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Pilot study on the decontamination efficacy of an installed 222-nm ultraviolet disinfection device (Care222™), with a motion sensor, in a shared bathroom

Kitagawa et al. 2021: In a pilot study, an automated 222-nm UVC system in shared bathrooms significantly reduced bacterial contamination on high-touch toilet surfaces (seat, control panel, paper holder), though effects were less on shaded areas, supporting UVC as an adjunct IPC measure.

sciencedirect.com

Toilet surfaces are contaminated with pathogens, and they may be a vector for disease transmission. In this study, we investigated the efficacy of an …

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Intensive Care Unit Wastewater Interventions to Prevent Transmission of Multispecies Klebsiella pneumoniae Carbapenemase–Producing Organisms

Mathers et al. 2018 @cidjournal.bsky.social : although not a direct toilet study, installing hopper covers significantly reduced patient acquisition of KPC organisms, supporting the role of covering high-energy flush systems to limit environmental dispersion from wastewater sources.

academic.oup.com

The role of the wastewater environment in nosocomial transmission of carbapenemase-producing organisms is increasingly recognized. We demonstrated that env

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Study on the air gap effect when closing toilet lid on droplet and pathogen escaping from flushing

Zhang et al. 2025: 92% of droplets are <1 μm, and even with the lid closed, bioaerosols escape via seat gaps; escape rises sharply with gap size (up to ~24–57% at 6 mm, higher for viruses), lid closure reduces but does not eliminate transmission risk.

sciencedirect.com

Closing the toilet lid before flushing is widely recommended to minimize the dispersal of pathogen-laden aerosols. However, an often-overlooked issue …

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Closing the toilet lid reduces aerosol generation and environmental contamination, particularly for larger particles. Fine aerosols can still escape through lid-seat gaps (up to ~24% leakage), meaning the lid provides partial protection but is not a complete IPC solution.

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Chemical disinfection is an adjunct outbreak control measure, but effects are often transient. Limitations include biofilm persistence, rapid re-seeding from plumbing, and variable compliance; reduced susceptibility to may further constrain effectiveness.

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Multidrug-Resistant Organisms and Resistance Genes Contaminating Shared Restroom

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Aerosol generation in public restrooms

Schreck et al. 2021: flushing generates large numbers of aerosols (0.3–3 μm) that can reach ≥1.52 m (breathing height) within seconds. Lid reduces larger droplets but does not prevent escape of fine aerosols, and repeated flushes lead to progressive accumulation in the room despite ventilation

pubs.aip.org

Aerosolized droplets play a central role in the transmission of various infectious diseases, including Legionnaire's disease, gastroenteritis-causing norovirus,

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Measuring the flushing-generated flow and aerosols in lavatory of commercial aircraft

Li et al. 2022: Commercial aircraft. Lid open, a single flush generates ~8,500 aerosols, ~92% submicron, with measurable spikes not just in the bowl but also near the floor and in the breathing zone

sciencedirect.com

Lavatory use on commercial aircraft may present a risk of contagion, especially on long-haul flights. Flushing the toilet can induce a strong sweeping…

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Commercial toilets emit energetic and rapidly spreading aerosol plumes - Scientific Reports

Crimaldi et al. 2022: flushing generates a high-energy turbulent jet that rapidly propels aerosols upwards, reaching ~1.5 m (breathing zone) within ~8 seconds; particle counts increase markedly post-flush (especially <1 µm), highlighting rapid exposure potential rather than slow diffusion

nature.com

Scientific Reports - Commercial toilets emit energetic and rapidly spreading aerosol plumes

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The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet

Barker & Jones 2005: flushing generates substantial bioaerosols, peaking immediately and remaining detectable for up to 60 minutes; importantly, aerosols arise from both bowl water and contaminated sidewalls, with subsequent fallout leading to contamination of surrounding surfaces.

academic.oup.com

Abstract. Aims: To determine the level of aerosol formation and fallout within a toilet cubicle after flushing a toilet contaminated with indicator organis

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The plume is dominated by small particles and reaches the 1.5 m breathing zone within ~8 seconds. So forget about flushing and running. Aerosols can persist in the environment for up to 60 minutes.

