Resistance of gram-negative bacilli to carbapenems is rapidly emerging worldwide. In 2016, the World Health Organization defined the hospital-built environment as a core component of infection prevention and control programs. The hospital-built environment (including water sources) has recently been reported as a source for outbreaks and sporadic transmission events of carbapenemase-producing gram-negative bacilli from the environment to patients. Interventions should focus primarily on hardware (new engineering solutions for sinks, showers and plumbing systems). New regulations and guidelines that formalize the management of sinks, showers, and sewage systems in hospitals should prescribe a number of specific requirements. These new guidelines should be in line with guidelines that aim to prevent health care–acquired legionnaires’ disease.

Dr Joost Hopman, Radboud University Medical Centre