Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in twenty-nine UK hospitals

The SinkBug Consortium

doi:10.1016/j.jhin.2025.02.002

Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in twenty-nine UK hospitals

The SinkBug Consortium

Research output: Contribution to journal › Article › peer-review

2 Citations (SciVal)

Abstract

Background: Hospital sinks are linked to healthcare-associated infections. Antibiotics and chemicals in sink traps can select for pathogens and antimicrobial resistance (AMR). Optimizing sink design and usage can mitigate sink-to-patient dissemination of pathogens. Aim: To perform a large-scale survey of hospital sink infrastructure. Methods: Twenty-nine UK hospitals submitted photos and metadata for sinks across three wards (intensive care unit (ICU)/medical/surgical; January–March 2023). Photos were used to classify sink design as ‘optimal’ according to guidelines and published studies. Sink trap aspirates were dipstick-tested for antibiotics and chemistry. Logistic regression was used to characterize associations of ward type and sink location with optimal sink design or detectable trap antibiotics. Findings: Of 287 sinks surveyed, 111 were in ICUs, 92 in medical wards, and 84 in surgical wards; 77 were in medicines/drug preparation rooms, 97 on patient bays, 25 in patient side-rooms, and 88 in sluice rooms. Sink-to-bed ratios ranged from 0.23 to 2.83 sinks per patient bed and were higher on ICUs (1.21 versus 0.82 and 0.84 on medical and surgical wards, respectively; P = 0.04). The median sink-to-patient distance was 1.5 m (interquartile range: 1.00–2.21 m). Sink design varied widely; it was deemed ‘optimal’ for 65/122 (53%) sinks in patient bays/side-rooms and ‘optimal’ design was associated with side-room location (P = 0.03). Antibiotics were detected in 95/287 (33%) sink traps and were associated with medicines/drug preparation rooms (P <0.001). Sink trap chemicals detected included metals, chlorine, and fluoride. Conclusion: Sinks are common in hospitals, frequently close to patients, and often sub-optimally designed. Commonly used antibiotics were detected in a third of sink traps and may contribute to the selection of pathogens and AMR in these reservoirs, and subsequent transmission to patients.

Original language	English
Pages (from-to)	140-147
Number of pages	8
Journal	Journal of Hospital Infection
Volume	159
Early online date	15 Feb 2025
DOIs	https://doi.org/10.1016/j.jhin.2025.02.002
Publication status	Published - 31 May 2025

Bibliographical note

Publisher Copyright:
© 2025 The Authors

Acknowledgements

We are grateful to all the participating hospitals and the NITCAR committee for enabling the study, and to K. Arunachalam, N. Forbes, S. Fudge, L. Gargee, M. Kyffin, A. Maxwell, H. Reddy, and J. Vasant. We also wish to make a special acknowledgement of the work and contribution of Dr A. Bali.

Funding

This study was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance (NIHR200915), a partnership between the UK Health Security Agency (UKHSA) and the University of Oxford, and was supported by the NIHR Oxford Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NIHR, UKHSA or the Department of Health and Social Care.

Keywords

Antibiotics
Antimicrobial resistance
Hospital-associated infection
Sink design
Sink drains
Sinks

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jhin.2025.02.002Licence: CC BY

Cite this

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title = "Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in twenty-nine UK hospitals",

