Carbapenem-resistant Enterobacteriaceae dispersal from sinks is linked to drain position and drainage rates in a laboratory model system
PHE ePoster Library. Aranega Bou P. Apr 9, 2019; 257486; 15352
Dr. Paz Aranega Bou
Dr. Paz Aranega Bou
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Abstract
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Abstract Carbapenem-resistant Enterobacteriaceae (CRE) have become increasingly important causes of healthcare-associated infection. Hospital reservoirs include hospital sinks, waste traps and drains.A laboratory model system simulating a clinical setting was built, including sinks in which water delivered from the tap flows directly into the drain and clinical handwash basins with the drain at the rear. Waste traps, known to be colonised with CRE, were taken from a hospital and installed within the model system. Dosing with nutrients (TSB) was required to maintain the Enterobacteriaceae populations. New waste traps were also installed and artificially inoculated with CRE. The potential for bacteria to be released during tap usage was assessed under fast and slow drainage conditions using cyclone air samplers and/or settle plates. It was found that when the waste traps were artificially contaminated and CRE colonisation was confined to the waste trap water, significantly fewer bacteria were dispersed from sinks that drained quickly (p=0.004) and/or from rear-draining sinks (p=0.002). When the waste traps were naturally contaminated and routinely dosed with TSB, CRE colonizing the trap spread to pipework and drain. In these conditions, there was a significant interaction between sink drainage and position of the drain (p<0.001). When drainage was slow, dispersal from rear-draining sinks was almost 30-fold less than from sinks with the drain underneath the tap (p<0.001). When drainage was fast, rear-draining sinks again released comparatively fewer CRE, although, in this case, the difference was not statistically significant (p=0.7). Contaminated splashes travelled up to 1m from the sink but concentrated mainly in the area around the sink.CRE can be dispersed from hospital sinks, particularly if inappropriate disposal of waste facilitates biofilm formation and colonization of the drain, water flows directly into the drain and/or if sink drainage is impaired. Funding Funding was received from PHE.
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