Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in twenty-nine UK hospitals

TY - JOUR

T1 - Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in twenty-nine UK hospitals

AU - Rodger, G.

AU - Chau, K. K.

AU - Bou, P. Aranega

AU - Moore, G.

AU - Roohi, A.

AU - Ambalkar, Shrikant

AU - Aziz, Kashif

AU - Bateman, Vhairi

AU - Bertram, Kevin

AU - Broadwell, Emily

AU - Chaput, Dominique

AU - Chourasia, Rinkuvijay

AU - Clare, Carly

AU - Cordey, Alan

AU - Darlow, Chris

AU - Dibbens, Michael

AU - Dietz, Vilde

AU - Edwards, Catherine

AU - Fleming, Vicki

AU - Goldenberg, Simon

AU - Goolden, Callum

AU - Graham, Clive

AU - Green, Anna

AU - Guyver, Hudson

AU - Halstead, Fenella

AU - Harrison, Tom

AU - Hookham, Lauren

AU - Hopkins, Katie

AU - Hopkins, Susan

AU - Hughes, Gareth

AU - Ibbotson, Wendy

AU - Davies, Rhys John

AU - Johnson, Alison

AU - Johnston, Claire

AU - Jones, Eben

AU - Jose, Sharon

AU - Joy, Justin

AU - Marek, Aleksandra

AU - Matlock, William

AU - Mawer, Damian

AU - May, Alex

AU - Mooney, Ciaran

AU - Muir, Alison

AU - Nye, Clemency

AU - Okoliegbe, Ijeoma

AU - Parcell, Benjamin

AU - Paterson, Suzanna

AU - Pritchard, Emma

AU - Wilson, Lorna

AU - Walker, Sarah

AU - Stoesser, Nicole

N1 - Publisher Copyright: © 2025 The Authors

PY - 2025/4/22

Y1 - 2025/4/22

N2 - Background: Hospital sinks are linked to healthcare-associated infections. Antibiotics and chemicals in sink traps can select for pathogens and antimicrobial resistance (AMR). Optimizing sink design and usage can mitigate sink-to-patient dissemination of pathogens. Aim: To perform a large-scale survey of hospital sink infrastructure. Methods: Twenty-nine UK hospitals submitted photos and metadata for sinks across three wards (intensive care unit (ICU)/medical/surgical; January–March 2023). Photos were used to classify sink design as ‘optimal’ according to guidelines and published studies. Sink trap aspirates were dipstick-tested for antibiotics and chemistry. Logistic regression was used to characterize associations of ward type and sink location with optimal sink design or detectable trap antibiotics. Findings: Of 287 sinks surveyed, 111 were in ICUs, 92 in medical wards, and 84 in surgical wards; 77 were in medicines/drug preparation rooms, 97 on patient bays, 25 in patient side-rooms, and 88 in sluice rooms. Sink-to-bed ratios ranged from 0.23 to 2.83 sinks per patient bed and were higher on ICUs (1.21 versus 0.82 and 0.84 on medical and surgical wards, respectively; P = 0.04). The median sink-to-patient distance was 1.5 m (interquartile range: 1.00–2.21 m). Sink design varied widely; it was deemed ‘optimal’ for 65/122 (53%) sinks in patient bays/side-rooms and ‘optimal’ design was associated with side-room location (P = 0.03). Antibiotics were detected in 95/287 (33%) sink traps and were associated with medicines/drug preparation rooms (P <0.001). Sink trap chemicals detected included metals, chlorine, and fluoride. Conclusion: Sinks are common in hospitals, frequently close to patients, and often sub-optimally designed. Commonly used antibiotics were detected in a third of sink traps and may contribute to the selection of pathogens and AMR in these reservoirs, and subsequent transmission to patients.

AB - Background: Hospital sinks are linked to healthcare-associated infections. Antibiotics and chemicals in sink traps can select for pathogens and antimicrobial resistance (AMR). Optimizing sink design and usage can mitigate sink-to-patient dissemination of pathogens. Aim: To perform a large-scale survey of hospital sink infrastructure. Methods: Twenty-nine UK hospitals submitted photos and metadata for sinks across three wards (intensive care unit (ICU)/medical/surgical; January–March 2023). Photos were used to classify sink design as ‘optimal’ according to guidelines and published studies. Sink trap aspirates were dipstick-tested for antibiotics and chemistry. Logistic regression was used to characterize associations of ward type and sink location with optimal sink design or detectable trap antibiotics. Findings: Of 287 sinks surveyed, 111 were in ICUs, 92 in medical wards, and 84 in surgical wards; 77 were in medicines/drug preparation rooms, 97 on patient bays, 25 in patient side-rooms, and 88 in sluice rooms. Sink-to-bed ratios ranged from 0.23 to 2.83 sinks per patient bed and were higher on ICUs (1.21 versus 0.82 and 0.84 on medical and surgical wards, respectively; P = 0.04). The median sink-to-patient distance was 1.5 m (interquartile range: 1.00–2.21 m). Sink design varied widely; it was deemed ‘optimal’ for 65/122 (53%) sinks in patient bays/side-rooms and ‘optimal’ design was associated with side-room location (P = 0.03). Antibiotics were detected in 95/287 (33%) sink traps and were associated with medicines/drug preparation rooms (P <0.001). Sink trap chemicals detected included metals, chlorine, and fluoride. Conclusion: Sinks are common in hospitals, frequently close to patients, and often sub-optimally designed. Commonly used antibiotics were detected in a third of sink traps and may contribute to the selection of pathogens and AMR in these reservoirs, and subsequent transmission to patients.

KW - Antibiotics

KW - Antimicrobial resistance

KW - Hospital-associated infection

KW - Sink design

KW - Sink drains

KW - Sinks

UR - https://www.scopus.com/pages/publications/105003134920

U2 - 10.1016/j.jhin.2025.02.002

DO - 10.1016/j.jhin.2025.02.002

M3 - Article

C2 - 39961513

AN - SCOPUS:105003134920

SN - 0195-6701

VL - 159

SP - 140

EP - 147

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

ER -