Infection prevention and control (IPC) is fundamental to reducing harm from pathogens in healthcare settings. Bacterial infections remain a major risk to hospitalised patients, particularly in maternal and neonatal units. Around the time of delivery, both mother and newborn are especially vulnerable. Infections contribute to nearly 1 in 10 maternal deaths globally (Sale et al, 2014). Neonatal infections, especially sepsis, are a leading cause of newborn mortality (WHO, 2025), with approximately 203,000 sepsis-related deaths globally each year (Zheng et al., 2025). In African hospitals, over 40% of admitted newborns are affected by sepsis, often linked to low birthweight, prematurity, or maternal infections (Wondifraw et al., 2025). At the same time, antimicrobial resistance (AMR) is growing, with common pathogens like E. coli and Klebsiella increasingly resistant to first-line antibiotics. 

The importance of good hygiene at birth has been recognised since Ignaz Semmelweis realised that doctors moving from cadavers to labouring women without washing their hands were contributing to maternal mortality. Today, IPC still relies heavily on hand hygiene and environmental cleanliness. The sink has become a symbol of cleanliness, and an assumed safeguard against infection. 

However, in maternity and neonatal units, sinks may also pose hidden risks. Growing evidence shows that drains can serve as persistent reservoirs for multidrug-resistant Gram-negative bacteria. In the moist, nutrient-rich environments of p-traps and pipes, these organisms evade cleaning, form biofilms, and contribute to outbreaks. As AMR rises in high-burden sepsis settings, understanding how infrastructure contributes to infection risk is more urgent than ever. Over the past decade, sinks have been identified as reservoirs for resistant organisms like Klebsiella pneumoniae and Pseudomonas spp. Studies from Kenya (unpublished data, L. Hookham), Botswana (Vurayai et al., 2021), France (Roux et al., 2013), and the UK (Decraene, et al, 2018) have detected these pathogens in sink drains, splash zones, and plumbing. 

Sinks present a risk due to the combination of moisture, nutrients, and antibiotic residues. UK hospitals have found traces of multiple antibiotic classes in sink drains, likely introduced through patient waste or disposal (Rodger et al., 2025). These conditions promote resistant bacteria, which persist in biofilms and spread via splashes. In a pilot study I conducted at Kilifi County Hospital in Kenya, we detected residues from commonly used antibiotics, such as beta-lactams and sulphonamides, in 20% of inpatient sink drains, most often in maternity and neonatal wards (Hookham et al., 2024).  

Sink design and placement further shape risk. In the UK, even new builds often feature poorly designed sinks, plugholes beneath taps, poor drainage, or missing splash guards (Rodger et al., 2025). In Kilifi, 75% of sinks in maternity and neonatal areas were within one metre of beds—some just 20 cm away. Nearly three-quarters showed visible splashing, and many had nearby patient items (Hookham et al., 2024). 

As part of my PhD, I’m working at Kawempe National Referral Hospital in Uganda to explore how environmental contamination contributes to the spread of multidrug-resistant Gram-negative bacteria (Hookham, 2025). I’ll be sampling sinks and high-touch surfaces, observing cleaning practices, and exploring the perceptions, challenges and barriers to environmental hygiene among cleaning staff and healthcare workers. My aim is to generate context-specific, practical evidence to improve infection prevention, not through new antibiotics, but through better use of infrastructure we already have. 

Hospital sinks may seem mundane, but they are microenvironments where AMR can take hold, evolve, and spread. In maternity and neonatal care, we can’t afford to overlook the basics. 
Infrastructure matters. Design matters. Cleaning matters. As we work to strengthen infection prevention globally, it’s time to pay closer attention to what lies beneath.