SINK’S ROLE IN SPREADING AMR “BUGS” OF CONCERN

Antimicrobial resistance (AMR) is not a disease for which we should expect ultimately to develop a cure. Instead, it is a?concept, a global concept, involving multiple disciplines – working locally, nationally, and globally – to attain optimal health for people, animals, and the environment.

A vast majority of bacteria are essential for life and the health of humans, animals, and the ecosystem and only a very small percentage of them cause disease. This implies that the treatment of infectious diseases should be in a way that they do not make the cure worse than the disease.

Design of and Water Use Patterns in Premise Plumbing Create Biofilms

A core principle for species survival, whether it be an animal, a plant or a microorganism is their need for food, water and shelter. Microorganisms can survive in potable water but may not thrive therein because potable water is relatively nutrient poor. The microorganisms of concern in a healthcare environment such as those causing HAIs require carbon, nitrogen and other key nutrients, in addition to water. Biofilms in premise plumbing systems are complex ecosystems, and it is within these biofilms that bacteria, fungi and amoeba find the food, water and shelter they need.

Biofilm formation, composition and function are well characterized. Bacterial cells must attach and adhere to the inner wall of a water pipe. Bacteria including Pseudomonas aeruginosa are often considered architects of the biofilm, due to their ability to produce a sticky exopolysaccharide or glycocalyx.

Biofilm development generally follows five steps.

The five steps are:

1. Initial attachment and adherence of microorganisms to a surface.2. Adherence further mediated by production of glycocalyx by one or more bacterial species. 3. Early development of biofilm structure. 4. Maturation of the biofilm. 5. The release of microorganisms from biofilm.

Bacterial and Fungal Pathogens May be Present in Biofilms Opportunist pathogens are likely to be among the community of microorganisms comprising a biofilm. In addition to P. aeruginosa, non-tuberculous mycobacteria establish themselves in part, due to their waxy outer cell wall. Legionella pneumophila also finds a home in the biofilm, as do bacterial-grazing (predatory) amoeba. Other opportunist pathogens including Acinetobacter baumannii, Stenotrophomonas maltophila, Aspergillus flavus and Fusarium solani are associated with biofilms.

Hospital plumbing systems are held to stringent standards to reduce transmission of infection to vulnerable patients. However, the aqueous environment presents unique challenges to infection prevention and control (IPC), with wet surfaces providing the solid-liquid interface that predisposes to biofilm formation.

These biofilms have been proven to harbor multidrug-resistant Gram-negative organisms (MDRO) which were genetically related to clinical isolates suggesting that aqueous environment can serve as a reservoir for human infections. Furthermore, waste material disposed into the sinks and drains potentially provide the nutrients necessary for the formation and maintenance of biofilms which function as a reservoir for MDRO?optimized sink drains.

Patients may be exposed to organisms in drains when water splashes from the drain. Splashes may occur when water flow hits the contaminated drain cover or when a toilet or hopper is flushed. Splashes can lead to dissemination of MDRO-containing droplets, which in turn may contaminate the local environment or the skin of nearby healthcare personnel and patients.

Multiple interventions have been attempted to reduce the burden of pathogens in contaminated drains. In general, biofilms are difficult to completely remove despite chemical interventions. Some interventions may reduce the amount of contaminated splashing that may occur from the drains and may have been useful in responding to outbreaks, but the most appropriate method remains unclear, UNTIL NOW!

Safe Health Solutions, LLC (SHS) has developed a revolutionary self-disinfecting sink that will eradicate internal bacterial growth and return sinks to their valued status in combating HAI’s and infections rates.??

To determine whether an engineered sink could limit microbial aerosol contaminants in the air and sink basin multiple comparisons were undertaken between an experimental sink, designed to limit aerosolization and p-trap contamination to a control hospital sink, both connected to a common drain system. The experimental sink was equipped with ultraviolet light (UV), an aerosol containment hood, ozonated water generator and a flush system to limit bacterial growth/aerosolization and limit microbial growth in the p-trap. Nutrient material was added daily to simulate typical material discarded into a hospital sink. Surface collection swabs, settle plates and p-trap contamination levels were assessed for bacteria and fungi.

Findings

The experimental sink had significantly decreased levels of bacterial and fungal p-trap contamination (99.9% for Tryptic Soy (TSA) and Sabouraud agar (SAB) plates) relative to the initial levels. Aerosol-induced contaminant from the p-traps was significantly lower for the experimental vs the control sink for TSA (76%) and SAB (86%) agar settle plates.

Conclusions

Limiting microbial contamination is critical for the control of nosocomial infections of in-room sinks, which provide a major source of contamination. The experimental sink studies document that regular ozonated water rinsing of the sink surface, decontamination of p-trap water, and UV decontamination of surfaces limits microbial aerosolization and surface contamination, with potential to decrease patient exposure and reduce hospital acquired infections.

? 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved. https://safehealthsolutions.net/mitigation-of-microbial-contamination-from-waste-water-and-aerosolization-by-sink-design/