The Hidden Truth in the Faucets: A QualityImprovement Project and Splash Study of Hospital Sinks

Abstract

BACKGROUND Sinks are potential sources of Healthcare Associated Infections (HAI) and have been linked to outbreaks. However, transmission of microorganisms from sink to patient is not well understood. Sink contents may be splashed onto patient care items, contaminating them during faucet use. A splash study was performed to understand the splash potential of the different faucet and sink designs in a larger academic teaching hospital in the Midwest, and an audit of sink cleanliness was conducted. METHODS Faucets/sinks in intensive care units (ICU) were assessed. Adenosine triphosphate (ATP) monitoring was used to assess cleanliness of the faucet spout and sink bowl/drain cover. Cultures were performed for some faucets/sinks. A splash study was performed using a commercially available fluorescent indicator. Photos were taken to record notable findings during the audit and the splash study. RESULTS Twenty faucet/sinks in four ICU's were evaluated, and eight different designs were observed. Faucet spouts were more soiled with organic material than sink bowls/drain covers as indicated by higher ATP readings. Pink slime/biofilm was observed on several faucet spouts and aerators. Visible biofilm was associated with higher ATP readings. Aerators were found on sinks where they had been removed previously. Cultures grew Pseudomonas aeruginosa, mold and other environmental organisms. The splash study showed visible splashing on the operator's body and over four feet from the sink. CONCLUSIONS Some sink designs enable splashing sink contents onto patient care items, healthcare worker hands and into patient care spaces. Faucets were much dirtier than expected and a faucet replacement program, eliminating aerators, is currently being developed.