Abstract
ObjectivesThe aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. MethodsA prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. ResultsSeventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates ≥0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate ≥51%, prevalence of sinks with visible splashes ≥14%, prevalence of sinks close to the patient's bed ≥21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016). DiscussionOur data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.
Highlights
Multidrug-resistant Pseudomonas aeruginosa (PA) and Enterobacteriaceae are involved in bloodstream infections (BSIs) and ventilator-associated pneumonia (VAP), leading to increased morbidity, mortality and hospital costs in intensive care units^pital Bre* Corresponding author
Of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks
MDR-associated bloodstream infection incidence rates 0.70/1000 patient days were associated with intensive care unit (ICU) meeting three or four of these conditions, i.e. a sink contamination rate 51%, prevalence of sinks with visible splashes 14%, prevalence of sinks close to the patient's bed 21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the
Summary
Multidrug-resistant Pseudomonas aeruginosa (PA) and Enterobacteriaceae are involved in bloodstream infections (BSIs) and ventilator-associated pneumonia (VAP), leading to increased morbidity, mortality and hospital costs in intensive care units^pital Bre* Corresponding author. Multidrug-resistant Pseudomonas aeruginosa (PA) and Enterobacteriaceae are involved in bloodstream infections (BSIs) and ventilator-associated pneumonia (VAP), leading to increased morbidity, mortality and hospital costs in intensive care units. To reduce the risk of infections and to combat antimicrobial resistance, the WHO guidelines have established core components for infection prevention and control programmes [3]. 90-degree bends to the horizontal, are one of the sources of bacteria colonizing patients in ICUs [4]. Based on genetic association between bacteria found in P-traps and those found in patients, sink-associated outbreaks have been reported in ICU patients [5e14]. Using fluorescent marker testing and bacteriacontaining biofilm, studies have helped to define the transmission of pathogens from a P-trap to patients [15e17].
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