Evaluating the risk of Clostridioides difficile infection from toilet flushing: A quantitative microbial risk assessment and implications for infection control.
Elizabeth N Paddy, M Sohail, Oluwasola O D Afolabi
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引用次数: 0
Abstract
Background: Despite stringent infection control measures, Clostridioides difficile infection (CDI) remains a challenge in healthcare settings, partly due to overlooked transmission vectors such as toilet plume bioaerosols.
Aim: To systematically quantify the risks associated with CDI transmission via toilet flushing and provide critical insights to inform CDI preventive strategies.
Methods: Impaction sampling was used to quantify airborne C. difficile post-flush and high-contact surfaces were swabbed to assess contamination levels, in a controlled toilet environment. A Quantitative Microbial Risk Assessment (QMRA) approach was then used to estimate the risk to subsequent users from contamination by a previously colonized individual.
Results: A single flush can release C. difficile into the air, with bioaerosol concentrations up to 29.50 ± 10.52 CFU/m3 and deposit about 8-11 CFU on immediate surfaces. Despite a 4.4 log reduction in bacterial concentration within the toilet bowl post-flush, bacteria persist on its inner walls. Relative humidity increases by approximately 31.28% within the first 10 minutes post-flush, potentially enhancing the viability and transmission of aerosolized C. difficile. The flush button contact and inhalation-followed-by-ingestion in frequent-use hospital settings present the highest risks and exceed US EPA and WHO acceptable infection risk thresholds.
Conclusion: The findings of this study necessitate a review of current toilet designs, public health policies and facility management practices to mitigate the overlooked risks of CDI transmission through toilet plume bioaerosols in healthcare settings. Additionally, this study lays a foundation for developing evidence-based interventions aimed at achieving substantial behavioural and infrastructural changes in infection control practices.
期刊介绍：
The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.
The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that:
provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings;
provide new insight into cleaning, disinfection and decontamination;
provide new insight into the design of healthcare premises;
describe novel aspects of outbreaks of infection;
throw light on techniques for effective antimicrobial stewardship;
describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control;
improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change;
improve understanding of the use of IT systems in infection surveillance and prevention and control.
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