Acetic acid as a decontamination method for ICU sink drains colonized by carbapenemase-producing Enterobacteriaceae and its effect on CPE infections

Smolders, David; Hendriks, B.; Rogiers, Peter; Mul, M.F.; Gordts, B.

doi:10.1016/j.jhin.2018.12.009

Cited by 35 publications

(25 citation statements)

References 22 publications

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“…Several studies have demonstrated that pouring liquid disinfectants down drains has only limited or transient efficacy in reducing sink drain colonization. 8 Buchan et al 16 recently reported that one of the hydrogen peroxide foam products that we tested (product 2 in Table 1) was more effective than liquid bleach in decreasing sink drain bacterial counts at 1 day posttreatment but not at 7 days posttreatment. The authors noted that further studies were needed to examine contamination between days 1 and 7; we found that this product suppressed colonization immediately after treatment, but not on days 1, 2, or 3 after treatment.…”

Section: Discussionmentioning

confidence: 82%

“…In recent years, contaminated sink drains and other wastewater drainage sites have been linked to numerous outbreaks caused by gram-negative bacilli, including Pseudomonas spp and carbapenemase-producing organisms (CPOs). [1][2][3][4][5][6][7][8] These wastewater drainage sites provide optimal conditions for biofilm formation and plasmid-mediated sharing of resistance genes. 9,10 Moreover, organisms colonizing sink drains can be dispersed from beneath the strainer to the sink bowl, and countertop, and to patients or personnel by splashing of flowing water.…”

mentioning

confidence: 99%

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Effectiveness of foam disinfectants in reducing sink-drain gram-negative bacterial colonization

Jones

Mana

Cadnum

et al. 2019

Infect. Control Hosp. Epidemiol.

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Background:Sink drainage systems are not amenable to standard methods of cleaning and disinfection. Disinfectants applied as a foam might enhance efficacy of drain decontamination due to greater persistence and increased penetration into sites harboring microorganisms.Objective:To examine the efficacy and persistence of foam-based products in reducing sink drain colonization with gram-negative bacilli.Methods:During a 5-month period, different methods for sink drain disinfection in patient rooms were evaluated in a hospital and its affiliated long-term care facility. We compared the efficacy of a single treatment with 4 different foam products in reducing the burden of gram-negative bacilli in the sink drain to a depth of 2.4 cm (1 inch) below the strainer. For the most effective product, the effectiveness of foam versus liquid-pouring applications, and the effectiveness of repeated foam treatments were evaluated.Results:A foam product containing 3.13% hydrogen peroxide and 0.05% peracetic acid was significantly more effective than the other 3 foam products. In comparison to pouring the hydrogen peroxide and peracetic acid disinfectant, the foam application resulted in significantly reduced recovery of gram-negative bacilli on days 1, 2, and 3 after treatment with a return to baseline by day 7. With repeated treatments every 3 days, a progressive decrease in the bacterial load recovered from sink drains was achieved.Conclusions:An easy-to-use foaming application of a hydrogen peroxide- and peracetic acid-based disinfectant suppressed sink-drain colonization for at least 3 days. Intermittent application of the foaming disinfectant could potentially reduce the risk for dissemination of pathogens from sink drains.

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Section: Discussionmentioning

confidence: 82%

mentioning

confidence: 99%

Effectiveness of foam disinfectants in reducing sink-drain gram-negative bacterial colonization

Jones

Mana

Cadnum

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…have recently been shown to inhibit hospital-associated pathogens, while also displaying high genetic stability with no evidence of acquisition of antibiotic resistance genes [35]. Given the significantly increased tolerance of biofilm bacteria compared with their planktonic counterparts [34], strategies to disrupt and remove biofilm, enhance activity of biocides against disrupted biofilm cells, and prevent the re-establishment of biofilm are imperative. This is likely to involve a multifaceted hygiene protocol that includes physical methods to remove established biofilm from surfaces, detergents and chelating agents [27], and possibly biological agents (probiotics) [35] to facilitate detachment and break-up of biofilm matrix, and the use of biocides to kill associated exposed bacteria.…”

Section: Biofilm In Healthcare Facilitiesmentioning

confidence: 99%

“…tap outlets and sink drain design), heat application, electromechanical vibration, and use of more potent anti-biofilm agents (e.g. acetic acid, oxidising agents) have all shown some success in removing environmental biofilm and facilitating infection control [ 32 – 34 ]. Additionally, sanitising agents based on non-pathogenic probiotic bacteria ( Bacillus spp.)…”

Section: Biofilm In Healthcare Facilitiesmentioning

confidence: 99%

Biofilm exacerbates antibiotic resistance: Is this a current oversight in antimicrobial stewardship?

Bowler

Murphy

Wolcott

2020

Antimicrob Resist Infect Control

173

125

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Objective To raise awareness of the role of environmental biofilm in the emergence and spread of antibiotic resistance and its consideration in antimicrobial stewardship. Background Antibiotic resistance is a major threat to public health. Overuse of antibiotics, increased international travel, and genetic promiscuity amongst bacteria have contributed to antibiotic resistance, and global containment efforts have so far met with limited success. Antibiotic resistance is a natural mechanism by which bacteria have adapted to environmental threats over billions of years and is caused either by genetic mutations or by horizontal gene transfer. Another ancient survival strategy involves bacteria existing within a self-produced polymeric matrix, which today is termed biofilm. Biofilm similarly enables bacterial tolerance to environmental threats, and also encourages the transfer of antibiotic resistance genes between bacterial species. This natural and ubiquitous mode of bacterial life has not been considered amongst strategies to tackle antibiotic resistance in healthcare facilities, despite its ability to significantly enhance bacterial survival and persistence, and to encourage antibiotic resistance. Conclusion Biofilm must be considered synonymously with antibiotic resistance because of its proficiency in transferring resistance genes as well as its innate phenotypic tolerance to antibiotics. Although biofilm falls outside of the current definition of antimicrobial stewardship, greater awareness of the existence, ubiquity, and consequences of environmental biofilm amongst healthcare practitioners is crucial to improving hygiene practices and controlling the emergence and spread of antibiotic resistance in healthcare facilities.

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“…Various plumbing components have been implicated in MDRGN outbreaks including sinks and washbasins in separate outbreaks of CRE, MDR P. aeruginosa and polyspecies German imipenemase-1 (GIM-1) [18][19][20][21], sink faucet aerators in a CRPA outbreak [22], and multiple plumbing components from the sink drains to wall pipes in a CRPA outbreak [23]. In a CR Sphingomonas koreensis outbreak, sink aerators, faucets, mixing valves, pipes and other plumbing fixtures were also found to be contaminated [24].…”

Section: Outbreak Reportsmentioning

confidence: 99%

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

Chia

Sengupta

Kukreja

et al. 2020

Antimicrob Resist Infect Control

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Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.

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Acetic acid as a decontamination method for ICU sink drains colonized by carbapenemase-producing Enterobacteriaceae and its effect on CPE infections

Cited by 35 publications

References 22 publications

Effectiveness of foam disinfectants in reducing sink-drain gram-negative bacterial colonization

Effectiveness of foam disinfectants in reducing sink-drain gram-negative bacterial colonization

Biofilm exacerbates antibiotic resistance: Is this a current oversight in antimicrobial stewardship?

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

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