Removing sinks from rooms in intensive care units (ICU) and introducing water-free patient care leads to lower bacteria colonization rates, especially in patients with a longer stay in ICU, finds a new study in Antimicrobial Resistance & Infection Control.
Researchers based in the Netherlands looked at reducing patient colonization with gram-negative bacilli (GNB), a bacteria that includes salmonella, pseudomonas, shigella Yersinia and the Enterobacteriaceae family. GNB is developing multi-drug resistance in hospitals and remains a growing problem.
Sinks have long been considered a best practice in ICU design, but reports since the 1970s show their link to hospital-associated infections. In 2014, researchers decided to examine this more after an Enterobacter cloacae outbreak at an ICU in a large Netherlands hospital. It was speculated the outbreak resulted from contaminated sinks, so when the hospital removed the sinks and implemented a water-free patient care method, researchers decided to evaluate the effect on colonization with GNB after one year.
They conducted a two- year pre/post and quasi-experimental study on patients admitted to the ICU for at least 48 hours during a 12-month pre-intervention phase, four months of intervention and a 12-month post-intervention that ended in 2015. They compared monthly GNB rates pre- and post-intervention using interrupted time series data and segmented regression analysis and evaluated their findings.
There were 1496 patients (9153 admission days) in the pre-intervention period and 1444 patients (9044 admission days) in the post-intervention period.
Regression analysis showed that the intervention was followed by a significant immediate reduction in GNB colonization, in the absence of a pre- or post-intervention trend in GNB colonization.
The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67–0.99; P = 0.02). The reduction in GNB colonization rate was greater in patients with longer ICU stays.
Two or more days showed a 1.22-fold drop, five or more days a 1.6-fold drop, 10 or more days a 2.5-fold drop and more than 14 days showed a 3.6-fold reduction.
Reconstructing hospital design to better direct compliance
Authors point out research limitations, such as the open-label, non-randomized nature of their single-hospital study. They also note their hospital is a low-GNB setting, so findings may not apply to other healthcare facilities.
But they add, “despite of the design limitations, in the absence of alternative explanations, we believe that it is conceivable that the removal of sinks and implementation of water-free patient care resulted in a significant reduction of GNB colonization.”
In light of the results, the researchers urge hospitals to reconsider the necessity of sinks and other wet areas in patient rooms.”
“Under time constraints, healthcare workers compliance with infection prevention and control measures is often reduced, specifically in the case of hand hygiene, infection prevention protocols and waste management protocols,” they wrote. “Reconstructing the hospital infrastructure in a way that behavior of healthcare workers is more directed towards good clinical practice is a step in the direction of sustainable infection control.”