Characterizations of handwashing sink activities in a single hospital medical intensive care unit. Issue 3 (November 2018)

• Record Type: Journal Article
• Authors: Grabowski, M.; Lobo, J.M.; Gunnell, B.; Enfield, K.; Carpenter, R.; Barnes, L.; Mathers, A.J.
• Is Part Of: Journal of hospital infection. Volume 100:Issue 3(2018)
• Page Start: e115
• Page End: e122
• Publication Date: 2018-11
• Subjects: Infection prevention and control -- Hand hygiene -- Sink reservoir -- Sink-trap transmission -- Behavioural analysis -- Remote video monitoring; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2018.04.025
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: 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. Aim: 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. Methods: 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. Findings: 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. Conclusion: 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.