A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit

• Published in: Clinical microbiology and infection Vol. 27; no. 9; pp. 1347.e9 - 1347.e14
• Main Authors: Valentin, Anne-Sophie, Decalonne, Marie, Mereghetti, Laurent, Daniau, Côme, van der Mee-Marquet, Nathalie, Aloe, L., Aurel, C., Bonjean, S., Bounoua, M., Bourigault, C., Chanay, O., Curnier, V., Dalmas, H., Degallaix, D., Del Guidice, F., Fribourg, A., Genillon, J.P., Glanard, A., Gouin, C., Gourmelen, F., Ionescu, P., Joron, S., Joseph, E., Laurent, B., Le Coq, M., Lecuru, M., Lehiani, O., Lepainteur, M., Lesteven, C., Magneney, M., Mahamat, A., Negrin, N., Pospisil, F., Sevin, T., Valdes, A., Vidal-Hollaender, B., Veyres, P., Aussant, P., Badetti, C., Berthon, M., Brunel, E., Burel, C., Cerf, C., Combaux, D., Da Silva, D., Damoisel, C., De Rudnicki, S., Debost, J., Dieye, E., Ferreira, L., Fillatre, P., Galin, X., Georges, H., Godde, F., Hira, M., Hoff, J., Illinger, J., Lambiotte, F., M'fam, W., Mariot, J., Martinet, O., Michaux, P., Montini, F., Muller, L., Pommier, C., Roger, C., Samat, C., Siami, S., Simonoviez, P.Y., Toledano, D., Travert, B., Trouillet, G., Arsene, S., Bachelier, M.N., Belmonte, O., Bensaid, T., Bertei, D., Bizet, J., Bonfils, F., Bonnet, R., Brisou, P., Chaplain, C., Dupin, C., Farrugia, C., Fougnot, S., Guerin, M., Guillet-Caruba, C., Heusse, E., Heym, B., Jacquemin, P., Lacomme, M.P., Lance, F., Lanselle, C., Lechat, S., Leotard, S., Luizy, N., Mignot, L., Poussing, S., Sanchez, R., Seraphin, H.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2021
• Subjects: Bloodstream infection; Cross Infection - epidemiology; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Equipment Contamination; Humans; Intensive care; Intensive Care Units; Prospective Studies; Pseudomonas aeruginosa; Risk Factors; Sink; Ventilator-associated pneumonia; Water Supply; Pseudomonas aeruginosa; Intensive care; Ventilator-associated pneumonia; Bloodstream infection; Sink; Enterobacteriaceae
• DOI: 10.1016/j.cmi.2021.02.018
• EISSN: 1469-0691
• ISSN: 1198-743X

The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting.
A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey.
Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates ≥0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate ≥51%, prevalence of sinks with visible splashes ≥14%, prevalence of sinks close to the patient's bed ≥21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016).
Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.