A reservoir of bacteria: sink drains next to toilets in patient rooms may harbor dangerous organisms

Contact: Shannon Quinn
202-657-7364
shannon.quinn@mslgroup.com

Liz Garman
202-454-2604, egarman@apic.org

A reservoir of bacteria: sink drains next to toilets in patient rooms may harbor dangerous organisms

Arlington, Va., February 4, 2019 – Sinks situated next to patient toilets in hospital rooms may be reservoirs for Klebsiella pneumoniae carbapenemase (KPC), increasing the risk of dangerous germ transmission, according to new research published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology.

The study found a high prevalence of KPC positivity in sink drains located next to toilets. Of the samples tested, 87.0 percent of patient sinks next to toilets tested positive for KPC – in stark comparison to the 21.7 percent of sink drains located closer to the entry door of the room.

Klebsiella is a type of bacteria that can cause a number of healthcare associated infections, such as pneumonia, bloodstream infections, wound infections or surgical site infections. Increasingly, Klebsiella bacteria have developed antimicrobial resistance, most recently to the class of antibiotics known as carbapenems.

In four of five rooms in which the entry-door sink tested positive, the sink near the toilet was also positive, suggesting a potential source for cross-contamination within the same room.

Researchers in Milwaukee, Wisconsin performed the study in the medical intensive care unit (MICU) of a 600-bed Wisconsin hospital. The MICU did not have any documented interactions with KPC-producing organisms within the past year.

“This study, if validated, could have major implications for infection control,” agree study authors, Blake Buchan, PhD and Silvia Munoz-Price, MD, PhD. “If sinks next to toilets are indeed a reservoir for KPC, additional interventions – such as modified hand hygiene practices and sink disinfection protocols – may be needed to stem the risk of transmission among healthcare providers and patients alike.”

This is the first study to directly examine the relevance of sink proximity to toilets in patient rooms. The researchers point out that while it’s not clear how contamination occurs, it is plausible that biofilms growing in pipes shared between toilets and sinks, or that flushing generates contaminated drops that reach the sink drains.

“The results of this study demonstrate the importance of remaining vigilant to potential areas of cross-contamination,” said 2019 APIC President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. “Maintaining a strong understanding of environmental risks is critical to protecting patient safety, and this is yet another example of how germs can lurk in often the most unexpected of places.”

ABOUT AJIC: AMERICAN JOURNAL OF INFECTION CONTROL

AJIC: American Journal of Infection Control (www.ajicjournal.org) covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

ABOUT APIC

APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou.

NOTES FOR EDITORS

“The relevance of sink proximity to toilets on the detection of Klebsiella pneumoniae carbapenemase inside sink drains,” by Blake W. Buchan, Marty Beth Graham, Jill Lindmair-Snell, Jennifer Arvan, Nathan A. Ledeboer, Rahul Nanchal, and L. Silvia Munoz-Price, appears in the American Journal of Infection Control, Volume 47, Issue 1 (January 2019).

AUTHORS

Blake W. Buchan, PhD, D(ABMM) 

Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI

Mary Beth Graham, MD 

Division of Infectious Diseases, The Medical College of Wisconsin, Milwaukee, WI

Jill Lindmair-Snell, RN, MSN, CIC 

Froedtert Memorial Lutheran Hospital, Milwaukee, WI

Jennifer Arvan, BSN, RN 

Froedtert Memorial Lutheran Hospital, Milwaukee, WI

Nathan A. Ledeboer, PhD, D(ABMM) 

Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI

Rahul Nanchal, MD

Division of Pulmonary and Critical Care Medicine, The Medical College of Wisconsin, Milkwaukee, WI

L. Silvia Munoz-Price, MD, PhD 

Division of Infectious Diseases, The Medical College of Wisconsin, Miluwakee, WI

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