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Wastewater drains: epidemiology and interventions in 23 carbapenem-resistant organism outbreaks

Published online by Cambridge University Press:  28 June 2018

Philip C. Carling*
Infectious Diseases Section, Steward Carney Hospital, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Author for correspondence: Philip C. Carling, MD, Infectious Diseases Section, Steward Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124. E-mail:


For many years, patient-area wastewater drains (ie, sink and shower drains) have been considered a potential source of bacterial pathogens that can be transmitted to patients. Recently, evolving genomic epidemiology tools combined with new insights into the ecology of wastewater drain (WWD) biofilm have provided new perspectives on the clinical relevance and hospital-associated infection (HAI) transmission risks related to these fixtures. To further clarify the clinical relevance of WWD-associated pathogen transmission, reports of outbreaks attributed to WWDs were selected for review that (1) investigated the outbreak epidemiology of WWD-associated transmission of bacterial pathogens, (2) utilized advanced microbiologic methods to establish clonality of outbreak pathogens and/or resistance genes, or (3) described interventions implemented to mitigate transmission of the outbreak pathogens from WWDs. These reports were collated, compared, and analyzed, and the results are presented here.

© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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