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Background
Carbapenemase-producing Enterobacteriaceae (CPE) can colonize hospital drains and
spread from drain to patient. The optimal approach to preventing drain colonization
is unknown. We present our hospital's experience with a drain decontamination protocol.
Methods
Our facility is a 450 bed academic hospital in Toronto. Between 2017 and 2019, we
identified 32 CPE positive inpatients 24 of whom were known to carry CPE or were CPE
screen positive on admission. We implemented a sink drain protocol to prevent plumbing
colonization. CPE patients admitted >48 hours have all drains in their room disinfected
weekly and when transferred or discharged. Hydrogen peroxide gel (4.5%) is poured
into the drain and flushed after 10 minutes. Drain swabs are collected >48 after disinfection;
some rooms were also tested pre-disinfection. If post-disinfection swabs were positive,
enhanced disinfection methods were used.
Results
4.7% (18/387) sink/drain swabs were CPE positive. Eight positive swabs were collected
before and ten after disinfection. These 18 positive swabs were from drains in 8 patient
rooms and 2 communal showers. Enterobacter species predominated (5/10) and CPE enzymes
included KPC(4), NDM(3), OXA-48(2), and mixed NDM&KPC(1). Positive room drains matched
the patient's CPE enzyme for 7 of 8 positive rooms. Drain disinfection was successful
for 70% (7/10) of positive sinks/drains. Three drains failed disinfection and required
the enhanced disinfection protocol. After successful disinfection, all room drains
have remained negative on at least one additional swab performed >1 month after successful
disinfection but two communal shower drains reverted to positive with the same CPE
enzyme on retesting >6 months post-disinfection.
Conclusions
Sink drains can become contaminated with CPE. Our disinfection protocol was largely
successful in eradicating CPE from drains, although two communal shower drains reverted
to positive. Disinfection of drains in CPE rooms routinely and at discharge may prevent
drain colonization and reduce CPE transmission risk.
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Identification
Copyright
© 2020 Published by Elsevier Inc.
