Why infection prevention is often just out of reach
Carbapenemase‑Producing Enterobacterales (CPE) bacteria are an increasingly serious concern in Canadian hospitals and long-term care facilities. They produce an enzyme that break down antibiotics, including ‘last resort’ carbapenem antibiotics, leaving very few treatment options for infected individuals.
Unfortunately, for those with severe infections, mortality rates can reach upwards of 50%. Due to the potentially fatal risk of this bacteria, proper infection prevention is critical to stop the spread and save lives.
How It Spreads
Enterobacterales are a family of bacteria, many of which are naturally occurring in our intestines. Most people carrying CPE are asymptomatic but are considered ‘colonized’, meaning the bacteria is present in their body without causing illness. They can easily spread the bacteria to others if proper hygiene protocols aren’t followed, posing a serious risk for immunocompromised patients in healthcare settings. Colonization can last for weeks or in some cases years, making healthcare decisions on discharge, isolation, and transfers difficult.
The good news is, CPE is relatively easy to kill when it’s outside the body. Routine disinfection and hand-hygiene are the best defense to prevent the spread. But one growing problem in CPE infection prevention comes from somewhere you might not expect.
Where It Spreads
Sink and shower drains create moist environments where biofilms form. Biofilms are resistant to standard cleaning and can harbour CPE for extended periods of time – making drains an important and often understated risk.
CPE makes its way into drains through improper disposal of contaminated liquids such as saliva and patient waste or by washing contaminated hands. While CPE is not airborne, washing hands over a contaminated drain can aerosolize bacteria into droplets, spreading it to surrounding surfaces or back onto hands during the process of washing.
This means a contaminated drain can repeatedly contaminate an otherwise clean space or person.
The Importance of Drain Maintenance
Routine drain maintenance removes a critical source of potential infection from healthcare environments. The goal is to remove biofilm, which in turn eliminates CPE. While there are multiple methods of removal, there’re not equally effective.
| Method | Pros | Cons |
| Brushing | Removes surface organic matter to allow for further cleaning and disinfection. | Potential splashes during cleaning. Cleaning and disinfection of surrounding area required after brushing. |
| Liquid Chemical Disinfection | Can kill surface organisms. | Insufficient contact time. Biofilm not removed. |
| Gel Chemical Disinfection | Improved contact time and can kill surface organisms. | Biofilm not removed. |
| Foam Chemical Disinfection | Controlled contact time that can remove biofilm. | May involve equipment purchase or rental. |
| Steam | Low toxicity and cost-effective. | Limited effect on certain materials or if access to biofilm is limited due to drain configuration. |
| Removal/Replacement of Drain Components | Removes organisms and biofilm to below P-trap | Biofilm remains in rest of system and can recolonize replacement parts. |
Experts suggest that foam and steam are the superior methods removal. Remember, when cleaning drains, proper donning and doffing of PPE is a must.
Ready to flush CPE from your facility?
Talk to our cleaning experts for an infection control and drain maintenance program that protects facility and patient health.
