Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs
Open Access
- 15 April 2017
- journal article
- research article
- Published by American Society for Microbiology in Applied and Environmental Microbiology
- Vol. 83 (8)
- https://doi.org/10.1128/aem.03327-16
Abstract
There have been an increasing number of reports implicating Gammaproteobacteria as often carrying genes of drug resistance from colonized sink traps to vulnerable hospitalized patients. However, the mechanism of transmission from the wastewater of the sink P-trap to patients remains poorly understood. Herein we report the use of a designated hand-washing sink lab gallery to model dispersion of green fluorescent protein (GFP)-expressing Escherichia coli from sink wastewater to the surrounding environment. We found no dispersion of GFP-expressing E. coli directly from the P-trap to the sink basin or surrounding countertop with coincident water flow from a faucet. However, when the GFP-expressing E. coli cells were allowed to mature in the P-trap under conditions similar to those in a hospital environment, a GFP-expressing E. coli-containing putative biofilm extended upward over 7 days to reach the strainer. This subsequently resulted in droplet dispersion to the surrounding areas (IMPORTANCE Many recent reports demonstrate that sink drain pipes become colonized with highly consequential multidrug-resistant bacteria, which then results in hospital-acquired infections. However, the mechanism of dispersal of bacteria from the sink to patients has not been fully elucidated. Through establishment of a unique sink gallery, this work found that a staged mode of transmission involving biofilm growth from the lower pipe to the sink strainer and subsequent splatter to the bowl and surrounding area occurs rather than splatter directly from the water in the lower pipe. We have also demonstrated that bacterial transmission can occur via connections in wastewater plumbing to neighboring sinks. This work helps to more clearly define the mechanism and risk of transmission from a wastewater source to hospitalized patients in a world with increasingly antibiotic-resistant bacteria that can thrive in wastewater environments and cause infections in vulnerable patients.Keywords
This publication has 44 references indexed in Scilit:
- A Long-Term Low-Frequency Hospital Outbreak of KPC-Producing Klebsiella pneumoniae Involving Intergenus Plasmid Diffusion and a Persisting Environmental ReservoirPLOS ONE, 2013
- Outbreak of Extended-Spectrum β-Lactamase–producingKlebsiella oxytocaInfections Associated with Contaminated Handwashing Sinks1Emerging Infectious Diseases, 2012
- Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unitJournal of Hospital Infection, 2012
- Evaluating hygienic cleaning in health care settings: What you do not know can harm your patientsAmerican Journal of Infection Control, 2010
- Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter speciesAmerican Journal of Infection Control, 2010
- Management of a multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit using novel environmental disinfection: A 38-month reportAmerican Journal of Infection Control, 2010
- Outbreak of Multidrug-ResistantPseudomonas aeruginosaColonization and Infection Secondary to Imperfect Intensive Care Unit Room DesignInfection Control & Hospital Epidemiology, 2009
- Multi-zone modeling of probable SARS virus transmission by airflow between flats in Block E, Amoy GardensIndoor Air, 2004
- Microbial Characterization of Biofilms in Domestic Drains and the Establishment of Stable Biofilm MicrocosmsApplied and Environmental Microbiology, 2003
- Pseudomonas in the sinks in an intensive care unit: relation to patients.Journal of Clinical Pathology, 1984