Enterobacteriaceae from hospital waste traps Paz Aranega Bou, - PowerPoint PPT Presentation

Use of a model hospital sink system to investigate proliferation, aerosolisation and dispersal of carbapenemase-producing Enterobacteriaceae from hospital waste traps Paz Aranega Bou, Infection Prevention 11th Annual Conference, Glasgow, 1 st October 2018

Carbapenemase-producing Enterobacteriaceae (CPE): the role of sinks. Number of isolates from UK laboratories confirmed to have carbapenemases by PHE’s AMRHAI reference unit How? Why? 2

PHE model sink and drain system Can CPE re-enter the clinical environment from a contaminated sink? Drain underneath the faucet Drain at rear 3

Drainage: good vs. poor 4

Sinks: the key suspects Tap Drain Drain Sink basin Waste trap 5

Dispersal from a contaminated waste trap ~1.6x10 ⁷ Drain at rear Drain underneath faucet 0 CFU (1 out of Good 3 positive after 0 splashes 0 CFU 0 splashes drainage enrichment) 2x10³ ± 1x10³ 1x10² ± 6x10¹ 0 CFU (1 out of Poor CFU splashes 3 positive after 0 Splashes drainage enrichment) 6

Hospital waste traps 7

Isolates from installed traps Sink Hospital location Upon installation 6-months after installation CPE Other Enterobacteriacea CPE Other Enterobacteriacea 2 Day room, ward 3 E. cloacae cx K. oxytoca E. cloacae cx. K. oxytoca E. cloacae cx. Kitchen, ward 3/4 K. pneumoniae E. cloacae cx. 3 E. cloacae cx. C. freundii R. ornithinolytica 5 Drug room, ward 45 E. cloacae cx. E. cloacae cx. C. freundii C. freundii C. freundii Treatment room, ward 4 E. cloacae cx. K. pneumoniae K. pneumoniae 6 K. pneumoniae Male staff toilet, ward 3 E. cloacae cx. E. cloacae cx. E. coli 8 C. freundii C. freundii E. cloacae cx. K. radicintans (transient) C. freundii 9 Mixed staff toilet, ward E. coli E. cloacae cx. E. coli 45/46 C. freundii (transient) C. freundii Treatment room, ward 3 E. cloacae cx. R. ornithinolytica E. cloacae cx. E. coli 10 (low) Treatment room, ward 4 C. sakazakii K. oxycota E. cloacae cx. K. oxycota 12 E. cloacae cx. E. cloacae cx. E. cloacae cx. R. ornithinolytica 8

Aerobiology with hospital traps Good drainage Poor drainage Around Around Distance from sink (cm) 0-27 27-54 54-100 Total 0-27 27-54 54-100 Total sink sink Flush 1 30.3 18.3 6.3 4 224 96 36.6 17 Drain 69.5 536.5 underneath faucet (Sink 2) Flush 2 2.7 1 6.6 0.3 106 34.3 17.3 5.3 Flush 1 0 0 0 0.3 14.3 0.6 0 0 Drain at rear 0.3 18.5 (Sink 5) Flush 2 0 0 0 0 3 0.3 0.3 0 9

Summary Good Poor Sink part drainage drainage Waste trap Drain Surface 10

Conclusions • Appropriate disposal of liquid waste is important to avoid CPE proliferation in the waste trap and drain. • Drain contamination , poor drainage and having the drain underneath the faucet are associated with higher dispersal from sinks. • Managing to contain the contamination in the waste trap , good drainage and having the drain at the rear of the sink are associated with lower dispersal from sinks. • Splashes can travel up to at least 1 m from the sink but the higher risk of cross-contamination occurs in the immediate area around the sink. 11

Thanks to: PHE Susan Paton Ginny Moore Biosafety, Air and Water Microbiology Group TRACE CONSORTIUM Ryan George . The views expressed in this presentation are those of the author and not necessarily those of PHE or any other Government Agency Paz.AranegaBou@phe.gov.uk @Paz_ArBou