Beware the Lowly Hospital Sink
https://lvg.virginia.edu/press/annual-reportsPreviously featured in Science, MSN, NBC News, and many other news outlets. The story below was featured in the LVG 2017 Annual Report.
The Sink Lab at UVA
AMY MATHERS, M.D., associate professor of medicine and pathology, Division of Infectious Disease and International Health at UVA, has been studying molecular epidemiology for more than 10 years. Her expertise in tracking bacterial DNA sequences has advanced the understanding of where antibiotic-resistant pathogens originate and how they spread in even the most sterile places, like hospitals.
Mathers arrived at UVA in 2006 for a fellowship in infectious disease and began studying the DNA signatures of antibiotic resistance genes to understand how they are shared between bacteria. During her fellowship, the team identified a gene of drug resistance that, when acquired by bacteria, becomes an antibiotic-destroying superbug. Superbugs pose a major threat because of how quickly they can move and cross over to different strains and species of bacteria. Another challenge to tracking superbugs is how they can be undetected in hospital and health care environments where patients are most susceptible to infections.
Determined to explain the resistance gene movement between bacteria and to understand and combat superbugs, Mathers trained at Oxford University in whole genome sequencing. When she returned to UVA, she used her broadened skillset to study how other transmissions of infectious bacteria were happening within health care settings and learned that a minority of transmissions came from patient-to-patient contact.
This discovery led her to consider that the unaccounted for transmissions might be coming from the hospital environment, including sink drains and toilets present in the health care environment. Working with colleagues at several institutions, she has documented over 100 cases around the world since 2010.
How BME Students Became Involved
To understand the dynamics of bacterial spread from hospital room sinks to patients, Mathers and her team built the only sink lab in the U.S., which is composed of 14 replica hospital sinks, to study the spread of drug-resistant bacteria from wastewater systems. A collaboration with the Biomedical Engineering Department facilitated a project for undergraduate students to build and test devices that could be used in the sink lab. In their BME 2000 class, taught by Associate Professor of Biomedical Engineering Will Guilford, Ph.D., student teams developed several devices that are now used in the lab to automate the sinks for various tests.
As active faculty researchers, Mathers and Guilford both engage with the UVA Licensing and Ventures Group regularly to keep the organization apprised of their progress. When their collaboration resulted in a student-designed device for the sink lab, LVG helped facilitate an invention disclosure to ensure the protection of the novel technology.
Making National News
With the assistance of another researcher on the team, Shireen Kotay, Ph.D., they used traceable strains of bacteria (E. coli) in the sink lab by colonizing samples in the U-pipe underneath the sink. Running water through the sinks indicated minimal bacteria growth, but they saw movement when the sinks were flushed with typical hospital waste like intravenous fluid and leftover beverages. Their findings, published in early 2017, indicated that nutrient-fed bacteria colonies grew up from the elbow of the drainpipe at an average rate of 1 inch per day, reaching the sink strainer where they can be further transmitted in just one week.
To better understand the role of the sink in transmission of antibiotic resistant bacteria, Mathers has received funding from the Centers for Disease Control and Prevention. She is working with collaborators at the University of British Columbia, Oxford University, and Public Health England to develop interventions that would mitigate the sink drain dispersion.
“You could say I have a bit of an entrepreneurial spirit,” Mathers said. “Since we have created the sink lab, we’ve been getting attention from industry who have shown interest in understanding the design of the sinks or using it for various testing. I’m grateful to have LVG as a partner in helping navigate those requests, and I look to their expertise to help us identify commercialization opportunities for the lab.”
Coulter Enables Partnership with the UVA Data Science Institute
Throughout her research, Mathers has collected an immense amount of data that she put to work in a collaborative Coulter Foundation funded project with the UVA Data Science Institute. The movement of bacteria within a hospital setting is extremely complicated to track because of how frequently patients are shuffled to different rooms to receive care. Mathers worked with colleagues to oversee the application of data science techniques to model patient geospatial movement to develop software that could be integrated into health system information technology. The initial software allows visualization of levels of surface cleanliness for each hospital room and informs health care workers, custodial staff, and infection preventionist specialists about areas where cleaning is inadequate as well as assist in hospital cleaning process improvement.
LVG is currently working to assess industry opportunities for the software and identify a third party that would be suited to utilize it in health care environments.