Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

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Wednesday, August 1, 2012

Are There Monsters in Your Drain?

As a child I’m sure we’ve all had nightmares about the monster under our bed, or perhaps hiding in the closet.  However, I don’t personally believe I ever feared the beast lurking in the sink drain.  Unfortunately, this has become a very real concern or nightmare for infection control professionals in healthcare facilities throughout North America and likely around the globe.  Multi-drug resistant strains of various bacteria including Pseudomonas aeruginosa and Klebsiella oxytoca are taking up residence in sink drains and wreaking havoc on the most immuno-compromised patients. Just recently the infection control staff at Mount SinaiHospital (MSH) in Toronto published a study recounting their strategy for addressing an outbreak that was traced back to the prevalence of K. oxytoca in the drains of their ICU handwashing sinks.  This scenario echoes a similar situation encountered by staff at TorontoGeneral Hospital (TGH) years earlier.  In the case of TGH, the bacterial strain was different but the source was the same – the sink drain in the ICU handwashing sinks.  Some of you may be asking – as I did when I first came across the TGH study – how in the world does bacteria dwelling in the deep, dark recesses of a sink drain infect dozens of patients in an ICU?  The simple answer: splashing.  Fact is, a dark and damp sink drain is the ideal location for bacteria to populate and proliferate.  When the tap is running, any splashing that may occur when the water hits the drain could spread germs to both neighbouring hand contact surfaces and directly to the hands of healthcare workers whom are trying to comply with their hand hygiene needs.  So how can we solve this problem?

In both studies, two interventions played a major role.  The first addresses the degree of splashing and is more complicated as it typically involves the renovation or replacement of the sinks in favour of those that are engineered to minimalize splashing.  The second intervention seeks to address the contamination at the source, so as to prevent the potential for transmission to other surfaces even if there is some splashing.  This involves the thorough cleaning and disinfection of the sink drain on a regular basis.  Unfortunately, because the sink drain is not only a perfect breeding ground for bacteria but also the ideal environment for the establishment of biofilm this tends to be a more involved task than everyday cleaning and disinfection.  In these situations particularly close attention needs to be paid to ensuring that the disinfectant remains wet on the surface for the required contact time.  This can prove difficult in a sink drain where a liquid disinfectant solution typically has fleeting contact with the contaminated surface as it races down the drain.  Therefore, preference should be given to rapid acting disinfectants and those that may be available in gelled formats which ensure adhesion to the surface and subsequent contact time compliance.  An equally important consideration is the type of disinfectant chosen for the application.  Preference should be given to oxidizing chemistries (e.g. hydrogen peroxide, chlorine based solutions) as they will chemically work to lift and remove the biofilm from the surface.  Other chemistries such as quaternary ammonium compounds are generally ineffective at penetrating and removing the biofilm.  In addition to selecting the appropriate disinfectant, the utilization of a tool to effectively clean the drains should also be strongly considered.

So does your facility have a procedure in place to ensure that your sink drains won’t be the cause of your next outbreak?

Hasta la vista

Lee – The Germinator

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