Abstract：
OBJECTIVE: The hospital water environment is an important reservoir of multidrug-resistant organisms (MDROs) and presents a risk for patient safety. We assessed the effectiveness of thermal and chemical interventions on sinks contaminated with MDRO in the hospital setting.
METHODS: We conducted a cross-sectional assessment of MDRO contamination of sinks and toilets in 26 clinical wards of a tertiary care hospital. MDRO-contaminated sink traps were then replaced and randomized (1:1:1) to receive chemical (sodium hypochlorite), thermal disinfection (steam), or no intervention. Interventions were repeated weekly for 4 weeks. Sinks were resampled 7 days after the last intervention. The primary outcome was the proportion of decontaminated sinks. MDROs of interest were extended spectrum beta-lactamase (ESBL) producing and carbapenemase-producing Enterobacterales, and non-fermentative Gram-negative bacilli.
RESULTS: In the cross-sectional assessment, at least one MDRO was identified in 258 (36%) of the 748 samples and in 91 (47%) of the 192 water sources. In total, 57 (42%) of the 137 sinks and 34 (62%) of the 55 toilets were contaminated with 137 different MDROs. The most common MDRO were ESBL Enterobacterales (69%, 95/137), followed by Verona Integron-Borne Metallo-β-Lactamase (VIM) carbapenemase producing Pseudomonas aeruginosa (9%, 12/137) and Citrobacter spp. (6%, 5/137). In the nested randomized trial, five of the 16 sinks (31%) in the chemical disinfection group were decontaminated, compared with 8 of 18 (44%) in the control group (OR 0.58; 95% CI, 0.14-2.32) and 9 of 17 (53%) in the thermal disinfection group (OR 1.40; 95% CI, 0.37-5.32).
CONCLUSIONS: Our study failed to demonstrate an added benefit of repeated chemical or thermal disinfection, beyond changing sink traps, in the MDRO decontamination of sinks. Routine chlorine-based disinfection of sinks may need to be reconsidered.
METHODS: We conducted a cross-sectional assessment of MDRO contamination of sinks and toilets in 26 clinical wards of a tertiary care hospital. MDRO-contaminated sink traps were then replaced and randomized (1:1:1) to receive chemical (sodium hypochlorite), thermal disinfection (steam), or no intervention. Interventions were repeated weekly for 4 weeks. Sinks were resampled 7 days after the last intervention. The primary outcome was the proportion of decontaminated sinks. MDROs of interest were extended spectrum beta-lactamase (ESBL) producing and carbapenemase-producing Enterobacterales, and non-fermentative Gram-negative bacilli.
RESULTS: In the cross-sectional assessment, at least one MDRO was identified in 258 (36%) of the 748 samples and in 91 (47%) of the 192 water sources. In total, 57 (42%) of the 137 sinks and 34 (62%) of the 55 toilets were contaminated with 137 different MDROs. The most common MDRO were ESBL Enterobacterales (69%, 95/137), followed by Verona Integron-Borne Metallo-β-Lactamase (VIM) carbapenemase producing Pseudomonas aeruginosa (9%, 12/137) and Citrobacter spp. (6%, 5/137). In the nested randomized trial, five of the 16 sinks (31%) in the chemical disinfection group were decontaminated, compared with 8 of 18 (44%) in the control group (OR 0.58; 95% CI, 0.14-2.32) and 9 of 17 (53%) in the thermal disinfection group (OR 1.40; 95% CI, 0.37-5.32).
CONCLUSIONS: Our study failed to demonstrate an added benefit of repeated chemical or thermal disinfection, beyond changing sink traps, in the MDRO decontamination of sinks. Routine chlorine-based disinfection of sinks may need to be reconsidered.
摘要：
目的：医院水环境是多药耐药菌（MDRO）的重要储存库，对患者安全构成风险。我们评估了在医院环境中对受MDRO污染的水槽进行热和化学干预的有效性。
方法：我们对三级医院26个临床病房的水槽和厕所的MDRO污染进行了横断面评估。然后更换受MDRO污染的水槽捕集器，并随机（1：1：1）接收化学品（次氯酸钠），热消毒（蒸汽），或者不干预。每周重复干预4周。在最后一次干预后七天，对水槽进行了重新采样。主要结果是净化汇的比例。感兴趣的MDRO是产超广谱β-内酰胺酶和产碳青霉烯酶的肠杆菌，和非发酵革兰氏阴性杆菌。
结果：在横断面评估中，在748个样品中的258个（36％）和192个水源中的91个（47％）中至少鉴定出了一个MDRO。总的来说,137个水槽中的57个（42％）和55个厕所中的34个（62％）被137个不同的MDRO污染。最常见的MDRO是产生ESBL的肠杆菌(69%，95/137），其次是产生VIM的铜绿假单胞菌(9%，12/137）和柠檬酸杆菌属。(6%,5/137）。在嵌套随机试验中，化学消毒组16个水槽中的5个(31%)被净化，对照组18人中有8人(44%)(OR0.58,95CI0.14-2.32)和热消毒组17人中有9人(53%)(OR1.40,95CI0.37-5.32).
结论：我们的研究未能证明重复化学或热消毒的额外益处，除了改变水槽陷阱，在MDRO净化水槽中。可能需要重新考虑对水槽进行常规的基于氯的消毒。
方法：我们对三级医院26个临床病房的水槽和厕所的MDRO污染进行了横断面评估。然后更换受MDRO污染的水槽捕集器，并随机（1：1：1）接收化学品（次氯酸钠），热消毒（蒸汽），或者不干预。每周重复干预4周。在最后一次干预后七天，对水槽进行了重新采样。主要结果是净化汇的比例。感兴趣的MDRO是产超广谱β-内酰胺酶和产碳青霉烯酶的肠杆菌，和非发酵革兰氏阴性杆菌。
结果：在横断面评估中，在748个样品中的258个（36％）和192个水源中的91个（47％）中至少鉴定出了一个MDRO。总的来说,137个水槽中的57个（42％）和55个厕所中的34个（62％）被137个不同的MDRO污染。最常见的MDRO是产生ESBL的肠杆菌(69%，95/137），其次是产生VIM的铜绿假单胞菌(9%，12/137）和柠檬酸杆菌属。(6%,5/137）。在嵌套随机试验中，化学消毒组16个水槽中的5个(31%)被净化，对照组18人中有8人(44%)(OR0.58,95CI0.14-2.32)和热消毒组17人中有9人(53%)(OR1.40,95CI0.37-5.32).
结论：我们的研究未能证明重复化学或热消毒的额外益处，除了改变水槽陷阱，在MDRO净化水槽中。可能需要重新考虑对水槽进行常规的基于氯的消毒。
