Sinks, Drains, Showers, and Baths
A recent article by Decraene and colleagues[1] describes an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE) infections on two wards within a major hospital in the United Kingdom. Literature-based infection control measures, including CRE screening of high-risk patients and patient cohorting, were implemented in 2014 in response to increased CRE infections. The affected wards were closed and terminally cleaned, and were decontaminated with hypochlorite and hydrogen peroxide vapor. In 2015, an outbreak involving KPC-producing Escherichia coli triggered implementation of enhanced infection prevention measures. Again, the wards were closed and environmental cleaning was undertaken. In addition, environmental sampling was introduced, with a total of 927 samples obtained throughout the hospital; 355 of those were taken from the affected wards.
Twenty-six samples (7%) from the affected wards were positive, with the majority of samples taken from sinks, drains, and shower and bath sites. In addition, sink trap replacements for colonized sinks occurred three distinct times throughout 2015, as did a one-time pipework cleaning to remove biofilms. Because of continued isolation of CRE from sink/drain sites and patient colonization, the plumbing structures were replaced (until they connected with the central drainage stacks). Despite this, sink and drain sites continued to test positive, and KPC-producing
