How Frequently Does Hospitalization of Patients Colonized With Carbapenemase-Producing Enterobacteriaceae Result in Contamination of Hospital Sink Drains?
Bibliographic record
Abstract
Background. There is growing evidence that hospital sinks and drains may be reservoirs for Gram-negative bacteria, which can be transmitted to patients. A report from Toronto implicating a sink drain in transmission of carbapenemase-producing Enterobacteriaceae (CPE) to a hospitalized patient led us to systematically culture sinks after they were exposed to patients colonized with CPE. Methods. At Mount Sinai Hospital (MSH), patients with risk factors for CPE are screened for colonization on admission with rectal swabs. Patients identified as colonized/infected with CPE are managed in private rooms with contact precautions and additional environmental disinfection. Beginning in 2013, we swabbed sink drains and overflows in rooms in which a patient with CPE had been present. Results. From October 2007 to May 2016, 18 patients colonized/infected with CPE have been identified at MSH (some with multiple strains/organisms); 16 were hospitalized including 1 who acquired CPE in hospital. There were 7 Klebsiella spp. (1 KPC, 1 OXA48, 1 NDM, 2 VIM, 2 OXA48 + NDM); 6 E. coli (3 OXA48, 2 NDM, 1 KPC); 3 E. cloacae (1 KPC, 1 VIM, 1 NMC); and 4 other (1 KPC, 1 NDM, 1 VIM, 1 OXA24 + OXA143). Since 2013, 14 hospitalized cases resulted in the exposure of 39 sinks to CPE. Swabs of five (12.8%) of these sinks, exposed to 3 different cases yielded CPE after discharge cleaning [3 E. coli (2 KPC, 1 OXA48); 1 E. cloacae (KPC); and 1 Klebsiella spp. (VIM)]. In all cases, the organism and the enzyme from the sink matched that of the patient previously admitted to the room. The median room exposure was 9 days (range 2–76) for patients whose sinks became contaminated, and 5 days (range 1–81) for patients whose sinks were negative for CPE on discharge (P = 0.56). Targeted cleaning of drains and was not successful in removing CPE. In three cases, removal of the sink drain from outlet to wall resulted in subsequent cultures from the sink being negative. In one sink with an overflow, replacement of the sink was also required before negative cultures were achieved. Another sink with an overflow remained culture negative after steam cleaning. Conclusion. In our hospital, 13% of sink drains were contaminated after exposure to CPE colonized patients. Procedures to protect hospital drains from CPE contamination are needed. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".