A systematic comparative review of drain decontamination methods used to remove carbapenemase-producing Enterobacteriaceae and multi-drug-resistant organisms from drainage systems in the clinical environment.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) acquisition and outbreaks in hospitals in the UK has led to an increase in healthcare-associated infection (HCAI), increased mortality and morbidity, longer inpatient stays, blocking of isolation facilities and an increased financial burden. CPE can be transferred within and throughout the clinical environment, with sinks and drains commonly identified as the source of many CPE outbreaks.

OBJECTIVE: The aim of this study was to establish evidence-based recommendations for effective decontamination of drainage systems. Data sources included CINAHL Plus with full text; Medline, PubMed, and Google Scholar.

METHODOLOGY: Boolean-enabled data capture of multiple but refined articles was conducted. Findings were limited to sources that had been peer reviewed, written in English, and published within the past decade. A mixed-method appraisal tool was used to identify and appraise findings. The research question was structured using the Population, Intervention, Comparison, Outcome framework, and the data analysis was conducted through a thematic/narrative inductive approach.

RESULTS: Twenty-eight studies were included in this review. peracetic acid and other chemical/thermal disinfection methods can remove CPE from hospital drains but only for short periods of time. Conversely, it seems that CPE cannot be removed from the drainage system as a whole. The use of bundle approaches during outbreak situations are likely to be of benefit. The removal of sinks from patient rooms and providing water safe care can demonstrate a reduction in HCAI.

CONCLUSION: There are suitable but not sustainable methods to remove CPE from hospital sinks and drainage systems.