Researchers think biofilms may be a result of shared piping between sinks and toilets or that the flush plume contaminates nearby sinks.
Infection Control Today (ICT) recently reported on new research published in the American Journal of Infection Control that found a “high prevalence of Klebsiella pneumoniae carbapenemase (KPC) positivity in sink drains located next to toilets.”
How high? According to the research, 87 percent of patient sinks located next to toilets tested positive for KPC, while only about 22 percent of sinks situated farther away from the toilets tested positive.
The study authors, Blake Buchan and Silvia Munoz-Price are quoted saying, “This study, if validated, could have major implications for infection control.” They go on to say that if sinks next to the toilets are the problem, hand hygiene practices and sink disinfection protocols may be needed. For help dealing specifically with biofilms, ICT published an in-depth article on the topic back in 2007 and is still worth a read today.
We agree that promoting better washing and disinfecting is never a bad idea, but it’s not enough. Tracking the cause of HAIs is difficult, as is finding a definitive way of stopping them altogether. Because of that uncertainty, hospitals should do everything they can think of and hope that something they are doing, or some combination of tactics will be useful in reducing HAIs.
The ICT KPC article does point out that the research is not clear on how the contamination occurs, just that it does happen. Buchan and Munoz-Price think it is possible that the biofilms are a result of shared piping between sinks and toilets, or that flushing generates contaminated drops that reach the sink drains.
Sink design has an important role to play in helping to reduce the spread of harmful bacteria. Offset drains, deep basins that allow for adequate washing, an internal slope to reduce backsplash, little to no counter space to discourage users from placing objects on the sink, and an added layer of protection in the form of durable antimicrobial solid surface material all help in infection prevention efforts.
Another option to consider is vacuum plumbing. In an independent study, AcornVac’s vacuum system, paired with Whitehall Manufacturing toilets, was tested side-by-side with your run of the mill gravity flush toilets to compare the presence of a flush plume. NSF International reported that AcornVac’s vacuum toilets produced no detectable levels of bacteria on the toilet seat or area surrounding the toilet, whereas the gravity flush toilets had detectable levels of bacteria on the toilet seat and the area surrounding the toilet.
We are not claiming that vacuum toilets or better sink design would end the KPC issue or eliminate the spread of HAIs. But we do believe the right fixtures can play an essential role in your infection prevention toolkit.