# Efficacy of a foamed disinfectant in reducing pathogen contamination in renovated inpatient in-room sinks: a randomized controlled trial

## TL;DR

A foamed disinfectant significantly reduced pathogen contamination in hospital sinks compared to standard cleaning methods.

## Contribution

Demonstrated that a hydrogen peroxide/peracetic acid foamed disinfectant effectively reduces and delays contamination by multidrug-resistant pathogens in hospital sinks.

## Key findings

- Foamed disinfectant reduced EIP-positive samples from 9% in intervention sinks versus 47% in control sinks.
- Intervention sinks had a delayed time to first pathogen detection compared to control sinks.
- Acinetobacter spp. and Stenotrophomonas spp. were the most frequently detected pathogens.

## Abstract

Hospital sinks are reservoirs for epidemiologically important pathogens (EIPs), yet practical, effective strategies for sustained decontamination are lacking.

We conducted a randomized controlled trial of 30 in-room sinks (15 intervention, 15 control) in a newly renovated hospital unit to evaluate the efficacy of a hydrogen peroxide/peracetic acid foamed disinfectant in reducing sink contamination. Intervention sinks received foamed disinfectant to sink drains three times weekly; control sinks underwent standard daily surface cleaning. Weekly sampling was performed from three sink locations (top surface, tail pipe, P-trap) over 35 weeks. The primary outcome was sink conversion events (SCEs), defined as first detection of ≥1 EIP, defined as Pseudomonas aeruginosa, Stenotrophomonas spp., or Acinetobacter spp., and ESBL-producing or carbapenem-resistant Enterobacterales, in previously negative sinks.

A total of 2880 samples were collected. All sinks were negative at baseline for study pathogens. Nearly all sinks (29/30) experienced an SCE during the study period. However, only 44 (9%) intervention sink samples were positive for EIPs, compared to 270 (47%) in control sinks (p < 0.00001). EIPs were recovered from 4% versus 24% of P-traps and 4% versus 39% of tail pipes; sink top/handle contamination was rare and similar (3% vs 4%). The most frequent EIPs were Acinetobacter spp. and Stenotrophomonas spp. Intervention sinks experienced a delayed time to SCE (p = 0.0001). Items were stored on/in sinks in 93% of observations.

Regular application of a foamed disinfectant reduced and delayed EIP contamination in renovated hospital sinks. Foam-based protocols may help mitigate environmental reservoirs of multidrug-resistant organisms.