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

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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

SLIDE 1

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, 1st October 2018

SLIDE 2

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?

SLIDE 3

Can CPE re-enter the clinical environment from a contaminated sink?

Drain underneath the faucet Drain at rear

PHE model sink and drain system

SLIDE 4

good vs. poor

Drainage:

SLIDE 5

Sinks: the key suspects

Tap Sink basin Waste trap Drain Drain

SLIDE 6

Dispersal from a contaminated waste trap

Drain underneath faucet ~1.6x10⁷ Drain at rear

Good drainage 0 CFU (1 out of 3 positive after enrichment) 0 splashes 0 CFU 0 splashes Poor drainage 2x10³ ± 1x10³ CFU 1x10² ± 6x10¹ splashes 0 CFU (1 out of 3 positive after enrichment) 0 Splashes

SLIDE 7

Hospital waste traps

SLIDE 8

Isolates from installed traps

Sink Hospital location Upon installation 6-months after installation

CPE Other Enterobacteriacea CPE Other Enterobacteriacea

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.
R. ornithinolytica
E. cloacae cx.
C. freundii

Drug room, ward 45

E. cloacae cx.
C. freundii
E. cloacae cx.
C. freundii
C. freundii

Treatment room, ward 4

E. cloacae cx.
K. pneumoniae
K. pneumoniae
K. pneumoniae

Male staff toilet, ward 3

E. cloacae cx.
C. freundii
K. radicintans
E. cloacae cx.
C. freundii

(transient)

E. coli
E. cloacae cx.
C. freundii

Mixed staff toilet, ward 45/46

E. coli
C. freundii
E. cloacae cx.

(transient)

E. coli
C. freundii

Treatment room, ward 3

E. cloacae cx.
R. ornithinolytica
E. cloacae cx.

(low)

E. coli

Treatment room, ward 4

C. sakazakii
E. cloacae cx.
R. ornithinolytica
K. oxycota
E. cloacae cx.
E. cloacae cx.
K. oxycota
E. cloacae cx.

SLIDE 9

Aerobiology with hospital traps

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

SLIDE 10

Summary

Sink part Good drainage Poor drainage Waste trap Drain Surface

SLIDE 11

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.

SLIDE 12

Thanks to:

PHE Susan Paton Ginny Moore Biosafety, Air and Water Microbiology Group TRACE CONSORTIUM Ryan George

Paz.AranegaBou@phe.gov.uk @Paz_ArBou

The views expressed in this presentation are those of the author and not necessarily those of PHE or any other Government Agency