Newcomer Erin P, O'Neil Caroline A, Vogt Lucy, McDonald David, Cass Candice, Wallace Meghan A, Hink Tiffany, Yerbic Francesca, Muenks Carol, Gordon Rebecca, Arter Olivia, Stewart Henry, Amor Mostafa, Jolani Kevin, Alvarado Kelly, Valencia Alyssa, Samuels Carleigh, Peacock Kate, Park Daniel, Struttmann Emily, Sukhum Kimberley V, Burnham Carey-Ann D, Dantas Gautam, Kwon Jennie H
The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine in St Louis, St Louis, MO, USA; Department of Biomedical Engineering, Washington University in St Louis, St Louis, MO, USA.
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA.
EBioMedicine. 2025 Jun;116:105772. doi: 10.1016/j.ebiom.2025.105772. Epub 2025 May 20.
Opportunistic premise plumbing pathogens (OPPPs) can establish reservoirs in hospital plumbing and cause healthcare associated infections (HAIs). There is currently no widely accepted protocol for sink drain cleaning to reduce OPPP burden.
We implemented a sink cleaning intervention in 12 intensive care unit (ICU) rooms. At low frequency (1×/week) and high frequency (5×/week) intervals, we wiped sink surfaces with 10% bleach wipes and pumped a foamed preacid disinfectant into sink drains. We also maintained untreated rooms (0×/week). We used E-swabs to sample sink drains and surrounding surfaces during one baseline, two intervention, and two post-intervention periods over 23 months. Samples were selectively cultured for bacterial growth and antimicrobial resistant organism (ARO) isolation. We conducted whole-genome sequencing (WGS) on Pseudomonas spp. and Stenotrophomonas spp. isolates to track impacts on reservoirs over time. We also collected and analysed clinical isolates from patients occupying the study rooms and information about HAIs that occurred.
The intervention reduced the proportion of sink drains yielding Gram-negative bacteria by up to 85% (95% CI: 56-114%) in high frequency rooms versus the baseline period, but this was not significant in low frequency rooms. It also reduced the proportion of sink drains yielding Pseudomonas spp. and Stenotrophomonas spp. by up to 100% (95% CI: 79-121%) and 95% (95% CI: 65-125%) versus the baseline period in high frequency rooms and up to 71% (95% CI: 50-92%, p < 0.001) and 66% (95% CI: 27-105%, p < 0.05) in low frequency rooms, respectively. WGS showed strains of Pseudomonas aeruginosa and Stenotrophomonas maltophilia that colonised sink drains for over 3 years across two studies. Following the intervention periods, P. aeruginosa reservoirs were replaced with new strains, while S. maltophilia reservoirs returned with the same strains.
This environmental hygiene intervention may be effective in reducing the burden of OPPPs in hospital sinks.
Agency for Healthcare Research and Quality (R01HS027621), National Institute of Allergy and Infectious Diseases (U01AI123394, 1K23AI137321), Barnes-Jewish Hospital Foundation (5102), Washington University Institute of Clinical and Translational Sciences (4462) from the National Center for Advancing Translational Sciences (UL1TR002345).
机会性建筑物内管道病原体（OPPPs）可在医院管道系统中形成储存库，并导致医疗保健相关感染（HAIs）。目前尚无广泛接受的水槽排水清洁方案来减轻OPPPs负担。
我们在12间重症监护病房（ICU）实施了水槽清洁干预措施。以低频（每周1次）和高频（每周5次）的间隔，用10%的漂白剂擦拭巾擦拭水槽表面，并将泡沫状的预酸消毒剂注入水槽排水口。我们还设置了未处理的房间（每周0次）作为对照。在23个月的一个基线期、两个干预期和两个干预后期，我们使用E拭子对水槽排水口及其周围表面进行采样。对样本进行选择性培养以分离细菌生长和抗菌耐药菌（ARO）。我们对铜绿假单胞菌和嗜麦芽窄食单胞菌分离株进行了全基因组测序（WGS），以追踪随时间对储存库的影响。我们还收集并分析了入住研究病房患者的临床分离株以及发生的HAIs相关信息。
与基线期相比，高频房间的干预措施使产生革兰氏阴性菌的水槽排水口比例降低了85%（95%置信区间：56 - 114%），但低频房间的这一降低不显著。与基线期相比，高频房间产生铜绿假单胞菌和嗜麦芽窄食单胞菌的水槽排水口比例分别降低了100%（95%置信区间：79 - 121%）和95%（95%置信区间：65 - 125%），低频房间分别降低了71%（95%置信区间：50 - 92%，p < 0.001）和66%（95%置信区间：27 - 105%，p < 0.05）。WGS显示，在两项研究中，铜绿假单胞菌和嗜麦芽窄食单胞菌菌株在水槽排水口中定殖超过3年。干预期后，铜绿假单胞菌储存库被新菌株取代，而嗜麦芽窄食单胞菌储存库则恢复为相同菌株。
这种环境卫生干预措施可能有效减轻医院水槽中OPPPs的负担。
医疗保健研究与质量局（R01HS027621）、国家过敏和传染病研究所（U01AI123394、1K23AI137321）、巴恩斯 - 犹太医院基金会（5102）、华盛顿大学临床与转化科学研究所（4462），均来自国家推进转化科学中心（UL1TR002345）。
