The findings based on a superbug outbreak that occurred in Tokyo in 2017. (Representational)
The risk of spread of multidrug-resistant bacteria is highest in hospital sinks, said a study on Thursday.
The findings are based on a multispecies outbreak of superbug carbapenemase-producing Enterobacterales (CPE) that occurred in a paediatric ward at the Toho University Omori Medical Center in Tokyo in 2017.
In the paper, published in the American Journal of Infection Control (AJIC), the team detailed that the first case of CPE was detected in a one-year-old boy hospitalised with cardiac disease in June 2016.
Nine months later in March 2017, a 15-year-old boy became the second to be infected with the deadly superbug.
Subsequently, the outbreak spread to 19 paediatric patients.
On investigation, 9 sinks were identified to be contaminated with CPE.
Of these, 6 were from hospital rooms with CPE-positive patients, and 3 from a nurse centre, a waste room, and an ice machine.
Genomic analysis identified bacterial strains such as "Klebsiella variicola, Klebsiella quasipneumoniae, and Escherichia coli."
Importantly, the CPE contamination continued, even after the team replaced all sinks in the paediatric ward with new ones that were thoroughly disinfected with hydrogen peroxide.
Further, DNA sequences showed that the resistance mechanism could have been passed from one bacterial species to another within the hospital, the team said.
"The discovery of the same bacterial species in sinks in adjoining rooms indicates that pathogen transmission may be possible from one sink to another via the drains and connected plumbing," the team said.
Preventive measures included recommending hand disinfection after using sinks, introducing disposable tools for cleaning sinks, prohibiting mouth-washing with sink water, enacting disinfection and drying procedures for any items exposed to sink water, and more.
The outbreak was finally controlled in October 2017.
"After months of intense infection control protocols, we were at last able to declare an end to this outbreak," said Sadako Yoshizawa, Associate Professor in the Department of Microbiology and Infectious Diseases at Toho University.
"Our experience highlights the importance of focusing on sinks and other water-related areas in hospital wards, as these are critical for CPE transmission and therefore major fronts in the fight against antibiotic resistance," Yoshizawa added.
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