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.
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.
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.
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.
Essentials of Public Reporting of Healthcare-Associated Infections: A Tool Kit [ http://www.cste2.org/webpdfs/06107498EssentialsToolKit.pdf]. Access 15 May 2017.
Weinstein RA, Hota B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis. 2004;39:1182–9. CrossRef
Io M. Emerging infections: microbial threats to health in the United States. Washington, DC: The National Academies Press; 1992.
Roberts K, Smith CF, Snelling AM, Kerr KG, Banfield KR, Sleigh PA, Beggs CB. Aerial dissemination of Clostridium Difficile spores. BMC Infect Dis. 2008;8:1. CrossRef
Pastuszka J, Marchwinska-Wyrwal E, Wlazlo A. Bacterial aerosol in Silesian hospitals: preliminary results. Pol J Environ Stud. 2005;14:883.
Augustowska M, Dutkiewicz J. Variability of airborne microflora in a hospital ward within a period of one year. Ann Agric Environ Med. 2006;13:99–106. PubMed
Darlow H, Bale W. Infective hazards of water-closets. Lancet. 1959;273:1196–200. CrossRef
Newsom S. Microbiology of hospital toilets. Lancet. 1972;300:700–3. CrossRef
Jessen C: Luftbarne mikroorganismer forekomst og bekaempelse [in danish]. Copenhagen; 1955.
Macher JM. Positive-hole correction of multiple-jet impactors for collecting viable microorganisms. Ann Agric Environ Med. 1989;50:561–8.
ACGIH. Bioaerosols: assessment and control. ACGIH: Cincinnati; 1999.
Hinds WC: Aerosol technology: properties, behavior, and measurement of airborne particles. 2: New York: Wiley; 1999.
Möhler O, Georgakopoulos DG, Morris CE, Benz S, Ebert V, Hunsmann S, Saathoff H, Schnaiter M, Wagner R. Heterogeneous ice nucleation activity of bacteria: new laboratory experiments at simulated cloud conditions. Biogeosciences. 2008;5:1425–35. CrossRef
Bauer H, Giebl H, Hitzenberger R, Kasper-Giebl A, Reischl G, Zibuschka F, Puxbaum H. Airborne bacteria as cloud condensation nuclei. J Geophys Res. 2003;108(D21):4658. https://doi.org/10.1029/2003JD003545.
- Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting
Samantha D. Knowlton
Corey L. Boles
Eli N. Perencevich
Daniel J. Diekema
Matthew W. Nonnenmann
CDC Epicenters Program
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II