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Introduction:

Did you know that when a toilet is flushed, a plume of aerosolized matter spreads into the air above the toilet? This can impact air quality and potentially spread infectious agents onto other surfaces in the bathroom. This blog post will explore what can be done to reduce community- and hospital-acquired infections caused by this phenomenon.

          1. How Toilets Spread Infections:

1.1 Harboring Pathogens:

The introduction of public sanitation, including toilets, has been recognized as one of the most impactful advances in the control of spreading communicable infections and diseases. However, the toilets commonly used today in various settings, including private homes, community areas, and healthcare facilities, can harbor dangerous pathogens such as E. Coli, Staphylococcus aureus, and other bacteria and fungi. These pathogens can be spread through the air and on surfaces, contributing to hospital- and community-acquired infections. In multiple studies, scientists have found that a plethora of pathogens are dispersed into the air and onto surfaces when a toilet is flushed. These particles can settle on the toilet seat surface, flushing handle, and other areas of the room where the toilet is located. While proper hand hygiene has been shown to reduce disease transmission significantly, there is the potential for particle inhalation, which can lead to someone acquiring an infection.

1.2 The Impact of Lid-Down Flushing: Flushing toilets with the lid down can reduce airborne bacteria by 50%. Lid-down flushing is effective in two ways:

1. Firstly, it prevents the escape of aerosolized particles. When a toilet is flushed with the lid up, aerosolized matter containing bacteria is released into the air. Flushing with the lid down contains these particles within the toilet bowl, reducing their dispersal and airborne transmission.

2. Secondly, lid-down flushing minimizes the spread of bacteria present on the toilet surface. Flushing with the lid up can cause water and bacteria to splash onto surrounding surfaces, increasing the risk of contamination. The closed lid acts as a barrier, preventing the spread of bacteria from the toilet surface.

By implementing lid-down flushing protocols, we can significantly reduce airborne bacteria and minimize the spread of bacteria in the bathroom, contributing to improved infection control.

​          2. Toilet Technology Being Developed:

2.1 Waterless Toilets:

Waterless toilets, known as dry or composting toilets, have shown promise in reducing disease transmission. They operate without water for flushing, which can minimize the release and spread of pathogens. Studies suggest lower rates of gastrointestinal infections in households using waterless toilets compared to traditional flush toilets. Similarly, in healthcare facilities, waterless toilets have the potential to reduce hospital-acquired infections by mitigating contamination and minimizing the generation of plumes. Further research is needed to understand the benefits fully, but waterless toilets promise to improve infection control in various settings.

2.2 HVAC and Ventilation Modifications:

Enhancing infection control in lavatories can be achieved through specific modifications to HVAC and ventilation systems. Here are some practical examples and suggestions:

1. Increased Airflow and Filtration: Modify the HVAC system to increase the airflow rate in the lavatory, ensuring adequate air exchange. Install high-efficiency air filters capable of capturing smaller particles, including microorganisms. This improves air quality and reduces the presence of airborne pathogens.
    
2. Directed Ventilation: Adjust the placement and direction of HVAC vents to optimize the airflow within the lavatory. Ensure that vents are strategically positioned to minimize the spread of aerosolized particles and maintain positive air pressure to prevent contamination from adjacent areas.
    
3. Separation of Ventilation Systems: Consider separate ventilation systems for toilets and other areas within the lavatory to prevent cross-contamination. This helps to prevent any airborne pathogens generated in the toilet area from spreading to other facility sections.
    
4. UV-C Light Disinfection: Install UV-C light fixtures within the ventilation system to provide continuous disinfection of the airflow. UV-C light has germicidal properties and can help inactivate microorganisms, further reducing the risk of infection transmission through the ventilation system.
    
5. Automatic Sensors and Controls: Implement automatic sensors and controls for ventilation systems, enabling increased airflow during high usage or occupancy periods. This helps maintain optimal air quality and reduces the accumulation of airborne pathogens.
    
6. Regular Maintenance and Cleaning: Establish a regular maintenance schedule for HVAC and ventilation systems in lavatories. Ensure proper cleaning, disinfection, and filter replacement to prevent the buildup and spread of contaminants.
    

By implementing these modifications, lavatories can benefit from improved air circulation, enhanced filtration, and reduced contamination risks, thereby contributing to better infection control measures.
 

2.3 Surface Engineered Disinfection: 
 

1. Automated UV Surface Decontamination in Unoccupied Toilets: 
 

• UV-C light, a specific wavelength of ultraviolet light, has proven germicidal properties and can effectively deactivate microorganisms, including bacteria and viruses. Automated UV surface decontamination systems are designed to operate in unoccupied toilets during specified time intervals. These systems use strategically positioned UV-C light fixtures to target high-touch surfaces such as toilet seats, flush handles, and door handles. When activated, the UV-C light irradiates these surfaces, effectively killing a wide range of pathogens that may be present.
   
