Are Sink Drainage Systems a Reservoir for Hospital-Acquired Gammaproteobacteria Colonization and Infection? A Systematic Review

Abstract

Increasing rates of antimicrobial-resistant organisms have focused attention on sink drainage systems as reservoirs for hospital-acquired Gammaproteobacteria colonization and infection. We aimed to assess the quality of evidence for transmission from this reservoir. We searched 8 databases and identified 52 studies implicating sink drainage systems in acute care hospitals as a reservoir for Gammaproteobacterial colonization/infection. We used a causality tool to summarize the quality of evidence. Included studies provided evidence of co-occurrence of contaminated sink drainage systems and colonization/infection, temporal sequencing compatible with sink drainage reservoirs, some steps in potential causal pathways, and relatedness between bacteria from sink drainage systems and patients. Some studies provided convincing evidence of reduced risk of organism acquisition following interventions. No single study provided convincing evidence across all causality domains, and the attributable fraction of infections related to sink drainage systems remains unknown. These results may help to guide conduct and reporting in future studies.

Antibiotic-resistant organisms establish reservoirs in new hospital built environments and are related to patient blood infection isolates

“…The process of ARO reservoir colonization of the hospital built environment is dependent on complex interactions, and transmission events to vulnerable patients are not well understood 27 , 84 , 85 . In this study we investigated the microbiologic changes in a new SCT ICU before and after patient or staff occupancy and tracked ARO strains cross ICU surfaces and patients.…”

“…Another model is that AROs are seeded from microbial communities which persistently colonize hospital built environments, particularly plumbing sources, where biofilms form and can act as a reservoir for potential pathogens (Fig. 1a ) 24 – 27 . These models are not mutually exclusive.…”

Hospital sink traps as a potential source of the emerging multidrug-resistant pathogen Cupriavidus pauculus: characterization and draft genome sequence of strain MF1

“…pauculus is an emerging human pathogen, having previously been chiefly isolated from soil and aquatic environments. Here, we present its isolation from a hospital sink trap -a niche known to act as a reservoir of pathogens in clinical settings and contribute to nosocomial transmission [36][37][38][39][40]. This study reports the draft hybrid genome sequence of the isolate and investigates its antimicrobial susceptibility, virulence in an in vivo model, and biofilm formation in relevant conditions compared to a wellcharacterized biofilm-forming model organism.…”

“…Sink traps (also known as U-bends or P-traps) are sections of wastewater plumbing systems (WPS), both domestic and commercial, designed to trap water and prevent unwanted flow of sewer gases into the sink and surrounding environment. Sinks are present in virtually all hospital wards and patient rooms to encourage best practice regarding hand hygiene [34,35], however these sink traps become heavily colonized with pathogenic bacteria and are an important reservoir of pathogens causing nosocomial infections [36][37][38][39][40]. The formation of biofilms, which are refractory to disinfection and facilitate long-term persistence of bacteria, poses an additional concern [41].…”

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

“…Besides acquisition of infections and colonization via contaminated products or involving health care workers, the environmental reservoir has been linked to long-term transmission events and outbreaks in the hospital setting ( 5 , 8 – 11 ). In particular, water systems in health care facilities have been reported as a source of nosocomial infection, especially among immunocompromised patients in critical care units ( 10 , 12 , 13 ). Decontamination and infection control measures are often arduous and time-consuming because of the tenacity and persistence of this pathogen ( 14 , 15 ).…”