Sink Drains in a Neonatal Intensive Care Unit: A Retrospective Risk Assessment and Evaluation

Area of Science:

• Healthcare-associated infections
• Microbiology
• Hospital infrastructure safety

Background:

• Water systems in healthcare facilities can harbor Gram-negative bacteria.
• Neonatal intensive care units (NICUs) are particularly vulnerable to hospital-acquired infections.
• Sink drains represent a potential reservoir for pathogenic bacteria in clinical environments.

Purpose of the Study:

• To retrospectively evaluate the risks associated with water-diverting systems, specifically sink drains, in a neonatal intensive care unit (NICU).
• To investigate the potential link between sink drains and nosocomial bacterial cluster events in a tertiary care hospital's NICU.
• To inform construction planning for new NICUs regarding patient safety and infection control.

Main Methods:

• Retrospective analysis of nosocomial cluster events in an existing NICU from 2017 to 2023.
• Identification and confirmation of Gram-negative bacterial clusters using clinical screening, whole-genome sequencing, and core genome multilocus sequence typing (cgMLST).
• Evaluation of the role of sink drains as a potential source of bacterial transmission.

Main Results:

• Nine nosocomial cluster events involving bacterial pathogens were recorded in the NICU between 2017 and 2023.
• Three Gram-negative bacterial clusters, including *Klebsiella oxytoca*, *Pseudomonas aeruginosa*, and *Enterobacter hormaechei*, were potentially linked to sink drains.
• Whole-genome sequencing and cgMLST confirmed the clonal relationship within these bacterial clusters.

Conclusions:

• Implementation of sink drains in NICUs can negatively impact patient safety due to potential bacterial reservoirs.
• Avoiding washbasins within patient rooms during the design or redesign of sensitive areas like NICUs is recommended.
• This study underscores the importance of infrastructure design in preventing healthcare-associated infections in vulnerable patient populations.