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Public health and healthcare-associated risk of electric, warm-water bidet toilets.
J Hosp Infect 2017; 97(3):296-300JH

Abstract

BACKGROUND

In recent years, installation of bidet toilets within hospitals in Japan has raised concerns regarding potential for cross-contamination by antimicrobial-resistant bacteria from patients who are hospitalized over an extended period.

AIM

To investigate the distribution of antimicrobial-resistant bacteria recovered from bidet toilets at a university-affiliated hospital in Japan.

METHODS

All 292 electric bidet toilets at a university hospital were sampled for contamination. Swabs for culture were used to sample water-jet nozzles and toilet seats.

FINDINGS

Of the 292 toilet seats sampled, warm-water nozzles of 254 (86.9%) were found to be contaminated by one or more of the following organisms: Staphylococcus aureus, Streptococcus spp., Enterococcus spp., Enterobacteriaceae and non-Enterobacteriaceae Gram-negative bacteria. S. aureus was recovered from one water-jet nozzle and nine toilet seats; of these, meticillin-resistant S. aureus was recovered from the water-jet nozzle and from one toilet seat. Both the water-jet nozzle and seat of the same toilet were contaminated with a CTX-M-9 group extended-spectrum β-lactamase-producing Escherichia coli. Of the Gram-negative isolates recovered from samples, the organism with the highest frequency of isolation was Stenotrophomonas maltophilia, which was recovered from 39 bidet toilets.

CONCLUSION

Warm-water nozzles of bidet toilets are contaminated with a wide range of bacteria, making them a potential vehicle for cross-infection. In the hospital setting, shared use of bidet toilets must consider the clinical background of patients. Based on these findings, these devices must be part of the risk management programme, and steps should be included for monitoring and disinfection.

Authors+Show Affiliations

Department of Infection Control and Prevention, Toho University Faculty of Nursing, Tokyo, Japan.Department of Infection Control and Prevention, Toho University Faculty of Nursing, Tokyo, Japan.Clinical Research Centre, Toho University School of Medicine, Tokyo, Japan; Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan.Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan.Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Kanagawa, Japan.Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Kanagawa, Japan.Department of Infection Control and Prevention, Toho University Faculty of Nursing, Tokyo, Japan. Electronic address: kobatora@med.toho-u.ac.jp.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28756169

Citation

Kanayama Katsuse, A, et al. "Public Health and Healthcare-associated Risk of Electric, Warm-water Bidet Toilets." The Journal of Hospital Infection, vol. 97, no. 3, 2017, pp. 296-300.
Kanayama Katsuse A, Takahashi H, Yoshizawa S, et al. Public health and healthcare-associated risk of electric, warm-water bidet toilets. J Hosp Infect. 2017;97(3):296-300.
Kanayama Katsuse, A., Takahashi, H., Yoshizawa, S., Tateda, K., Nakanishi, Y., Kaneko, A., & Kobayashi, I. (2017). Public health and healthcare-associated risk of electric, warm-water bidet toilets. The Journal of Hospital Infection, 97(3), pp. 296-300. doi:10.1016/j.jhin.2017.07.021.
Kanayama Katsuse A, et al. Public Health and Healthcare-associated Risk of Electric, Warm-water Bidet Toilets. J Hosp Infect. 2017;97(3):296-300. PubMed PMID: 28756169.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Public health and healthcare-associated risk of electric, warm-water bidet toilets. AU - Kanayama Katsuse,A, AU - Takahashi,H, AU - Yoshizawa,S, AU - Tateda,Kazuhiro, AU - Nakanishi,Y, AU - Kaneko,A, AU - Kobayashi,I, Y1 - 2017/07/26/ PY - 2017/07/02/received PY - 2017/07/20/accepted PY - 2017/8/2/pubmed PY - 2018/6/7/medline PY - 2017/7/31/entrez KW - Antimicrobial-resistant bacteria KW - Bacterial contamination KW - Bidet toilet SP - 296 EP - 300 JF - The Journal of hospital infection JO - J. Hosp. Infect. VL - 97 IS - 3 N2 - BACKGROUND: In recent years, installation of bidet toilets within hospitals in Japan has raised concerns regarding potential for cross-contamination by antimicrobial-resistant bacteria from patients who are hospitalized over an extended period. AIM: To investigate the distribution of antimicrobial-resistant bacteria recovered from bidet toilets at a university-affiliated hospital in Japan. METHODS: All 292 electric bidet toilets at a university hospital were sampled for contamination. Swabs for culture were used to sample water-jet nozzles and toilet seats. FINDINGS: Of the 292 toilet seats sampled, warm-water nozzles of 254 (86.9%) were found to be contaminated by one or more of the following organisms: Staphylococcus aureus, Streptococcus spp., Enterococcus spp., Enterobacteriaceae and non-Enterobacteriaceae Gram-negative bacteria. S. aureus was recovered from one water-jet nozzle and nine toilet seats; of these, meticillin-resistant S. aureus was recovered from the water-jet nozzle and from one toilet seat. Both the water-jet nozzle and seat of the same toilet were contaminated with a CTX-M-9 group extended-spectrum β-lactamase-producing Escherichia coli. Of the Gram-negative isolates recovered from samples, the organism with the highest frequency of isolation was Stenotrophomonas maltophilia, which was recovered from 39 bidet toilets. CONCLUSION: Warm-water nozzles of bidet toilets are contaminated with a wide range of bacteria, making them a potential vehicle for cross-infection. In the hospital setting, shared use of bidet toilets must consider the clinical background of patients. Based on these findings, these devices must be part of the risk management programme, and steps should be included for monitoring and disinfection. SN - 1532-2939 UR - https://www.unboundmedicine.com/medline/citation/28756169/Public_health_and_healthcare_associated_risk_of_electric_warm_water_bidet_toilets_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0195-6701(17)30403-6 DB - PRIME DP - Unbound Medicine ER -