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Bacteria in Sinks

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Bacteria in Sinks

Kotay SM, Donlan RM, Ganim C, Barry K, Christensen BE, Mathers AJ. 2019. Droplet

rather than aerosol-mediated dispersion is the primary mechanism of bacterial transmission from

contaminated hand-washing sink traps. Appl Environ Microbiol 85:e01997-18. https://

doi.org/10.1128/AEM.01997-18.

Hospital sinks are a source of antibio-strengthened infections, but the mechanisms of

bacteria dispersal from sinks are little known. The authors try to characterize the dispersion

mechanism, thus helping to inform an appropriate procedure. In particular, the aim is to assess if

aerosolized (<5gm) or droplets (>5gm) particles are the source of the dispersion and what factors

are the cause. Factors that cause spontaneous spraying of aerosols are also investigated.

The authors have attempted to insulate colonization of the plumbing elements to see if

this is a part of the bacterial dispersion. The authors have been colonizing various parts of the

sink plumbing. The water in the P-trap, drain and P-trap plus drain line have been or may have

been inoculated in separate experiments. The sinks could be kept in check for two hours, or they

were activated one time an hour and two hours at the beginning of the experiment. The authors

inoculated the sink plumbing with (GFP)-expressing Escherichia coli to differentiate it from

natural bacteria. The handles and the soap are tested and simulated to wash hands. This

bacterium is not naturally occurring, and green fluorescent colonies can only be colonized from

the sink on a platform.

A variety of methods have been utilized for detecting GFP-E Coli dispersion. First, the

sink, the rough rod and handles and spruce shields were placed on either side of the sink.

Dispersed bacteria can be incubated, and colonies are counted on settle plates during the course

of the experiment. Three different air sampling techniques have simultaneously been applied: (a)
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the impact of air on a plate that forces particles to adhere to a plaque, (b) the impingement of air

in a fluid medium which allows for bacteria to colonize the media, and (c) the filtering of gel in a

gel media, which captures the particles, where the air is filtered.

The authors observed GFP-E. Coli dispersion after the drain and drain line colonization

but not during P-trap inoculation alone. The authors only found GFP-E. Coli in the presence of

faucet events, and especially after the first faucet event at the start of the two-hour experiment.

Following the first faucet event, only a few GFP-E. Coli was found. Importantly, GFP-E. Coli

was not noticed 30 minutes after a faucet event. On settle plates placed on the splatter guards,

very small numbers of GFP-E. Coli was sensed in all cases. The dispersion was ten times lower

in the existence of mannequin hands as measured on settle plates. Still, the authors note that the

faucet will be allowed to run unhindered before and after the handwashing itself during regular

handwashing.

Since GFP-E. Coli was detected only for a short time following an event, and because the

settling plates on the splatter guard were so low, the authors conclude that droplets >5 gm are

responsible for dispersing bacteria. According to prior knowledge, Larger particles settle quickly

due to gravity, whereas smaller particles may remain airborne for a long time and travel longer

distances. In the control group, no spontaneous aerosol production was observed, and no

dispersion was observed between faucet events. The Authors recommend redesigning plumbing

to prevent the water from running directly into the drain, prevent the storage of items in the small

dispersion radius of droplets, prevent sinks from moving away from patient care areas, and

prevent the disposal of nutrients in plumbing.

The authors were able and used newly found knowledge to make recommendations to

determine key factors that govern the dispersion of bacteria from sinks. Furthermore, their results
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on particle size contradict previous assumptions. However, the authors took their own

assumptions as to the duration of certain particle size. The size of GFP E. coli containing

particles could be directly measured by means of a Cascade Impact Air Sampler instead of by the

air impactor of the SAS90. Cascade impacts the 0-sized particles separately, and the presence of

aerosolized particles would have directly been confirmed.

In addition, for the faucet event, the authors used only one water pressure. A range of

pressures can take place in clinical settings and differently affect dispersion. Finally, one kind of

bacteria had been detected by the authors. The dispersion may also be affected by differing

biofilm creations between species. The recommendations made by the authors should be

investigated further. An ambitious study would compare infection rates among hospitals that do

not follow the recommendations.