sink Interview with:
Gili Regev-Yochay, MD, Lead author
Director of the Infection Prevention & Control Unit
Sheba Medical Center
Tel HaShomer, Israel. What is the background for this study?

Response: CPE (Carbapenemase producing Enterobacteriaceae) is endemic in Israel. In our ICU we had a prolonged CPE outbreak with one particular bacteria, which is not that common (OXA-48 producing-Serratia marcescens).  Enhancing our regular control measures (hand hygiene, increased cleaning etc..) did not contain the outbreak. What are the main findings? 

Response: The outbreak source were the sink-traps in nearly all the patient rooms, which were contaminated with this same bacteria. Once we understood that this was the source we took two measures:

1) Sink decontamination efforts, including intensive chlorine washes of the drainage and water system, replacement of all sink-traps, acetic acid treatment and more, all these efforts were only partially and only temporarily successful. So that even today, after a year of such efforts and a period in which we didn’t have any patients with this infection, the drainage system is still contaminated with these bugs and they grow in the sink-traps and can be found in the sink outlets.

2) The second measure we took was an educational intervention, where we engaged the ICU team through workshops to the issue of the contaminated sinks and together enforced strict “sink-use guidelines” (sinks are to be used ONLY for hand washing, prohibiting placement of any materials near the sinks, etc.). Using these two measure the outbreak was fully contained.

To date, nearly 1.5 years since the last outbreak case, we did not have any further infections in our ICU patients with this bug. What should readers take away from your report?

Response: Sink-traps and drainage systems can be a major source of CPE transmission.

While traditionally CPE outbreaks were attributed to patient-to patient transmission, the environment and particularly water and drainage system appears to play a major role. What recommendations do you have for future research as a result of this work? 

Response: There is urgent need to find a technological solution for drainage system contaminations.

While some have suggested to get rid of sinks in ICU this is probably not realistic in the era of emerging Clostridium infections (where washing hands, and not only alcohol rubs are needed). 


Gili Regev-Yochay, Gill Smollan, Ilana Tal, Nani Pinas Zade, Yael Haviv, Valery Nudelman, Ohad Gal-Mor, Hanaa Jaber, Eyal Zimlichman, Nati Keller, Galia Rahav. Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit. Infection Control & Hospital Epidemiology, 2018; 1 DOI: 1017/ice.2018.235

Oct 6, 2018 @ 7:24 pm



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