Abstract
Handwashing sinks and their associated premise plumbing are an ideal environment for pathogen-harboring biofilms to grow and spread throughout facilities due to the connected system of wastewater plumbing. This study was designed to understand the distribution of pathogens and antibiotic resistant organisms (ARO) within and among handwashing sinks in healthcare settings, using culture-dependent methods to quantify Pseudomonas aeruginosa, opportunistic pathogens capable of growth on a cefotaxime-containing medium (OPP-C), and carbapenem-resistant Enterobacteriaceae (CRE). Isolates from each medium identified as P. aeruginosa or Enterobacteriaceae were tested for susceptibility to aztreonam, ceftazidime, and meropenem; Enterobacteriaceae were also tested against ertapenem and cefotaxime. Isolates exhibiting resistance or intermediate resistance were designated ARO. Pathogens were quantified at different locations within handwashing sinks and compared in quantity and distribution between healthcare personnel (HCP) and patient room (PR) sinks. ARO were compared between samples within a sink (biofilm vs planktonic samples) and between sink types (HCP vs. PR). The drain cover was identified as a reservoir within multiple sinks that was often colonized by pathogens despite daily sink cleaning. P. aeruginosa and OPP-C mean log10 CFU/cm2 counts were higher in p-trap and tail pipe biofilm samples from HCP compared to PR sinks (2.77 ± 2.39 vs. 1.23 ± 1.62 and 5.27 ± 1.10 vs. 4.74 ± 1.06) for P. aeruginosa and OPP-C, respectively. P. aeruginosa and OPP-C mean log10 CFU/ml counts were also higher (p < 0.05) in HCP compared to PR sinks p-trap water (2.21 ± 1.52 vs. 0.89 ± 1.44 and 3.87 ± 0.78 vs. 3.21 ± 1.11) for P. aeruginosa and OPP-C, respectively. However, a greater percentage of ARO were recovered from PR sinks compared to HCP sinks (p < 0.05) for Enterobacteriaceae (76.4 vs. 32.9%) and P. aeruginosa (25.6 vs. 0.3%). This study supports previous work citing that handwashing sinks are reservoirs for pathogens and ARO and identifies differences in pathogen and ARO quantities between HCP and PR sinks, despite the interconnected premise plumbing.
Highlights
Handwashing sinks and their associated premise plumbing are an ideal environment for pathogenharboring biofilms to grow and spread throughout facilities due to the connected system of wastewater plumbing
Sink drain covers can become contaminated by patient or healthcare personnel (HCP) input or by pathogen-containing biofilms that can grow from the p-trap to the drain cover, highlighting the importance that biofilm growth mode plays in the dissemination of organisms in premise plumbing systems[12]
Previous studies have examined the role sinks play in healthcare-associated infections (HAI), but this study details the contribution of individual sink and premise plumbing components and the role that HCP sinks play as a reservoir
Summary
Handwashing sinks and their associated premise plumbing are an ideal environment for pathogenharboring biofilms to grow and spread throughout facilities due to the connected system of wastewater plumbing. Pathogens were quantified at different locations within handwashing sinks and compared in quantity and distribution between healthcare personnel (HCP) and patient room (PR) sinks. From 2014 to 2017, 21.6% of Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion consultations involved water-related healthcare-associated infections (HAI) Among these investigations, 29.9%, 18.7%, and 10.4% were attributed to nontuberculous mycobacteria (NTM), Pseudomonas spp., and members of the Enterobacteriaceae family, respectively[1]. 29.9%, 18.7%, and 10.4% were attributed to nontuberculous mycobacteria (NTM), Pseudomonas spp., and members of the Enterobacteriaceae family, respectively[1] Plumbing fixtures, such as sinks, showers and toilets, with which patients, visitors, and healthcare personnel (HCP) interact are known reservoirs for pathogenic and opportunistic organisms[2,3,4]. Previous studies have examined the role sinks play in HAI, but this study details the contribution of individual sink and premise plumbing components and the role that HCP sinks play as a reservoir
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