Decontamination approaches and strategies for the prevention of sink drain-related healthcare-associated infections

SUMMARY Contaminated hospital sink drains are significant reservoirs for healthcare-associated pathogens and are frequently linked to outbreaks in medical settings. Pathogens such as multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Enterobacterales thrive in biofilms, which are notoriously difficult to eradicate. Preventing patient exposure to these pathogens poses a unique and complex challenge for infection control practitioners as effective solutions lie at the intersection of environmental engineering and infectious disease. This narrative review explores the characteristics, complexities, and challenges of wastewater biofilms in sink drains and traps in healthcare settings, their resistance to standard cleaning and disinfection methods, and potential pathways for pathogen spread to patients and other areas of wastewater premise plumbing. We emphasize the need for scientifically based guidance on sink drain decontamination approaches and examine current barriers to developing such guidance. Furthermore, we summarize reports from the medical literature on sink drain decontamination and mitigation strategies implemented in both outbreak and non-outbreak settings, alongside relevant studies on biofilm management from the engineering and basic science disciplines. Finally, we highlight ongoing gaps in research and guidelines, stressing the need for multidisciplinary approaches that integrate infection control and engineering solutions. This review aims to equip healthcare epidemiologists, infection preventionists, and facility personnel with pertinent insights to mitigate sink drain-related outbreaks effectively.