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Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk.
J Hosp Infect 2012; 80(1):1-5JH

Abstract

BACKGROUND

Toilet facilities in healthcare settings vary widely, but patient toilets are commonly shared and do not have lids. When a toilet is flushed without the lid closed, aerosol production may lead to surface contamination within the toilet environment.

AIM

To substantiate the risks of airborne dissemination of C. difficile following flushing a toilet, in particular when lids are not fitted.

METHODS

We performed in-situ testing, using faecal suspensions of C. difficile to simulate the bacterial burden found during disease, to measure C. difficile aerosolization. We also measured the extent of splashing occurring during flushing of two different toilet types commonly used in hospitals.

FINDINGS

C. difficile was recoverable from air sampled at heights up to 25 cm above the toilet seat. The highest numbers of C. difficile were recovered from air sampled immediately following flushing, and then declined 8-fold after 60 min and a further 3-fold after 90 min. Surface contamination with C. difficile occurred within 90 min after flushing, demonstrating that relatively large droplets are released which then contaminate the immediate environment. The mean numbers of droplets emitted upon flushing by the lidless toilets in clinical areas were 15-47, depending on design. C. difficile aerosolization and surrounding environmental contamination occur when a lidless toilet is flushed.

CONCLUSION

Lidless conventional toilets increase the risk of C. difficile environmental contamination, and we suggest that their use is discouraged, particularly in settings where CDI is common.

Authors+Show Affiliations

Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22137761

Citation

Best, E L., et al. "Potential for Aerosolization of Clostridium Difficile After Flushing Toilets: the Role of Toilet Lids in Reducing Environmental Contamination Risk." The Journal of Hospital Infection, vol. 80, no. 1, 2012, pp. 1-5.
Best EL, Sandoe JA, Wilcox MH. Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk. J Hosp Infect. 2012;80(1):1-5.
Best, E. L., Sandoe, J. A., & Wilcox, M. H. (2012). Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk. The Journal of Hospital Infection, 80(1), pp. 1-5. doi:10.1016/j.jhin.2011.08.010.
Best EL, Sandoe JA, Wilcox MH. Potential for Aerosolization of Clostridium Difficile After Flushing Toilets: the Role of Toilet Lids in Reducing Environmental Contamination Risk. J Hosp Infect. 2012;80(1):1-5. PubMed PMID: 22137761.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk. AU - Best,E L, AU - Sandoe,J A T, AU - Wilcox,M H, Y1 - 2011/12/02/ PY - 2011/08/03/received PY - 2011/08/23/accepted PY - 2011/12/6/entrez PY - 2011/12/6/pubmed PY - 2012/4/12/medline SP - 1 EP - 5 JF - The Journal of hospital infection JO - J. Hosp. Infect. VL - 80 IS - 1 N2 - BACKGROUND: Toilet facilities in healthcare settings vary widely, but patient toilets are commonly shared and do not have lids. When a toilet is flushed without the lid closed, aerosol production may lead to surface contamination within the toilet environment. AIM: To substantiate the risks of airborne dissemination of C. difficile following flushing a toilet, in particular when lids are not fitted. METHODS: We performed in-situ testing, using faecal suspensions of C. difficile to simulate the bacterial burden found during disease, to measure C. difficile aerosolization. We also measured the extent of splashing occurring during flushing of two different toilet types commonly used in hospitals. FINDINGS: C. difficile was recoverable from air sampled at heights up to 25 cm above the toilet seat. The highest numbers of C. difficile were recovered from air sampled immediately following flushing, and then declined 8-fold after 60 min and a further 3-fold after 90 min. Surface contamination with C. difficile occurred within 90 min after flushing, demonstrating that relatively large droplets are released which then contaminate the immediate environment. The mean numbers of droplets emitted upon flushing by the lidless toilets in clinical areas were 15-47, depending on design. C. difficile aerosolization and surrounding environmental contamination occur when a lidless toilet is flushed. CONCLUSION: Lidless conventional toilets increase the risk of C. difficile environmental contamination, and we suggest that their use is discouraged, particularly in settings where CDI is common. SN - 1532-2939 UR - https://www.unboundmedicine.com/medline/citation/22137761/Potential_for_aerosolization_of_Clostridium_difficile_after_flushing_toilets:_the_role_of_toilet_lids_in_reducing_environmental_contamination_risk_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0195-6701(11)00339-2 DB - PRIME DP - Unbound Medicine ER -