Acetic acid as a decontamination method for sink drains in a nosocomial outbreak of metallo-β-lactamase-producing Pseudomonas aeruginosa

Aspelund, A. Stjärne; Sjöström, Karin; Liljequist, B. Olsson; Mörgelin, Matthias; Melander, Eva; Påhlman, Lisa I.

doi:10.1016/j.jhin.2016.05.009

Cited by 57 publications

(51 citation statements)

References 15 publications

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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%

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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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Section: Outbreak Reportsmentioning

confidence: 99%

“…Shower drains have also been implicated with CRPA outbreak [25]. In a study by Stjärne et al, investigation of a CRPA outbreak revealed contamination of sinks with isolates closely related to CRPA from patients [23]. Following sink replacement, CRPA reappeared on sink surveillance cultures after a mean duration of 13 weeks.…”

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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“…U-bend biofilms are usually heterogenous communities consisting of a range of opportunistic bacterial pathogens, including Pseudomonas spp., Acinetobacter spp., Klebsiella spp. and Enterobacter spp., which can exhibit resistance to the major classes of antibiotics [2,4,6,10]. Furthermore, recent reports are increasingly highlighting the importance of wastewater pipework as a reservoir for the nosocomial transmission of carbapenemase-producing Enterobacteriaceae, an emerging global health threat [11].…”

Section: Introductionmentioning

confidence: 99%

“…A variety of approaches to U-bend decontamination have been investigated with varying success, most of which involve disruption to service and have financial implications, including the replacement of fixtures and/or associated pipework [2,6,10]. Replacement is ineffective in the long term as new washbasins and pipework rapidly become recolonized with micro-organisms.…”

Section: Introductionmentioning

confidence: 99%

Minimizing microbial contamination risk simultaneously from multiple hospital washbasins by automated cleaning and disinfection of U-bends with electrochemically activated solutions

Deasy

Moloney

Boyle

et al. 2018

Journal of Hospital Infection

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“…These communities will be exposed to liquids and waste that are discarded in a sink and may include antimicrobials, discarded beverages, soap, presumably pathogenic bacteria from health care workers' hands, and other items. In short, sink traps could serve as a breeding ground for opportunistic and highly antimicrobial-resistant bacteria that cannot be easily cleaned or removed (23)(24)(25)(26)(27)(28).…”

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confidence: 99%

Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs

Kotay

Chai

Guilford

et al. 2017

Appl Environ Microbiol

150

128

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There have been an increasing number of reports implicating Gammaproteobacteria as often carrying genes of drug resistance from colonized sink traps to vulnerable hospitalized patients. However, the mechanism of transmission from the wastewater of the sink P-trap to patients remains poorly understood. Herein we report the use of a designated hand-washing sink lab gallery to model dispersion of green fluorescent protein (GFP)-expressing Escherichia coli from sink wastewater to the surrounding environment. We found no dispersion of GFP-expressing E. coli directly from the P-trap to the sink basin or surrounding countertop with coincident water flow from a faucet. However, when the GFP-expressing E. coli cells were allowed to mature in the P-trap under conditions similar to those in a hospital environment, a GFP-expressing E. coli-containing putative biofilm extended upward over 7 days to reach the strainer. This subsequently resulted in droplet dispersion to the surrounding areas (<30 in.) during faucet operation. We also demonstrated that P-trap colonization could occur by retrograde transmission along a common pipe. We postulate that the organisms mobilize up to the strainer from the P-trap, resulting in droplet dispersion rather than dispersion directly from the P-trap. This work helps to further define the mode of transmission of bacteria from a P-trap reservoir to a vulnerable hospitalized patient.IMPORTANCE Many recent reports demonstrate that sink drain pipes become colonized with highly consequential multidrug-resistant bacteria, which then results in hospital-acquired infections. However, the mechanism of dispersal of bacteria from the sink to patients has not been fully elucidated. Through establishment of a unique sink gallery, this work found that a staged mode of transmission involving biofilm growth from the lower pipe to the sink strainer and subsequent splatter to the bowl and surrounding area occurs rather than splatter directly from the water in the lower pipe. We have also demonstrated that bacterial transmission can occur via connections in wastewater plumbing to neighboring sinks. This work helps to more clearly define the mechanism and risk of transmission from a wastewater source to hospitalized patients in a world with increasingly antibiotic-resistant bacteria that can thrive in wastewater environments and cause infections in vulnerable patients.

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Acetic acid as a decontamination method for sink drains in a nosocomial outbreak of metallo-β-lactamase-producing Pseudomonas aeruginosa

Abstract: Acetic acid is highly effective against Pae-MBL biofilms, and may be used as a simple method to decontaminate sink drains and to prevent nosocomial transmission.

Cited by 57 publications

References 15 publications

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

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

Minimizing microbial contamination risk simultaneously from multiple hospital washbasins by automated cleaning and disinfection of U-bends with electrochemically activated solutions

Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs

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