We recently received a question from a major hospital that I thought was interesting.
“There is compelling evidence that sink drains are a source of multi-drug resistant gram negatives in hospitals, and we need to think carefully about sink placement. Therefore, hand wash sinks should be located in hallways, not in patient rooms.”
To help, I reached out to a number of experts and received the following observations. (NOTE: I have not tried to verify them, at this point; I am just reporting on them.):
1. At least one study shows that removal of sinks from patient rooms in an ICU was associated with reduced colonization of Gram negative bacilli. As far as we can tell, no other studies show a difference in compliance with sinks in the hall or in the patient room. (Side-note, I am interested in working with a facility who may have both installations to observe behaviors and see if there is a difference – contact me!)
2. Deeper sinks (how deep??) reduces the potential for splashing, and, in general, installations with deeper sinks may have fewer problems with waterborne pathogens, and may be the critical variable in preventing spread of disease (rather than sink location).
3. Another factor for splash control is the water pressure coupled with the surface that the water strikes (striking the drain was worse than striking the bottom of the sink).
4. Hand-washing observations are easier with the sinks in the corridor instead of in the rooms.
5. Another factor to consider is location of the alcohol-based hand rub (ABHR) but not sink location.
6. Water splash in the corridor may create increased slip and fall risk.
7. Sometimes, water washing is necessary, and ABHR is not a replacement.
8. Proximity of hand wash facilities to the patient, all else equal, improves hand wash adherence. (NOTE: The studies I have on this have to do with distance between patient and sink in the same room, not between in room and out of room, which, though intuitive, also introduces a confounding variable that may be significant.)
At this point, I am unsure what to conclude with this information. I’m just an engineer, but it does seem to me that the unmistakable trajectory of these observations would incline me to recommend hallway sinks, immediately adjacent to the patient room, and designing them to prevent splashing, with an ABHR at the footwall of the patient room.
I would be curious to see what others think about this, and whether the evidence to date is strong enough to warrant (a) any future proposals to the Fundamentals (we are evidence-advised, and we want to improve quality of care) or (b) Beyond Fundamentals paper.
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