Caitlyn Stulpin , 2025-05-16 21:01:00
Key takeaways:
- Sinks in patient rooms can harbor and spread pathogens to workers and patients.
- The use of disinfectant foam led to significantly fewer epidemiologically important pathogens being reported in these sinks.
ORLANDO — The use of a disinfectant foam intervention in the sinks in patient rooms led to fewer positive cultures and less sink contamination, researchers found.
“There are roughly 700,000 [heath care associated-infections] that occur annually in the United States … Outbreaks that are related to hospital wastewater have been increasingly recognized, but it’s what’s within those sinks that are inside of patient rooms that are of particular concern,” Bobby G. Warren, MPS, director of the Disinfection, Resistance and Transmission Epidemiology Lab at Duke University Medical Center, said during a presentation at the SHEA Spring meeting.
Bobby Warren, MPS, explained that sinks are not designed with infection prevention in mind, making consistent disinfection efforts crucial to prevent the spread pathogens trapped in sinks. Image: Adobe Stock.
Warren explained that sinks in patient rooms — and in general — were “designed with sewage and smells in mind, without infection prevention,” meaning there is water in the pipes to prevent sewage, for example, from coming back up. This, Warren said, presents a “horrible situation.”
“We frequently provide nutrients for pathogens such as coffee, medical waste, etc, [and] we also inoculate with pathogens via hand washing,” he said. “As a result of all these issues, there’s been a lot of work on [how to] disinfect this line.”
Some disinfection methods that have been evaluated in the past include using liquid-based disinfectants, bleach, hydrogen peroxide and parasitic acid, as well as using lime plumbing and copper. Warren said that these studies yielded mixed results and some of these methods can be “insanely expensive.”
“The problem with sinks is, like a lot of issues of infection control, most of the data that have actually published on this have been done in response to an outbreak,” Warren said. “And how many outbreaks go unpublished? I would argue that’s the majority of them. So, we barely have a sense of the scope.”
Through a randomized controlled trial in a recently renovated general medicine unit, Warren and colleagues assessed the timing and frequency of epidemiologically important pathogen (EIP) contamination of in-room sinks and tested the efficacy of a disinfectant on drains.
According to the study, sinks were randomized 1:1, with 15 intervention sink drains being cleaned with foam disinfectant every Monday, Wednesday and Friday, and 15 control sinks undergoing standard disinfection. Every week, samples were taken from three locations in each sink: the top of the bowl, the tail pipe and the P-trap.
The primary outcome was sink conversion events, or species-specific EIP contamination of a sink where that EIP had not previously been detected.
A total of 1,980 cultures — 990 in each study arm — were collected between July 2024 and January 2025. The researchers recorded 10 sink conversion events in the intervention group and 15 in the control group (P < .01). From these, a total of 346 EIPs were recovered — 53 from intervention sinks and 293 from control sinks (P < .01). Acinetobacter species was the most common organism recovered (n = 135), followed by Stenotrophomonas maltophilia (n = 116) and Enterobacter species (n = 38).
According to the study, on the first round of sampling, six intervention sinks and three control sinks already harbored EIP. Of them, none of the intervention sinks were detected during later samplings, whereas all three from the control arm were detected.
“There is a measurable, large difference that the intervention is making,” Warren told Healio. “The large takeaway for now is, until we can figure out how to reliably and consistently disinfect and keep these sinks disinfected, sink mitigation is more important — so, how to use a sink properly and how to use it safely, even when it is contaminated, to not harm your patients.”
For more information:
Bobby G. Warren, MPS, can be reached at bobby.warren@duke.edu.
Sources/Disclosures
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Warren BG, et al. Abstract 156. Presented at: SHEA Spring; April 27-30, 2025; Orlando.
Disclosures:
Warren reports no relevant financial disclosures.
