Role of surfaces and sinks in the control of multiresistant bacteria in Intensive Care Unit

Abstract

Abstract Background Control of multiresistant bacteria (MRB) outbreaks in the Intensive Care Unit (ICU) is a challenge of Public Health. There is strong evidence that surfaces, and sinks are reservoirs of MRB. In 2020, because of isolation of Klebsiella type IMP, OXA-48 and VIM in moist reservoirs in ICU of Clinico San Cecilio Hospital and another carbapenemase-producing Enterobacteriaceae (CPE) outbreak, it arises our aim, which is to highlight the relevance of periodic control of humid reservoirs and surfaces in ICU to prevent MRB transmission. Methods Retrospective, descriptive study from March to June 2021. Due to a rise of cases of a CPE outbreak in our ICU in Granada, samples of surfaces and taps of different boxes were taken, after discharging patients and their corresponding terminal cleaning, whether they were CPE-colonised patient or not. Results Samples of 20 boxes were taken (N = 325). CPE OXA-48 was isolated in 7,38% of the samples which correspond to 40% of the boxes, most of them Enterobacter cloacae. 25% of the positive samples isolated two types of resistance, OXA-48, and VIM. 79,2% of the positive samples were found in March. The rest of them in April and May, after establishing control measures in surfaces. CPE was isolated in blood pressure monitor, pulse oximeter, electrocardiogram and stethoscope from 6 boxes. 3 CPE humid reservoirs were found in the tap and drain sinks of 2 boxes, one of them with CPE colonised patient. Conclusions We have observed the existence of carbapenem-resistant plasmids in surfaces and the persistence of humid reservoirs in our ICU, despite of establishing control measures of an outbreak. In conjunction with classical monitoring measures such as observation and training of hand hygiene, we recommend the use of disposable materials, systematic disinfection of reservoirs, appropriate use of gloves, chlorination of sinks and the goal of an ICU without water should be fundamental elements in the prevention of MRB transmission. Key messages • Multifactorial approach for the control of multiresistant bacteria outbreaks in the Intensive Care Unit. • Intensive Care Unit without water to avoid humid reservoirs of multiresistant bacterias.