Characterizations of handwashing sink activities in a single hospital medical intensive care unit

Handwashing sink drains are increasingly implicated as a potential reservoir of antibiotic-resistant bacteria in hospital outbreaks; however, usage patterns that may promote this source remain unknown. To understand behaviours in the intensive care unit (ICU) that may facilitate establishment and no...

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Published in:The Journal of hospital infection Vol. 100; no. 3; pp. e115 - e122
Main Authors: Grabowski, M., Lobo, J.M., Gunnell, B., Enfield, K., Carpenter, R., Barnes, L., Mathers, A.J.
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.11.2018
Subjects:
Behavioural analysis
Cross Infection - epidemiology
Cross Infection - prevention & control
Disease Transmission, Infectious - prevention & control
Environmental Microbiology
Hand Disinfection
Hand hygiene
Hospitals
Humans
Infection prevention and control
Intensive Care Units
Pilot Projects
Remote video monitoring
Sink reservoir
Sink-trap transmission
Sink reservoir
Sink-trap transmission
Behavioural analysis
Hand hygiene
Infection prevention and control
Remote video monitoring
ISSN:0195-6701, 1532-2939, 1532-2939
Online Access:Get full text
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Summary:Handwashing sink drains are increasingly implicated as a potential reservoir of antibiotic-resistant bacteria in hospital outbreaks; however, usage patterns that may promote this source remain unknown. To understand behaviours in the intensive care unit (ICU) that may facilitate establishment and nosocomial transmission of multidrug-resistant Gram negatives from a sink-trap reservoir to a patient. Motion-sensitive cameras captured anonymized activity paired with periodic in-person observations during a quality investigation from four ICU sinks (two patient rooms and two patient bathrooms) in a university hospital. We analysed 4810 sink videos from 60 days in patient rooms (3625) and adjoining bathrooms (1185). There was a false-positive rate of 38% (1837 out of 4810) in which the camera triggered but no sink interaction occurred. Of the 2973 videos with analysed behaviours there were 5614 observed behaviours which were assessed as: 37.4% medical care, 29.2% additional behaviours, 17.0% hand hygiene, 7.2% patient nutrition, 5.0% environmental care, 4.2% non-medical care. Handwashing was only 4% (224 out of 5614) of total behaviours. Sub-analysis of 2748 of the later videos further categorized 56 activities where a variety of nutrients, which could promote microbial growth, were disposed of in the sink. Several non-hand hygiene activities took place regularly in ICU handwashing sinks; these may provide a mechanism for nosocomial transmission and promotion of bacterial growth in the drain. Redesigning hospital workflow and sink usage may be necessary as it becomes apparent that sink drains may be a reservoir for transmission of multidrug-resistant bacteria.
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ISSN:0195-6701
1532-2939
1532-2939
DOI:10.1016/j.jhin.2018.04.025