There is perhaps no more important place for hand hygiene than in healthcare. In hospitals and healthcare facilities, cleanliness is critical for infection prevention. Unfortunately, in many hospitals and care facilities, there are unintended consequences from the actual devices designed to help employees keep their hands clean.

Sinks and the water splashing out of them during handwashing can quickly spread contaminants during the cleaning process. This includes faucets and basins not being appropriately cleaned as well as improper cleaning practices.

While this might seem like common sense, according to research from the University of Michigan Health System presented at a gathering of the Association for Professionals in Infection Control and Epidemiology (APIC), sinks and other handwashing stations can spread infection and bacteria.

According to the report, researchers reviewed eight varieties of designs across four intensive care units to determine how dirty sinks and faucets were. It turns out that the shallower the sink pan, the more likely the possibility that the sinks and surrounding areas could be contaminated.

Shallow sink bowl depth may enable the spread of potentially contaminated water because water can more easily splash onto patient care items, healthcare workers' hands and clothes, and into patient care spaces. In fact, researchers found that sink splashback can reach distances of four feet or more from the actual sink basin.

"The inside of faucets, where you can't clean, was much dirtier than expected," says study author Kristen VanderElzen, according to a statement supporting the study. "Potentially hazardous germs in and around sinks present a quandary for infection preventionists since having accessible sinks for handwashing is so integral to everything we promote. Acting on the information we found, we have undertaken a comprehensive faucet replacement program across our hospital."

To determine the amount of dirt and grime in the sinks, the researchers used adenosine triphosphate (ATP) monitoring to measure for cleanliness. Researchers said they witnessed a visible biofilm with higher ATP readings. Furthermore, cultures tested over the course of the investigation grew Pseudomonas aeruginosa, mold, and other environmental organisms.

Researchers also found sink aerators that had previously been removed were replaced, pointing to inconsistencies of equipment management protocols across the healthcare facility.

Included in the design improvement program were sink guards shown to limit splash significantly. Sink mats also may help limit splashback in shallow sinks.

"As we learn more about the stealthy ways germs can spread inside healthcare facilities, infection preventionists play an increasingly important role in healthcare facility design — including in the selection of sink and faucet fixtures — as this study illustrates," said Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC, and APIC president.

"Because the healthcare environment can serve as a source of resistant organisms capable of causing dangerous infections, an organization's infection prevention, and control program must ensure that measures are in place to reduce the risk of transmission from environmental sources and monitor compliance with those measures.”

Because of these findings, facility managers in these organizations likely could gain more responsibility in caring for the elimination of infection and bacteria from these areas.