Centers for Disease Control and Prevention, Atlanta, GA, USA.
Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
Sci Rep. 2020 May 19;10(1):8234. doi: 10.1038/s41598-020-65052-7.
Handwashing sinks and their associated premise plumbing are an ideal environment for pathogen-harboring biofilms to grow and spread throughout facilities due to the connected system of wastewater plumbing. This study was designed to understand the distribution of pathogens and antibiotic resistant organisms (ARO) within and among handwashing sinks in healthcare settings, using culture-dependent methods to quantify Pseudomonas aeruginosa, opportunistic pathogens capable of growth on a cefotaxime-containing medium (OPP-C), and carbapenem-resistant Enterobacteriaceae (CRE). Isolates from each medium identified as P. aeruginosa or Enterobacteriaceae were tested for susceptibility to aztreonam, ceftazidime, and meropenem; Enterobacteriaceae were also tested against ertapenem and cefotaxime. Isolates exhibiting resistance or intermediate resistance were designated ARO. Pathogens were quantified at different locations within handwashing sinks and compared in quantity and distribution between healthcare personnel (HCP) and patient room (PR) sinks. ARO were compared between samples within a sink (biofilm vs planktonic samples) and between sink types (HCP vs. PR). The drain cover was identified as a reservoir within multiple sinks that was often colonized by pathogens despite daily sink cleaning. P. aeruginosa and OPP-C mean log CFU/cm counts were higher in p-trap and tail pipe biofilm samples from HCP compared to PR sinks (2.77 ± 2.39 vs. 1.23 ± 1.62 and 5.27 ± 1.10 vs. 4.74 ± 1.06) for P. aeruginosa and OPP-C, respectively. P. aeruginosa and OPP-C mean log CFU/ml counts were also higher (p < 0.05) in HCP compared to PR sinks p-trap water (2.21 ± 1.52 vs. 0.89 ± 1.44 and 3.87 ± 0.78 vs. 3.21 ± 1.11) for P. aeruginosa and OPP-C, respectively. However, a greater percentage of ARO were recovered from PR sinks compared to HCP sinks (p < 0.05) for Enterobacteriaceae (76.4 vs. 32.9%) and P. aeruginosa (25.6 vs. 0.3%). This study supports previous work citing that handwashing sinks are reservoirs for pathogens and ARO and identifies differences in pathogen and ARO quantities between HCP and PR sinks, despite the interconnected premise plumbing.
洗手池及其相关的前置管道系统是病原体滋生和传播的理想环境，因为废水管道系统是相互连接的。本研究旨在通过培养依赖的方法来了解医疗机构洗手池内部和之间的病原体和抗生素耐药菌（ARB）的分布情况，以定量检测铜绿假单胞菌（PA）、能够在含头孢噻肟的培养基（OPP-C）上生长的机会性病原体（OPP）和耐碳青霉烯类肠杆菌科（CRE）。从每种培养基中鉴定为 PA 或肠杆菌科的分离物均经过了对氨曲南、头孢他啶和美罗培南的药敏试验；肠杆菌科还接受了厄他培南和头孢噻肟的药敏试验。对表现出耐药性或中介耐药性的分离物进行了ARB 鉴定。在洗手池的不同位置对病原体进行了定量，并比较了医护人员（HC）和病人房间（PR）洗手池之间的数量和分布。比较了同一洗手池内（生物膜与浮游样本）和不同类型洗手池（HC 与 PR）之间的 ARB。尽管每天都对洗手池进行清洁，但在多个洗手池的排水盖中发现了耐病原体的储水池。与 PR 洗手池相比，HC 洗手池的 p 型弯管和尾管生物膜样本中的 PA 和 OPP-C 平均对数 CFU/cm 计数更高（PA 分别为 2.77 ± 2.39 vs. 1.23 ± 1.62 和 OPP-C 为 5.27 ± 1.10 vs. 4.74 ± 1.06）。与 PR 洗手池相比，HC 洗手池的 p 型弯管水样本中的 PA 和 OPP-C 平均对数 CFU/ml 计数也更高（p < 0.05）（PA 分别为 2.21 ± 1.52 vs. 0.89 ± 1.44 和 OPP-C 为 3.87 ± 0.78 vs. 3.21 ± 1.11）。然而，与 HC 洗手池相比，PR 洗手池中回收的 ARB 百分比更高（p < 0.05），包括肠杆菌科（76.4% vs. 32.9%）和 PA（25.6% vs. 0.3%）。本研究支持了先前的研究，即洗手池是病原体和 ARB 的储水池，并确定了 HC 和 PR 洗手池之间病原体和 ARB 数量的差异，尽管它们具有相互连接的前置管道系统。
