Sink Drains and a Contaminated Water Dispenser Drove a Hospital CPE Outbreak.
Key Takeaway
In an 87-patient outbreak of carbapenemase-producing Enterobacteriaceae in the cardiology units of a Korean hospital, the organisms were recovered from a contaminated water dispenser and the sink drains. A case-control analysis tied brushing teeth at the sink to acquisition (83% vs 30%, P=0.03), and molecular typing matched the environmental and patient isolates, naming the sinks and dispenser as the reservoirs.
The Study
Jung and colleagues investigated an outbreak of carbapenemase-producing Enterobacteriaceae (CPE) in the cardiology intensive care units and wards of Asan Medical Center, a tertiary hospital in Seoul, Korea, from July to December 2018. Eighty-seven patients were affected. Environmental sampling recovered CPE from a shared water dispenser and from sink drains, and pulsed-field gel electrophoresis confirmed the environmental and patient isolates shared identical pulsotypes. A case-control analysis found that patients who brushed their teeth at the ward sinks were far more likely to acquire CPE (83% vs 30%, P=0.03).
Key Findings
Sink drains and a water dispenser were the reservoirs
Carbapenemase-producing Enterobacteriaceae were recovered from a shared water dispenser and from sink drains in the cardiology units; both were implicated as environmental reservoirs.
87 patients affected
The outbreak involved 87 patients over about six months before the reservoirs were identified and controlled.
Sink use was tied to acquisition
In a case-control analysis, patients who brushed their teeth at the ward sinks acquired CPE far more often (83% vs 30%, P=0.03), linking sink contact to acquisition.
Molecular typing matched drain and patient isolates
Pulsed-field gel electrophoresis confirmed identical pulsotypes between the environmental isolates (sinks and dispenser) and the patient isolates.
What This Means For Your Facility
This outbreak makes the sink-to-patient pathway explicit: the CPE in the sink drains matched the CPE infecting patients, and the more patients used the contaminated sinks, the more likely they were to acquire the organism. The same standing-water sink and floor-drain traps exist throughout commercial, food-service, and healthcare buildings.
Green Drain is a waterless one-way valve that allows water to drain but restricts the retrograde movement of air and aerosols from the drainage system into the occupied space. It removes the standing water a conventional trap relies on, and it does not remediate an existing biofilm. This study did not test a trap seal; in the independent SGS aerosol-retention test (Report QDF25-0049810-01) the GD3 retained over 99.9% of an aerosolized MS2 bacteriophage viral surrogate in a controlled bench test. As a supportive, passive engineering control, it complements, not replaces, cleaning, stewardship, and infection prevention.
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Related Research
Remove the Standing Water a Conventional Trap Relies On
Green Drain's waterless trap seal removes the standing water a conventional trap relies on and restricts the upward movement of air and aerosols from the drain. One installation. A supportive engineering control that complements, not replaces, infection prevention.