Better sanitary ware design for infection control

Published: 3-Aug-2017

Iconic British manufacturer Armitage Shanks has launched new healthcare sanitary ware designed specifically to help reduce the opportunity for bacterial growth in hospital basins, taps and WCs. Susan Birks reports

In recent years, hospital sinks have been the focus of research into the spread of hospital acquired infections. As a result, a growing body of evidence suggests badly designed sanitary ware and plumbing can act as a breading ground for antibiotic resistant microbes.

For example, S. Kotay, W. Chai, W. Guilford et al published a study online on 24 February in the journal of Applied Environmental Microbiology1 that modelled how E.coli spread from sinks to patient. Before setting up their study, they reviewed more than 32 papers on the spread of bacteria resistant to the antibiotic carbapenem via sinks and other water reservoirs within hospitals. Their experimental study found the bacteria colonised the elbow of the drain pipes, then grew slowly towards the sink strainers from where they quickly got splattered around the sink and surrounding counters, where they could be picked up by patients.

Some ‘quasi experimental’ studies have gone as far as removing sinks from intensive care unit (ICUs) to see if it has any effect on gram-negative bacilli; infections did appear to reduce.

Removal of sinks from the hospital setting altogether would be considered by many as impractical and drastic. So British commercial sanitary ware provider Armitage Shanks, has been working in partnership with leading scientists and specialists to develop innovative healthcare sanitary ware that can help reduce the spread of infection in hospitals.

The company believes its two new clinical ceramics ranges, the Markwik 21+ fittings and Contour 21+, significantly push forward hygiene innovation and bacterial prevention. Tony Rheinberg, Marketing Manager at Armitage Shanks/ Ideal Standard, says: “We have taken a scientific approach, working with a host of leading NHS trust partners and researchers to bring new clinical solutions to all areas of the hospital.”

Markwik 21+ and Contour 21+ address specific hygienic design issues, such as pooling and water stagnation, while also reducing splashing and the amount of static water in the system. The company has also worked with materials that limit the opportunity for bacteria to feed and provided a more flexible maintenance system for cleansing fixtures and fittings.

Dealing with splashing

Research shows a high level of splashing occurs when taps run into clinical basins, spreading bacteria and viruses into the air, onto the face, clothing and the surrounding area, such as hospital beds. This splashing and spreading of germs can reach over a metre in distance. To prevent this spread, Armitage Shanks has designed HydroFin — an innovative fin in the Contour 21+ basin which deflects splashing and reduces it by over 90%.

Rheinberg says: “Often some of the most simple of issues can be the most difficult to solve — and that’s what makes our new hydrofin design so ground-breaking, as it reduces the recognised major risks of spreading infection caused by splashing water from a tap in a basin.”

The Contour 21+ range also includes integral SmartGuard antimicrobial additive technology. This antimicrobial protection is designed to reduce the threat of cross-contamination and help keep surfaces clean and hygienic across their lifetime.

In addition, Contour 21+’s ultra-smooth glaze (SmartGuard+) has been designed to make it more difficult for bacteria to cling to the surface.

Water pooling in basin wastes is a prevalent source of bacterial growth and a common problem in clinical, back-outlet basins, says Armitage Shanks. The Contour 21+ basin features advanced drainage to combat this. Its simple waste assembly ensures the water drains instantly and vertically, through a smooth pipe system, free of steps or hanging points.

The sanitary ware range outer surfaces’ feature thinner, more angular rims, steeper slopes and a smaller back area — all designed to avoid water pooling and facilitate easy cleaning.

The Markwik 21+ range is over 85% brass and reduces polymer content by 66%. Waterways are also reduced in size, reducing the amount of water left in the tap by 34%

The Markwik 21+ range is over 85% brass and reduces polymer content by 66%. Waterways are also reduced in size, reducing the amount of water left in the tap by 34%

Advanced tap fittings

Mixer taps have also been identified as a potential risk area where bacteria can grow. Pseudomonas aeruginosa presents a particular threat up to 2 m back from the outlet. Legionella can grow where water stagnates in pipes and fittings.

Markwik 21+ has been developed following extensive research into where and how bacteria grows. Care has been taken in removing materials that bacteria can feed on, reducing the amount of water left in taps after use, and providing more options to cleanse fittings either by thermal cleanse procedures or the complete dismantling of fittings for disinfection.

For example, Markwik 21+ is almost entirely free of polymers and contains glass, brass and antimicrobial copper components, minimising the likelihood of Pseudomonas infection and other growth. The new range is over 85% brass and reduces polymer content by 66%. Waterways are diminished in size reducing the amount of water left in the tap by 34%.

A manual thermal flush feature allows maintenance staff to override the thermostat and flush the fitting through with hot water to help reduce bacteria deposits, maximising the antimicrobial effect. An integral thermostat enables water to be mixed closer to the point of discharge — eliminating the cold water ‘dead leg’ and minimising warm water areas, both of which can harbour germs.

The range’s auto-flush technology ensures irregularly used electronic fittings are flushed through with water every 24 hrs, preventing the formation of bacteria. A ‘hydro-purge’ facility flushes water through the pipework and inlets to ensure a debris-free system after installation and enables flushing after chemical disinfection.

In addition, detachable spouts, one piece designs and demountable body components allow for complete immersion disinfection and autoclaving.

The Contour 21+ basin features advanced drainage to combat <br> bacterial growth in clinical, back-outlet basins

The Contour 21+ basin features advanced drainage to combat
bacterial growth in clinical, back-outlet basins

Designed for use in patient areas

Armitage Shanks says currently hospitals tend to use bottom outlet basins with deck taps. This type of basin can pose a threat to patients with weak immune systems as bacteria growing in wastes can be released when water flows directly down the drain. The new Contour 21+ deck basin comes with back outlet and a special clinical tap that can be easily detached from the basin, dismantled and disinfected. This is the first basin and tap of its kind and is a major advance in bringing clinical solutions across all areas of the hospital.

The easy and flexible installation options of the new ranges makes them simple to install. Contour 21+ can even be installed by one person in 7 minutes, saving both time and costs compared to its predecessor which took two people 18 minutes.

All taps in the range are fully compatible with Pall Medical sterilising water filters, adding an extra barrier against infection. Both ranges also fit seamlessly together, providing a fully integrated tap and basin system that offers the optimum in clinical hygiene.

Rheinberg says: “The new Contour 21+ and Markwik 21+ ranges demonstrate our innovation based approach, which is built on 200 years of experience and continues to pushes forward with healthcare innovation, aiding the battle in the fight against infection.


1. Kotay S, Chai W, Guilford W, et al. Spread from the sink to the patient: in situ study using green fluorescent protein (GFP) expressing- Escherichia coli to model bacterial dispersion from hand washing sink trap reservoirs [published online 24 Feb, 2017]. Appl. Environ. Microbiol. doi: 10.1128/AEM.03327-16

N.B. Ideal Standard International is a manufacturer of healthcare bathroom solutions sold under brands such as Ideal Standard, Armitage Shanks (UK), Porcher (France), Ceramica Dolomite (Italy) and Vidima (Eastern Europe).

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