• The advantage of this technology lies in its ability to provide continuous decontamination without the need for manual intervention. Automating the process ensures consistent and thorough disinfection of toilet surfaces, even in between cleaning schedules. This reduces the potential for surface contamination and the risk of transmission to subsequent users. However, it is important to note that automated UV surface decontamination systems should only be used when toilets are unoccupied to prevent exposure to UV-C light, which can be harmful to human health.
   
• This technology offers an additional layer of protection in the fight against infection transmission in toilets. By incorporating automated UV surface decontamination systems in unoccupied toilets, we can enhance the overall hygiene and infection control measures in these spaces. It complements other prevention strategies and contributes to creating safer environments for users.
   

2. Copper Surfaces: 
 

• Incorporating metal alloys with antimicrobial properties, such as copper, in manufacturing toilet handles and seats can further enhance infection control. These surfaces release copper ions when in contact with moisture or touched by hands, which have a destructive effect on bacteria, viruses, and fungi. The continuous release of copper ions reduces the microbial load on these high-touch surfaces, limiting the survival and spread of pathogens.
   

2.4 Combining Infection Prevention Approaches:

Combining multiple approaches for a comprehensive infection prevention strategy is important to effectively reduce the spread of infections. By implementing a range of measures, we can significantly enhance our ability to control the transmission of pathogens. Let's explore some key considerations when combining these approaches:
 

• Synergistic Effects: Each infection prevention approach contributes in its own way to reducing the spread of infections. For example, lid-down flushing helps minimize the release of aerosolized particles during toilet flushing, while waterless toilets eliminate the need for water and decrease the generation of plumes altogether. Additionally, HVAC and ventilation modifications improve air circulation and filtration, further reducing the presence of airborne pathogens. By combining these approaches, we create a synergistic effect that maximizes the effectiveness of infection control.
   
• Practical Examples: Real-life examples demonstrate the positive impact of combining infection prevention approaches. In a healthcare setting, for instance, a comprehensive strategy may involve implementing lid-down flushing protocols, installing waterless toilets in high-risk areas, optimizing HVAC systems for better air quality, and ensuring rigorous cleaning and disinfection practices. Such combined measures have been shown to reduce infection rates significantly.
   
• Overcoming Challenges: Implementing a comprehensive infection prevention strategy may come with challenges. These can include costs, infrastructure requirements, and user behavior. However, various strategies can help overcome these obstacles. For instance, organizations can prioritize investments in key areas based on risk assessment, gradually introduce waterless toilets in phases, educate and train users on proper toilet hygiene practices, and establish clear protocols and guidelines to ensure adherence.
   

By combining these approaches and addressing potential challenges, we can establish robust infection prevention measures that effectively reduce the spread of infections and promote a safer environment for communities and healthcare facilities.
 

Conclusion:
 

Toilets have been recognized as both contributors to and potential targets for infection control. The spread of community- and hospital-acquired infections through toilets is a significant concern. This blog post explored various approaches to reduce infection transmission and improve infection control in toilets.

By adopting best practices in toilet design, maintenance, and user behavior, we can make significant strides in preventing the spread of infections. Lid-down flushing reduces the release of aerosolized particles and limits the spread of bacteria on toilet surfaces. Waterless toilets eliminate the need for water and minimize the generation of plumes altogether. HVAC and ventilation modifications enhance air circulation and filtration, reducing the presence of airborne pathogens.

Combining these infection prevention approaches creates a synergistic effect that maximizes the effectiveness of infection control. Whether in households, community settings, or healthcare facilities, these measures can significantly reduce the risk of infection transmission and contribute to safer environments.

As we move forward, it is essential to prioritize the implementation of these infection prevention measures. Investing in toilet technology, promoting best practices, and educating users on proper hygiene practices are crucial steps toward creating healthier communities and reducing the burden of hospital-acquired infections.

Remember, infection prevention is a collective responsibility. Each of us has a role to play in maintaining clean and hygienic toilet environments. Together, we can make a difference in reducing the spread of infections and creating safer spaces for all.

Take action today by implementing these best practices and spreading awareness about the importance of infection control in toilets. Let us strive for a future where safe and hygienic toilets become the norm, protecting our communities and promoting overall well-being.

Thank you for reading and joining us in this important mission!

References:
 

Toilet hygiene—review and research needs - PMC (nih.gov)

The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet - PubMed (nih.gov)

Can a toilet promote virus transmission? From a fluid dynamics perspective - PMC (nih.gov)

Does putting the lid down when flushing the toilet really make a difference? | Microbiology Society