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Superbugs breeding in hospital plumbing put patients at risk

Why executives should be concerned enough about the threat they pose to hire an infection control officer.

Beth Jones Sanborn, Managing Editor

Hospital executives not accustomed to thinking a lot about plumbing should take note that drug-resistant organisms frequently consider pipes to be a fertile nest. 

Why this matters: A hospital's rate of hospital-acquired infections is a major metric by which they are judged and potentially penalized, both monetarily and in the court of public opinion. Hospital leaders might do well to consider an investment in an infection control officer, weighing the possibility of a monetary penalty for substandard infection rates versus paying the salary of someone charged solely with preventing them and ensuring patient safety. And according to the CDC each year in the United States at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result of these infections.

[Also: Superbug fungus proves formidable force in U.S. hospitals, is resistant to most drugs that treat it]

Antibiotic-resistant organisms are found on multiple surfaces in hospitals including frequently touched areas like countertops, doorknobs, computers and sinks. According to the study, which was conducted by researchers at the National Institutes of Health in Bethesda, Maryland, now it seems, there are high volumes of them in hospital plumbing as well, according to Science Daily who published the findings. 

The majority of samples studied that came from the pipes and sewers tested positive for bacterial plasmids that transfer and spread to other organisms a resistance to carbapenems, which are "last-resort" antibiotics given to hospital patients who develop infections from multidrug-resistant pathogens. 

It has been suggested that these organisms flourish in waste because of the common use of strong antibiotics in hospitals, leading to an increase in antibiotic-resistant microbes in the sewers. 

"The bacteria fight with each other and plasmids can carry genes that help them survive. As part of a complex bacterial community, they can transfer the plasmids carrying resistance genes to each other," said Karen Frank, NIH Clinical Center hospital Chief of Microbiology, who co-led the study. "That lateral gene transfer means bacteria can gain resistance, even without exposure to the antibiotics."

Frank and her team compared their data to five years' worth of patient data and samples collected from sinks and other high-touch areas, like countertops, door knobs, and computers. Despite a high prevalence of carbapenem-resistant plasmids in the pipes and sewers, areas to which patients had access did not show the same presence. Of 217 samples analyzed from high-touch surfaces, only three tested positive for carbapenem-resistant organisms. Of the 340 samples collected from drains, only 11 were positive.

The findings support the validity and purpose of infection surveillance efforts in reducing the frequency of patient infections. And so does the NIH's own experience with a superbug outbreak. In 2011, the NIH Clinical Center saw an outbreak of infections of a carbapenem-resistant bug called Klebsiella pneumoniae. Researchers traced the transmission of the bug. The hospital plumbing and drains were common sources of the bug as were housekeeping closets. An epidemiologist involved in that effort, Tara Palmore, said that the 2011 NIHCC outbreak spawned increased monitoring of high-risk patients and regular sampling of the hospital environment. Palmore said knowing where the organisms hide gives the hospital a better chance of keeping them away from patients and preventing infection.

Hospital staff should prioritize keeping wastewater, dirty mops and anything else that could spread the germs away from patients, and the NIH has adjusted their own practices accordingly, Frank told NBC News.  

Frank also said every hospital needs an infection control officer.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

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