abstract = "Background: Hospital sinks are linked to healthcare-associated infections. Antibiotics and chemicals in sink traps can select for pathogens and antimicrobial resistance (AMR). Optimizing sink design and usage can mitigate sink-to-patient dissemination of pathogens. Aim: To perform a large-scale survey of hospital sink infrastructure. Methods: Twenty-nine UK hospitals submitted photos and metadata for sinks across three wards (intensive care unit (ICU)/medical/surgical; January–March 2023). Photos were used to classify sink design as {\textquoteleft}optimal{\textquoteright} according to guidelines and published studies. Sink trap aspirates were dipstick-tested for antibiotics and chemistry. Logistic regression was used to characterize associations of ward type and sink location with optimal sink design or detectable trap antibiotics. Findings: Of 287 sinks surveyed, 111 were in ICUs, 92 in medical wards, and 84 in surgical wards; 77 were in medicines/drug preparation rooms, 97 on patient bays, 25 in patient side-rooms, and 88 in sluice rooms. Sink-to-bed ratios ranged from 0.23 to 2.83 sinks per patient bed and were higher on ICUs (1.21 versus 0.82 and 0.84 on medical and surgical wards, respectively; P = 0.04). The median sink-to-patient distance was 1.5 m (interquartile range: 1.00–2.21 m). Sink design varied widely; it was deemed {\textquoteleft}optimal{\textquoteright} for 65/122 (53\%) sinks in patient bays/side-rooms and {\textquoteleft}optimal{\textquoteright} design was associated with side-room location (P = 0.03). Antibiotics were detected in 95/287 (33\%) sink traps and were associated with medicines/drug preparation rooms (P <0.001). Sink trap chemicals detected included metals, chlorine, and fluoride. Conclusion: Sinks are common in hospitals, frequently close to patients, and often sub-optimally designed. Commonly used antibiotics were detected in a third of sink traps and may contribute to the selection of pathogens and AMR in these reservoirs, and subsequent transmission to patients.",

keywords = "Antibiotics, Antimicrobial resistance, Hospital-associated infection, Sink design, Sink drains, Sinks",

author = "\{The SinkBug Consortium\} and G. Rodger and Chau, \{K. K.\} and Bou, \{P. Aranega\} and G. Moore and A. Roohi and Shrikant Ambalkar and Kashif Aziz and Vhairi Bateman and Kevin Bertram and Emily Broadwell and Dominique Chaput and Rinkuvijay Chourasia and Carly Clare and Alan Cordey and Chris Darlow and Michael Dibbens and Vilde Dietz and Catherine Edwards and Vicki Fleming and Simon Goldenberg and Callum Goolden and Clive Graham and Anna Green and Hudson Guyver and Fenella Halstead and Tom Harrison and Lauren Hookham and Katie Hopkins and Susan Hopkins and Gareth Hughes and Wendy Ibbotson and Davies, \{Rhys John\} and Alison Johnson and Claire Johnston and Eben Jones and Sharon Jose and Justin Joy and Aleksandra Marek and William Matlock and Damian Mawer and Alex May and Ciaran Mooney and Alison Muir and Clemency Nye and Ijeoma Okoliegbe and Benjamin Parcell and Suzanna Paterson and Emma Pritchard and Lorna Wilson and Walker, \{A. S.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = may,

day = "31",

doi = "10.1016/j.jhin.2025.02.002",

language = "English",

volume = "159",

pages = "140--147",

journal = "Journal of Hospital Infection",

issn = "0195-6701",

publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in twenty-nine UK hospitals

AU - The SinkBug Consortium

AU - Rodger, G.

AU - Chau, K. K.

AU - Bou, P. Aranega

AU - Moore, G.

AU - Roohi, A.

AU - Ambalkar, Shrikant

AU - Aziz, Kashif

AU - Bateman, Vhairi

AU - Bertram, Kevin

AU - Broadwell, Emily

AU - Chaput, Dominique

AU - Chourasia, Rinkuvijay

AU - Clare, Carly

AU - Cordey, Alan

AU - Darlow, Chris

AU - Dibbens, Michael

AU - Dietz, Vilde

AU - Edwards, Catherine

AU - Fleming, Vicki

AU - Goldenberg, Simon

AU - Goolden, Callum

AU - Graham, Clive

AU - Green, Anna

AU - Guyver, Hudson

AU - Halstead, Fenella

AU - Harrison, Tom

AU - Hookham, Lauren

AU - Hopkins, Katie

AU - Hopkins, Susan

AU - Hughes, Gareth

AU - Ibbotson, Wendy

AU - Davies, Rhys John

AU - Johnson, Alison

AU - Johnston, Claire

AU - Jones, Eben

AU - Jose, Sharon

AU - Joy, Justin

AU - Marek, Aleksandra

AU - Matlock, William

AU - Mawer, Damian

AU - May, Alex

AU - Mooney, Ciaran

AU - Muir, Alison

AU - Nye, Clemency

AU - Okoliegbe, Ijeoma

AU - Parcell, Benjamin

AU - Paterson, Suzanna

AU - Pritchard, Emma

AU - Wilson, Lorna

AU - Walker, A. S.

