International Scientific Forum on Home Hygiene

Home Hygiene & Health

The Leading Source of Scientific, Professional & Consumer Information
International Scientific Forum on Home Hygiene

Home Hygiene & Health

The Leading Source of Scientific, Professional & Consumer Information

Lifting the lid on toilets and healthcare-associated infections

Wastewater systems (sinks, showers and more recently toilets) are attracting attention as their role in healthcare associated infections (HCAIs) continues to gathers evidence. This blog takes a closer look at toilets and their potential role in transmission, as well highlighting some of the current challenges facing healthcare organisations around wastewater management.

I’ve always had a research interest in biofilms and their role in healthcare associated infections (HCAIs), and given biofilms and wastewater go hand in hand; the challenge of keeping wastewater safe has always fascinated me. We are frequently seeing wastewater systems (and biofilms) being linked to outbreaks.

Multidrug resistant Gram-negative bacteria such as Citrobacter, PseudomonasAcinetobacter and Klebsiella species commonly cause these outbreaks (typically in venerable vulnerable patients), with outbreaks often lasting for months and even years. A recent publication from Regad et al, (2024) demonstrated that persistent contamination of washbasins with an OXA-48 producing strain of C. farmeri was the source of an outbreak, lasting several years. The only link between the patients affected by the outbreak was that they had stayed in the same room (months apart) and environmental screening confirmed the presence of C. farmeri in washbasin drains. Frequently (as in this case) a real challenge for IPC and microbiology teams is that contamination of wastewater systems by multi drug resistant organisms (MDROs) often persists, despite multiple interventions designed to eliminate it.

Sinks, showers and drains are now well recognised as potential sources of HAI transmission, which isn’t surprising given that they create a perfect environment (moisture, nutrients and protection from external stresses (such as disinfectants)) for bacterial biofilms to thrive. Sinks pose a challenge for healthcare organisations; placement, design, everyday use (correct and incorrect) and what goes down them, are all factors which must be considered when aiming to reduce transmission risk. The study by Garvey et al. (2023) coined the terms the sink splash (Garvey) zone demonstrating just how far and how much equipment could potentially be contaminated by everyday sink usage. A lot of the focus has been on sinks and drains, but is it time for us to be talking about toilets too?  After all toilets are just big drains, aren’t they?

It is clear the challenge for healthcare organisations around management of wastewater systems is significant and we need to start thinking about how we can proactively monitor and continuously keep wastewater systems (including toilets) safe to prevent the spread of HCAIs.

Resource Link:

https://reflectionsipc.com/2024/04/23/lifting-the-lid-on-toilets-and-healthcare-associated-infections/#more-5207