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Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting - Antimicrobial Resistance & Infection Control

Antimicrobial Resistance & Infection Control(Knowlton et al. 2018): flushing significantly increases bioaerosols (especially with fecal waste), dominated by <3 μm particles, but no reduction across distance or time, indicating a persistent, well-mixed plume rather than localized exposure.

link.springer.com

Background 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 relati...

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Bioaerosols generated from toilet flushing in rooms of patients with Clostridioides difficile infection | Infection Control & Hospital Epidemiology | Cambridge Core

Wilson et al. 2020 @ichejournal.bsky.social : flushing doubles culture positivity (13% → 26%), with pathogens (e.g. Enterococcus spp.) detected up to 1 m; concentrations increase post-flush at all distances, and larger particles (5–10 μm) rise significantly, supporting airborne spread potential.

cambridge.org

Bioaerosols generated from toilet flushing in rooms of patients with Clostridioides difficile infection - Volume 41 Issue 5

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Understanding horizontal spread, vertical spread, and plume persistence is critical for effective IPC measures. Horizontal spread: Toilet flushing generates bioaerosols spreading ≥1 m with no drop-off (p≈0.91). Mostly <3 μm (respirable) and fecal-origin (e.g. C. difficile, Enterococcus).

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WHO @who.int · 04/06/2025

Here’s a thread on the talk I gave at #ESCMIDGlobal 2026: “Toilets: Flushing and Spread of Pathogens” — nicknamed “You can’t outrun the plume.” Using published studies, I covered the key components shown below. There’s a surprising amount of data, but still a lack of high-quality intervention trials

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Reposted by Kalisvar

New guideline on the clinical management and infection prevention and control of #mpox. This guidance is designed to support: ✅ Patients with mpox — whether at home, in the community, or in healthcare facilities ✅ The health workers and caregivers supporting them 🔗 bit.ly/43YOzjf

Picture of Tresor, a health worker, checks on two-year-old Ibrahim, who is being treated for mpox, at the Nyiragongo General Referral Hospital, north of Goma in the Democratic Republic of the Congo (DRC) on 14 August 2024.

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Reposted by Kalisvar

Alex Sundermann, DrPH @sundermannaj.bsky.social · 28/05/2025

New CID study out from Art Baker & team: 12,855 NTM episodes across 10 hospitals over 8 years 💥 1 in 4 were hospital-onset! 📉 HO rates ⏬ 38% over time but varied 15x btwn hospitals ▶️ They used a clean, simple definition for HO NTM (day 3+) NTM = underestimated #IDSky 🔗 doi.org/10.1093/cid/...

doi.org

Epidemiology of Healthcare Facility-Associated Nontuberculous Mycobacteria From 2012 Through 2020 in a 10-Hospital Network in the United States

Incidence rates of hospital-onset nontuberculous mycobacteria (NTM) episodes decreased from 2014 through 2020 within a hospital network, but rates varied s

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Reposted by Kalisvar

Sean Ong @seanong.bsky.social · 20/05/2025

Honoured to be invited to write this commentary with @steventong.bsky.social, on an excellent target trial emulation study which showed that antibiotic use was not associated with improved outcomes in non-severe COVID-19. jamanetwork.com/journals/jam... #IDSky

jamanetwork.com

Target Trial Emulation for Antibiotic Use in Acute COVID-19

This study by Pulia and colleagues1 reports results from a large population-based cohort using target trial emulation to examine the associations of antibiotic treatment with clinical outcomes in pati...