PY - 2025/5/31

Y1 - 2025/5/31

N2 - Background: Hospital sinks are linked to healthcare-associated infections. Antibiotics and chemicals in sink traps can select for pathogens and antimicrobial resistance (AMR). Optimizing sink design and usage can mitigate sink-to-patient dissemination of pathogens. Aim: To perform a large-scale survey of hospital sink infrastructure. Methods: Twenty-nine UK hospitals submitted photos and metadata for sinks across three wards (intensive care unit (ICU)/medical/surgical; January–March 2023). Photos were used to classify sink design as ‘optimal’ according to guidelines and published studies. Sink trap aspirates were dipstick-tested for antibiotics and chemistry. Logistic regression was used to characterize associations of ward type and sink location with optimal sink design or detectable trap antibiotics. Findings: Of 287 sinks surveyed, 111 were in ICUs, 92 in medical wards, and 84 in surgical wards; 77 were in medicines/drug preparation rooms, 97 on patient bays, 25 in patient side-rooms, and 88 in sluice rooms. Sink-to-bed ratios ranged from 0.23 to 2.83 sinks per patient bed and were higher on ICUs (1.21 versus 0.82 and 0.84 on medical and surgical wards, respectively; P = 0.04). The median sink-to-patient distance was 1.5 m (interquartile range: 1.00–2.21 m). Sink design varied widely; it was deemed ‘optimal’ for 65/122 (53%) sinks in patient bays/side-rooms and ‘optimal’ design was associated with side-room location (P = 0.03). Antibiotics were detected in 95/287 (33%) sink traps and were associated with medicines/drug preparation rooms (P <0.001). Sink trap chemicals detected included metals, chlorine, and fluoride. Conclusion: Sinks are common in hospitals, frequently close to patients, and often sub-optimally designed. Commonly used antibiotics were detected in a third of sink traps and may contribute to the selection of pathogens and AMR in these reservoirs, and subsequent transmission to patients.

AB - Background: Hospital sinks are linked to healthcare-associated infections. Antibiotics and chemicals in sink traps can select for pathogens and antimicrobial resistance (AMR). Optimizing sink design and usage can mitigate sink-to-patient dissemination of pathogens. Aim: To perform a large-scale survey of hospital sink infrastructure. Methods: Twenty-nine UK hospitals submitted photos and metadata for sinks across three wards (intensive care unit (ICU)/medical/surgical; January–March 2023). Photos were used to classify sink design as ‘optimal’ according to guidelines and published studies. Sink trap aspirates were dipstick-tested for antibiotics and chemistry. Logistic regression was used to characterize associations of ward type and sink location with optimal sink design or detectable trap antibiotics. Findings: Of 287 sinks surveyed, 111 were in ICUs, 92 in medical wards, and 84 in surgical wards; 77 were in medicines/drug preparation rooms, 97 on patient bays, 25 in patient side-rooms, and 88 in sluice rooms. Sink-to-bed ratios ranged from 0.23 to 2.83 sinks per patient bed and were higher on ICUs (1.21 versus 0.82 and 0.84 on medical and surgical wards, respectively; P = 0.04). The median sink-to-patient distance was 1.5 m (interquartile range: 1.00–2.21 m). Sink design varied widely; it was deemed ‘optimal’ for 65/122 (53%) sinks in patient bays/side-rooms and ‘optimal’ design was associated with side-room location (P = 0.03). Antibiotics were detected in 95/287 (33%) sink traps and were associated with medicines/drug preparation rooms (P <0.001). Sink trap chemicals detected included metals, chlorine, and fluoride. Conclusion: Sinks are common in hospitals, frequently close to patients, and often sub-optimally designed. Commonly used antibiotics were detected in a third of sink traps and may contribute to the selection of pathogens and AMR in these reservoirs, and subsequent transmission to patients.

KW - Antibiotics

KW - Antimicrobial resistance

KW - Hospital-associated infection

KW - Sink design

KW - Sink drains

KW - Sinks

UR - https://www.scopus.com/pages/publications/105003134920

U2 - 10.1016/j.jhin.2025.02.002

DO - 10.1016/j.jhin.2025.02.002

M3 - Article

SN - 0195-6701

VL - 159

SP - 140

EP - 147

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

ER -

Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in twenty-nine UK hospitals

Abstract

Bibliographical note

Acknowledgements

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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Cite this