preventing the spread of MDRO as well as non-organism-based AMR avoiding long-term colonization of the human population. Otherwise, a situation could be reached where we will see non-avoidable and non-treatable HAIs. Something we must not allow to occur.

  CALL TO ACTION

  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 do the following:

• 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 in-house assessment 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.).