Our efforts to reduce hospital acquired infections (HAIs) may have hit a challenging conundrum. On the one hand, we know that handwashing is essential to break the chain of transmission from infected (or colonized) host to vulnerable patient. On the other hand, one of the key tools in facilitating handwashing has recently demonstrated to play a role in transmitting pathogens. That tool? The sink. Many think sinks are beginning to tip the balance toward doing more harm than good.
Sinks are by their very nature perfect places for pathogens to flourish and spread. Wet and dark, they provide ample space for pathogens to set up shop. Add to that a regular stream of nutrients in the form of soaps, organic debris, poured out drinks and even leftover IV fluid, and sinks provide microorganisms everything they could ever desire in life. Thanks to recent studies into the way sink pathogens grow, spread, and contaminate the patient's environment, researchers are urging design changes that could make sinks tip the balance more in favor of doing more good than harm. While these are not yet requirements under building codes, leaders in healthcare design have put them in their most recent guidelines.
Avoiding splashes is the main goal of 4 of these goals. Since the sink harbors pathogens, any splashes that land outside of the basin bring potentially disease-causing pathogens into the patient environment.
#1 Offset Faucets | Faucets that aim water directly onto the strainer over the drain tend to splash more. By simply offsetting the faucet from the drain, you can reduce the amount of splashing.
#2 Deep Basin | A deep basin means that splashes are caught by the basin before entering the patient environment.
#3 Sloped Basin | Splashes can be further minimized by having the water stream hit a sloped surface that tilts towards the drain. This helps direct any splashing towards the back of the sink.
#4 Proper Placement | Sinks should be placed where healthcare workers can see and access them easily, but they should be kept as far away from the patient as feasible. Additionally, the area around the sink should not encourage using the sink for storage. If the sink must be connected to a storage or work area, barriers should be installed.
But what if we could also reduce sink contamination at the source? A less-contaminated sink basin means less risk from splashes.
#5 Biocidal Materials | The final design change that would make sinks safer would be to fabricate the basin itself from a material that can actively and continuously kill bacteria. With a biocidal sink, any bacteria on the basin would be killed in under 2 hours, meaning less bioburden to be picked up and splashed by water in the first place. Research has even proven that biocidal surfaces maintain an 80% reduced bioburden between routine cleanings, staying below 200 CFU without any human intervention at all. The implications of this suggest a biocidal basin is worth considering.
With a few changes, sinks can go from being a potential threat to patients and return to their original role as a key tool in preventing HAIs. While this type of change might take time - time for designers to become aware of new products as well as systems having the time and resources to retrofit sinks - it is a change that could have significant impact on patient outcomes.
Editor's Note: This post was originally published in May 2019 and has been updated for freshness, accuracy and comprehensiveness.