A Scoping Review of Disinfection Strategies for Carbapenemase-Producing Enterobacterales (CPE) in Hospital Water Systems

BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) pose a global health crisis. Their resistance to conventional antimicrobials and many disinfectants, increases the healthcare costs of treatment and risk mitigation. Hospital water systems are reservoirs for CPE, necessitating targeted infection prevention and control (IPC) strategies.

OBJECTIVE: To review and consolidate current evidence of disinfection strategies for CPE in hospital water systems, focusing on practical application, challenges and IPC integration.

METHODOLOGY: A scoping review was conducted following PRISMA guidelines, encompassing studies from 1 st December 2014 to 31 st December 2024. Of 1,188 records screened, 22 met inclusion criteria. Thematic analysis categorised findings into chemical, physical and integrative strategies.

KEY FINDINGS: Sodium hypochlorite and hydrogen peroxide reduced contamination temporarily but were poorly effective against biofilms, while acetic acid showed consistent efficacy with regular use. Quaternary ammonium compounds proved effective but required standardised protocols. Physical interventions, such as steam cleaning and drain covers, reduced contamination; and plumbing modifications minimised biofilm formation. Resource-intensive measures, like removing contaminated sinks or adopting water-free environments were also effective. Integrative approaches combining chemical disinfection, infrastructural upgrades and enhanced sink protocols demonstrated the most sustained outcomes, with novel technologies like UV light and biofilm-targeting foams showing great promise.

CONCLUSION: Effective CPE control in hospital water systems requires multidisciplinary action addressing biofilm-protected reservoirs. Regular application of proven disinfectants, tailored to specific contexts, coupled with infrastructural upgrades and comprehensively implemented IPC strategies, offers the most promising outcomes. Novel technologies and updated guidelines are essential to standardising practices and mitigating the broader threat of antimicrobial resistance.