Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-16T17:50:44.173Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of foam disinfectants in reducing sink-drain gram-negative bacterial colonization

Published online by Cambridge University Press:  05 December 2019

Lucas D. Jones ,
Thriveen S.C. Mana ,
Jennifer L. Cadnum ,
Annette L. Jencson ,
Sandra Y. Silva ,
Brigid M. Wilson  and
Curtis J. Donskey
Lucas D. Jones
Affiliation:
Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, ClevelandOhio Research Service, Louis Stokes Cleveland Veterans’ Affairs Medical Center, ClevelandOhio
Thriveen S.C. Mana
Affiliation:
Research Service, Louis Stokes Cleveland Veterans’ Affairs Medical Center, ClevelandOhio Division of Infectious Diseases and HIV Medicine, Case Western Reserve University School of Medicine, ClevelandOhio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Cleveland Veterans’ Affairs Medical Center, ClevelandOhio
Annette L. Jencson
Affiliation:
Research Service, Louis Stokes Cleveland Veterans’ Affairs Medical Center, ClevelandOhio
Sandra Y. Silva
Affiliation:
Clinical Translational Science Program, Case Western Reserve University School of Medicine, Cleveland, Ohio
Brigid M. Wilson
Affiliation:
Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Author for correspondence: Curtis J. Donskey, E-mail: Curtis.Donskey@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Sink drainage systems are not amenable to standard methods of cleaning and disinfection. Disinfectants applied as a foam might enhance efficacy of drain decontamination due to greater persistence and increased penetration into sites harboring microorganisms.

Objective:

To examine the efficacy and persistence of foam-based products in reducing sink drain colonization with gram-negative bacilli.

Methods:

During a 5-month period, different methods for sink drain disinfection in patient rooms were evaluated in a hospital and its affiliated long-term care facility. We compared the efficacy of a single treatment with 4 different foam products in reducing the burden of gram-negative bacilli in the sink drain to a depth of 2.4 cm (1 inch) below the strainer. For the most effective product, the effectiveness of foam versus liquid-pouring applications, and the effectiveness of repeated foam treatments were evaluated.

Results:

A foam product containing 3.13% hydrogen peroxide and 0.05% peracetic acid was significantly more effective than the other 3 foam products. In comparison to pouring the hydrogen peroxide and peracetic acid disinfectant, the foam application resulted in significantly reduced recovery of gram-negative bacilli on days 1, 2, and 3 after treatment with a return to baseline by day 7. With repeated treatments every 3 days, a progressive decrease in the bacterial load recovered from sink drains was achieved.

Conclusions:

An easy-to-use foaming application of a hydrogen peroxide- and peracetic acid-based disinfectant suppressed sink-drain colonization for at least 3 days. Intermittent application of the foaming disinfectant could potentially reduce the risk for dissemination of pathogens from sink drains.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 3 , March 2020 , pp. 280 - 285
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

