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Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting.

Abstract

Background

In the United States, 1.7 million immunocompromised patients contract a healthcare-associated infection, annually. These infections increase morbidity, mortality and costs of care. A relatively unexplored route of transmission is the generation of bioaerosols during patient care. Transmission of pathogenic microorganisms may result from inhalation or surface contamination of bioaerosols. The toilet flushing of patient fecal waste may be a source of bioaerosols. To date, no study has investigated bioaerosol concentrations from flushing fecal wastes during patient care.

Methods

Particle and bioaerosol concentrations were measured in hospital bathrooms across three sampling conditions; no waste no flush, no waste with flush, and fecal waste with flush. Particle and bioaerosol concentrations were measured with a particle counter bioaerosol sampler both before after a toilet flushing event at distances of 0.15, 0.5, and 1 m from the toilet for 5, 10, 15 min.

Results

Particle concentrations measured before and after the flush were found to be significantly different (0.3-10 μm). Bioaerosol concentrations when flushing fecal waste were found to be significantly greater than background concentrations (p-value = 0.005). However, the bioaerosol concentrations were not different across time (p-value = 0.977) or distance (p-value = 0.911) from the toilet, suggesting that aerosols generated may remain for longer than 30 min post flush. Toilets produce aerosol particles when flushed, with the majority of the particles being 0.3 μm in diameter. The particles aerosolized include microorganisms remaining from previous use or from fecal wastes. Differences in bioaerosol concentrations across conditions also suggest that toilet flushing is a source of bioaerosols that may result in transmission of pathogenic microorganisms.

Conclusions

This study is the first to quantify particles and bioaerosols produced from flushing a hospital toilet during routine patient care. Future studies are needed targeting pathogens associated with gastrointestinal illness and evaluating aerosol exposure reduction interventions.

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  • Authors+Show Affiliations

    ,

    1Department of Occupational and Environmental Health, College of Public Health, University of Iowa, 100 CPHB, S346 CPHB, Iowa City, IA 52242 USA.

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    1Department of Occupational and Environmental Health, College of Public Health, University of Iowa, 100 CPHB, S346 CPHB, Iowa City, IA 52242 USA.

    ,

    2University of Iowa Health Care, Iowa City, IA 52242 USA. 3Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242 USA.

    ,

    2University of Iowa Health Care, Iowa City, IA 52242 USA. 3Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242 USA.

    ,

    1Department of Occupational and Environmental Health, College of Public Health, University of Iowa, 100 CPHB, S346 CPHB, Iowa City, IA 52242 USA.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29423191

    Citation

    TY - JOUR T1 - Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting. AU - Knowlton,Samantha D, AU - Boles,Corey L, AU - Perencevich,Eli N, AU - Diekema,Daniel J, AU - Nonnenmann,Matthew W, AU - ,, Y1 - 2018/01/26/ PY - 2017/07/25/received PY - 2018/01/11/accepted PY - 2018/2/10/entrez PY - 2018/2/10/pubmed PY - 2018/2/10/medline KW - Aerosol KW - Bacteria KW - Bioaerosol KW - Exposure KW - Flushing KW - Health care KW - Infection KW - Toilet SP - 16 EP - 16 JF - Antimicrobial resistance and infection control JO - Antimicrob Resist Infect Control VL - 7 N2 - Background: In the United States, 1.7 million immunocompromised patients contract a healthcare-associated infection, annually. These infections increase morbidity, mortality and costs of care. A relatively unexplored route of transmission is the generation of bioaerosols during patient care. Transmission of pathogenic microorganisms may result from inhalation or surface contamination of bioaerosols. The toilet flushing of patient fecal waste may be a source of bioaerosols. To date, no study has investigated bioaerosol concentrations from flushing fecal wastes during patient care. Methods: Particle and bioaerosol concentrations were measured in hospital bathrooms across three sampling conditions; no waste no flush, no waste with flush, and fecal waste with flush. Particle and bioaerosol concentrations were measured with a particle counter bioaerosol sampler both before after a toilet flushing event at distances of 0.15, 0.5, and 1 m from the toilet for 5, 10, 15 min. Results: Particle concentrations measured before and after the flush were found to be significantly different (0.3-10 μm). Bioaerosol concentrations when flushing fecal waste were found to be significantly greater than background concentrations (p-value = 0.005). However, the bioaerosol concentrations were not different across time (p-value = 0.977) or distance (p-value = 0.911) from the toilet, suggesting that aerosols generated may remain for longer than 30 min post flush. Toilets produce aerosol particles when flushed, with the majority of the particles being 0.3 μm in diameter. The particles aerosolized include microorganisms remaining from previous use or from fecal wastes. Differences in bioaerosol concentrations across conditions also suggest that toilet flushing is a source of bioaerosols that may result in transmission of pathogenic microorganisms. Conclusions: This study is the first to quantify particles and bioaerosols produced from flushing a hospital toilet during routine patient care. Future studies are needed targeting pathogens associated with gastrointestinal illness and evaluating aerosol exposure reduction interventions. SN - 2047-2994 UR - https://www.unboundmedicine.com/medline/citation/29423191/Bioaerosol_concentrations_generated_from_toilet_flushing_in_a_hospital_based_patient_care_setting_ L2 - https://aricjournal.biomedcentral.com/articles/10.1186/s13756-018-0301-9 ER -