Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-19T01:27:15.522Z Has data issue: false hasContentIssue false
  • English
  • Français

Bioaerosols generated from toilet flushing in rooms of patients with Clostridioides difficile infection

Published online by Cambridge University Press:  31 January 2020

Geneva M. Wilson Open the ORCID record for Geneva M. Wilson [Opens in a new window] ,
Virgil B. Jackson ,
Linda D. Boyken ,
Marin L. Schweizer ,
Daniel J. Diekema ,
Christine A. Petersen ,
Patrick J. Breheny ,
Matthew W. Nonnenmann ,
Eli N. Perencevich  and
for the CDC Prevention Epicenter Program
Geneva M. Wilson*
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa
Virgil B. Jackson
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Linda D. Boyken
Affiliation:
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa University of Iowa Hospitals and Clinics, Iowa City, Iowa
Marin L. Schweizer
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
Daniel J. Diekema
Affiliation:
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa University of Iowa Hospitals and Clinics, Iowa City, Iowa
Christine A. Petersen
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa
Patrick J. Breheny
Affiliation:
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
Matthew W. Nonnenmann
Affiliation:
Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa
Eli N. Perencevich
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa University of Iowa Hospitals and Clinics, Iowa City, Iowa Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
*
Author for correspondence: Geneva M. Wilson, E-mail: geneva-wilson@uiowa.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Clostridioides difficile infection (CDI) is the most frequently reported hospital-acquired infection in the United States. Bioaerosols generated during toilet flushing are a possible mechanism for the spread of this pathogen in clinical settings.

Objective:

To measure the bioaerosol concentration from toilets of patients with CDI before and after flushing.

Design:

In this pilot study, bioaerosols were collected 0.15 m, 0.5 m, and 1.0 m from the rims of the toilets in the bathrooms of hospitalized patients with CDI. Inhibitory, selective media were used to detect C. difficile and other facultative anaerobes. Room air was collected continuously for 20 minutes with a bioaerosol sampler before and after toilet flushing. Wilcoxon rank-sum tests were used to assess the difference in bioaerosol production before and after flushing.

Setting:

Rooms of patients with CDI at University of Iowa Hospitals and Clinics.

Results:

Bacteria were positively cultured from 8 of 24 rooms (33%). In total, 72 preflush and 72 postflush samples were collected; 9 of the preflush samples (13%) and 19 of the postflush samples (26%) were culture positive for healthcare-associated bacteria. The predominant species cultured were Enterococcus faecalis, E. faecium, and C. difficile. Compared to the preflush samples, the postflush samples showed significant increases in the concentrations of the 2 large particle-size categories: 5.0 µm (P = .0095) and 10.0 µm (P = .0082).

Conclusions:

Bioaerosols produced by toilet flushing potentially contribute to hospital environmental contamination. Prevention measures (eg, toilet lids) should be evaluated as interventions to prevent toilet-associated environmental contamination in clinical settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 517 - 521
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Johnson, DL, Mead, KR, Lynch, RA, Hirst, DV. Lifting the lid on toilet plume aerosol: a literature review with suggestions for future research. Am J Infect Control 2013;41:254–258.CrossRefGoogle ScholarPubMed
Zemouri, C, de Soet, H, Crielaard, W, Laheij, A. A scoping review on bioaerosols in healthcare and the dental environment. PloS One 2017;12:e0178007.CrossRefGoogle Scholar
Best, EL, Fawley, WN, Parnell, P, Wilcox, MH. The potential for airborne dispersal of Clostridium difficile from symptomatic patients. Clin Infect Dis 2010;50:1450–1457.CrossRefGoogle ScholarPubMed
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;80:1–5.CrossRefGoogle ScholarPubMed
Ghose, C. Clostridium difficile infection in the twenty-first century. Emerg Microbes Infect 2013;2:e62.CrossRefGoogle ScholarPubMed
Janezic, S, Rupnik, M. Genomic diversity of Clostridium difficile strains. Res Microbiol 2015;166:353–360.CrossRefGoogle ScholarPubMed
O’Neill, G, Adams, JE, Bowman, RA, Riley, TV. A molecular characterization of Clostridium difficile isolates from humans, animals and their environments. Epidemiol Infect 1993;111:257–264.CrossRefGoogle ScholarPubMed
Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of healthcare-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Nearly half a million Americans suffered from Clostridium difficile infections in a single year. Centers for Disease Control and Prevention website. https://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html. Published 2015. Accessed January 14, 2020.Google Scholar
Fekety, R, Kim, KH, Brown, D, Batts, DH, Cudmore, M, Silva, J Jr. Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am J Med 1981;70:906–908.CrossRefGoogle ScholarPubMed
Kim, KH, Fekety, R, Batts, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981;143:42–50.CrossRefGoogle ScholarPubMed
Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.CrossRefGoogle ScholarPubMed
Weinstein, RA, Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:1182–1189.CrossRefGoogle Scholar
Barker, J, Jones, MV. The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet. J Appl Microbiol 2005;99:339–347.CrossRefGoogle ScholarPubMed
Fisher, K, Phillips, C. The ecology, epidemiology and virulence of Enterococcus. Microbiology (Reading, England) 2009;155:1749–1757.CrossRefGoogle ScholarPubMed
Satlin, MJ, Walsh, TJ. Multidrug-resistant Enterobacteriaceae, Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus: three major threats to hematopoietic stem cell transplant recipients. Transplant Infect Dis 2017;19(6). doi: 10.1111/tid.12762.CrossRefGoogle ScholarPubMed
Hidron, AI, Edwards, JR, Patel, J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29:996–1011.CrossRefGoogle ScholarPubMed
McDermott, H, Skally, M, O’Rourke, J, Humphreys, H, Fitzgerald-Hughes, D. Vancomycin-resistant enterococci (VRE) in the intensive care unit in a nonoutbreak setting: identification of potential reservoirs and epidemiological associations between patient and environmental VRE. Infect Control Hosp Epidemiol 2018;39:40–45.CrossRefGoogle Scholar
Knowlton, SD, Boles, CL, Perencevich, EN, et al. Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting. Antimicrob Resist Infect Control 2018;7:16.CrossRefGoogle Scholar
Roberts, K, Smith, CF, Snelling, AM, et al. Aerial dissemination of Clostridium difficile spores. BMC Infect Dis 2008;8:7.CrossRefGoogle ScholarPubMed
Supplementary material: File

Wilson et al. supplementary material

Wilson et al. supplementary material

Download Wilson et al. supplementary material(File)
File 380.7 KB