References

Kizny Gordon, AE, Mathers, AJ, Cheong, EYL, et al.The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections—a systematic review of the literature. Clin Infect Dis 2017;64:1435–1444.CrossRefGoogle ScholarPubMed
Roux, D, Aubier, B, Cochard, H, Quentin, R, van der Mee-Marquet, N.Contaminated sinks in intensive care units: an underestimated source of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the patient environment. J Hosp Infect 2013;85:106–111.CrossRefGoogle ScholarPubMed
De Geyter, D, Blommaert, L, Verbraeken, N, et al.The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit. Antimicrob Resist Infect Control 2017;6:24.CrossRefGoogle ScholarPubMed
Starlander, G, Melhus, Å.Minor outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in an intensive care unit due to a contaminated sink. J Hosp Infect 2012;82:122–124.CrossRefGoogle Scholar
Hoque, SN, Graham, J, Kaufmann, ME, Tabaqchali, S.Chryseobacterium (Flavobacterium) meningosepticum outbreak associated with colonization of water taps in a neonatal intensive care unit. J Hosp Infect 2001;47:188–192.CrossRefGoogle Scholar
Hota, S, Hirji, Z, Stockton, K, et al.Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect Control Hosp Epidemiol 2009;30:25–33.CrossRefGoogle ScholarPubMed
Leitner, E, Zarfel, G, Luxner, J, et al.Contaminated handwashing sinks as the source of a clonal outbreak of KPC-2-producing Klebsiella oxytoca on a hematology ward. Antimicrob Agents Chemother 2015;59:714–716.CrossRefGoogle ScholarPubMed
Smolders, D, Hendriks, B, Rogiers, P, Mul, M, Gordts, B.Acetic acid as a decontamination method for ICU sink drains colonized by carbapenemase-producing Enterobacteriaceae and its effect on CPE infections. J Hosp Infect 2019;102:82–88.CrossRefGoogle ScholarPubMed
Parkes, LO, Hota, SS.Sink-related outbreaks and mitigation strategies in healthcare facilities. Curr Infect Dis Rep 2018;20(10):42.CrossRefGoogle ScholarPubMed
Kanamori, H, Weber, DJ, Rutala, WA.Healthcare outbreaks associated with a water reservoir and infection prevention strategies. Clin Infect Dis 2016;62:1423–1435.CrossRefGoogle ScholarPubMed
Kotay, S, Chai, W, Guilford, W, Barry, K, Mathers, AJ.Spread from the sink to the patient: in situ study using green fluorescent protein (GFP)-expressing Escherichia coli to model bacterial dispersion from hand-washing sink-trap reservoirs. Appl Environ Microbiol 2017;83(8): e03327–16.CrossRefGoogle ScholarPubMed
Hajar, Z, Mana, TSC, Cadnum, JL, Donskey, CJ.Dispersal of gram-negative bacilli from contaminated sink drains to cover gowns and hands during hand washing. Infect Control Hosp Epidemiol 2019;40:460–462.CrossRefGoogle ScholarPubMed
Gestrich, SA, Jencson, AL, Cadnum, JL, Livingston, SH, Wilson, BM, Donskey, CJ. A multicenter investigation to characterize the risk for pathogen transmission from healthcare facility sinks. Infect Control Hosp Epidemiol 2018;39:1467–1469.CrossRefGoogle ScholarPubMed
Cadnum, JL, Livingston, SH, Gestrich, SA, Jencson, AL, Wilson, BM, Donskey, CJ.Use of a stop valve to enhance disinfectant exposure may improve sink drain disinfection. Infect Control Hosp Epidemiol 2018;18:1–3. doi: 10.1017/ice.2018.318.Google Scholar
Jones, LD, Mana, TSC, Cadnum, JL, et al. Instillation of disinfectant behind a temporary obstruction created by an inflated urinary catheter balloon improves sink drain disinfection. Am J Infect Control 2019; pii: S0196-6553(19)30687-X. doi: 10.1016/j.ajic.2019.07.007.CrossRefGoogle Scholar
Buchan, BW, Arvan, JA, Graham, MB, et al.Effectiveness of a hydrogen peroxide foam against bleach for the disinfection of sink drains. Infect Control Hosp Epidemiol 2019;40:724–726.CrossRefGoogle ScholarPubMed
Lowe, C, Willey, B, O’Shaughnessy, A, et al.Outbreak of extended-spectrum β-lactamase–producing Klebsiella oxytoca infections associated with contaminated handwashing sinks. Emerg Infect Dis 2012;18:1242–1247.CrossRefGoogle ScholarPubMed
Livingston, S, Cadnum, JL, Gestrich, S, Jencson, AL, Donskey, CJ.Efficacy of automated disinfection with ozonated water in reducing sink drainage system colonization with Pseudomonas species and Candida auris. Infect Control Hosp Epidemiol 2018;39:1497–1498.CrossRefGoogle ScholarPubMed
Ayliffe, GAJ, Collins, BJ, Babb, JR, Lowbury, EJL, Newsom, SWB.Pseudomonas aeruginosa in hospital sinks. Lancet 1974;304:578–581.CrossRefGoogle Scholar
Döring, G, Ulrich, M, Müller, W, et al.Generation of Pseudomonas aeruginosa aerosols during handwashing from contaminated sink drains, transmission to hands of hospital personnel, and its prevention by use of a new heating device. Zentralbl Hyg Umweltmed. 1991;191:494–505.Google ScholarPubMed
de Jonge, E, de Boer, MGJ, van Essen, EHR, Dogterom-Ballering, HCM, Veldkamp, KE.Effects of a disinfection device on colonization of sink drains and patients during a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit. J Hosp Infect 2019;102:70–74.CrossRefGoogle Scholar
Lewis, SS, Smith, BA, Sickbert-Bennett, EE, Weber, DJ.Water as a source for colonization and infection with multidrug-resistant pathogens: focus on sinks. Infect Control Hosp Epidemiol 2018;39:1463–1466.CrossRefGoogle ScholarPubMed
Hopman, J, Tostmann, A, Wertheim, H, et al.Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of ‘water-free’ patient care. Antimicrob Resist Infect Control 2017;6:59.CrossRefGoogle ScholarPubMed
Livingston, SH, Cadnum, JL, Gestrich, S, Jencson, AL, Donskey, CJ.A novel sink drain cover prevents dispersal of microorganisms from contaminated sink drains. Infect Control Hosp Epidemiol 2018;39:1254–1256.CrossRefGoogle ScholarPubMed
Piedrahita, CT, Cadnum, JL, Jencson, AL, Shaikh, AA, Ghannoum, MA, Donskey, CJ.Environmental surfaces in healthcare facilities are a potential source for transmission of Candida auris and other Candida species. Infect Control Hosp Epidemiol 2017;38:1107–1109.CrossRefGoogle ScholarPubMed