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9/ 💡Key takeaway: Patient safety demands a zone-based, proactive, multidisciplinary approach to managing both water and wastewater in hospitals. Redefining “water safety” may be one of the most important moves in the AMR era. 🧵/end

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8/ 📊 Whether it’s clinical handwash stations, shower design, or cleaning workflows, each part of the system needs integrated thinking. “Clinically integrated water/wastewater safety” is the new north star—tying engineering, IPC & clinical workflows together.

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7/ 📉 The authors warn against a reactive mindset. Retrofitting drains after AMR outbreaks is costly—and sometimes impossible. New builds must proactively bake in safety. Hospitals designed today will serve during peak AMR eras. We can’t afford to get it wrong.

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6/ 🛠️ The paper suggests renaming Water Safety Groups to Water/Wastewater Safety Groups (you get the idea) —broadening scope to include wastewater hazards, which are often invisible but just as risky.

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5/ 🚿 Some hospitals have responded with “water-free” or “water-lite” ICUs—removing sinks, switching to wipes, etc. These aren’t fringe moves—they’re targeted interventions to stop recurring outbreaks when other measures fail. (Personal note: Implementation not so easy!)

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4/ 🔄 Zone B—the periphery—is often neglected, yet staff interact with it constantly. One ICU study showed only 4% of sink use was for handwashing 🤯 Design flaws here can spread AMR via showers, pantries, even jug-filling.

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3/ 🧠 The term “water safety” masks critical risk zones. The authors redefine hospital plumbing into 3 zones: A) Main water system B) Periphery (e.g. sinks, traps, final 2m of pipe) C) Main wastewater system Each zone needs separate oversight & expertise. #BuiltEnvironment

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2/ The authors argue that our traditional idea of “water safety” is outdated—especially in the age of antimicrobial resistance. They propose a new, more precise framework that accounts for risks from both water and wastewater systems. 🚽🧫 The following are the key points (that I liked) 🧵👇

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Alex Sundermann, DrPH @sundermannaj.bsky.social · 12/05/2025

🧵1/ We need more research and reviews around “water safety” in healthcare facilities. This new paper in @thejhi.bsky.social by Weinbren et al. (2025) provides a fresh perspective—challenging the idea that it's just about legionella and outlet water quality. 🏥💧 #HospEpi #AMR

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Reposted by Kalisvar

🧼 Not all endoscope brushes are created equal A new study in @thejhi.bsky.social compared different brush types ▶️ metal shafts + DuPont fibre bristles removed organic matter >>> than plastic or microfiber brushes More passes = cleaner scopes 📄: www.journalofhospitalinfection.com/article/S019...

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8/ Bottom line? This Singapore study offers a real-world, real-cost case for smart PPE deescalation. 🛡️ Safety preserved 💵 Costs down 🌱 Carbon cut It’s time to reimagine IPC and assess how we protect health workers — and the planet.

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Optimizing Personal Protective Equipment for a Sustainable Future

6/ The accompanying editorial calls this a “larger imperative.” jamanetwork.com/journals/jam... We’re not just talking COVID-19 here — it’s a pivot toward sustainable, evidence-aligned PPE use across all of healthcare. The gowns we use (and toss) daily? They have a carbon footprint too.

jamanetwork.com

The important study by Sutjipto et al1 shows that deescalating personal protective equipment (PPE) requirements for COVID-19 can reduce cost and carbon impacts without compromising safety. This 24-mon...

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5/But it wasn’t just about safety. Check out the sustainability win: 💥 440,532 disposable gowns saved ♻️ 66,080 kg plastic waste avoided 🌍 398,681 kg CO₂ emissions prevented 💸 ~SGD 454k (USD ~$334k) saved

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4/💡Result: No increase in infections. COVID-19 incidence among staff tracked with community trends. ➕ Median staff-to-community infection ratio actually dropped from 2.6 to 1.5 after PPE deescalation. Safety? ✔️

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3/📊 The study looked at 12 months before & after the policy change at a major hospital campus. ⚕️ >10,000 healthcare staff 🗓️ 24 months of data Key question: Did COVID-19 cases among staff rise post-change?

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