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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
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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

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