In recent months I’ve read a lot about the infection risks associated with sinks and drains in areas of healthcare organisations which house some of our most sick and vulnerable patients. The retrospective study carried out in Germany, comparing hospital acquired infection (HAI) rates in 552 intensive Care Units (ICUs) with and without sinks was perhaps the most compelling, concluding that ICU rooms with sinks were associated with a higher rate of HAIs (in comparison to those without sinks). I’ve also read with interest how many healthcare organisations have tackled the infection risk posed by sinks and water through the implementation of water-free or water light (which I personally prefer) systems. More and more evidence is emerging that this approach has merit in reducing the transmission of HAIs in ICUs, with a recent systematic review  suggesting that sink removal and other water-free interventions in ICUs, helped terminate infection outbreaks.

However, are there unintended consequences to this approach? The subject of today’s blog shows there really are….and they are ones which you can see! Published as a Letter to the Editor in the Journal of Hospital Infection, the title instantly caught my attention: Collateral damage of a waterless intensive care unit. The authors discuss their experience of water-free care at Genva University Hospital, were all sinks were removed and tubes sealed off, in the hospitals ICU. As part of this, an auto-effluent drain was installed to manage disposal of dialysis effluent, which is connected to the hospital sewerage system.

Four years after the implementation of waterless care, larvae (yes larvae), were found at the entrance of a pipe dedicated to dialysis effluent evacuation. Being a microbiologist, I’ve always been fascinating by the challenge caused by microorganisms we can’t see with the naked eye! So, imagine my surprise to read about a challenge (and infection risk?) we can see. The authors go on to explain how waterless care may disrupt wastewater evacuation, leading to the stagnation of liquid (which we know is a big concern for IPC). Stagnation of liquid may also provide an optimal environment for the breeding of larvae; however, the authors note the presence of larval contamination far from the patient zone does not pose a direct risk to patient health. A combination of thermal and chemical methods resulting in eradication of the larvae and no new larvae were detected over a six month follow up period.

The article demonstrates how we cannot afford to sit back once we implement changes in healthcare organisations and that IPC teams must remain vigilant as elimination of one problem could result in future new problems. The evidence base that waterless free/water light care can reduce infection rates and improve patient care is growing, but as more and more organisations adopt this approach, we need to remain watchful for collateral damage. 

Finally, and continuing the watery theme of this post, a reminder that Dr Mark Garvey will be leading IPC Partners Journal Club tomorrow on “The sink splash zone” at 1000 EST / 1500 GMT (UK) – register here.