Toilet plume

A toilet plume is the rapid upward dispersal of microscopic urine, faeces, vomit and menstrual particles as a result of flushing a toilet. Day to day use of a toilet is considered to be of a lower health risk; However this dynamic changes quickly if a sick individual is shedding out virulent pathogens in their urine, faeces or vomitus. Flushing an unclean toilet ejects or aerosolizes (like a spray can) particles up to 15ft into the air, of a sneeze-like cloud comprised of dirty toilet water particles. Aerosols containing harmful viruses and bacteria from the infected stool, urine or vomitus of the last several users of that toilet. There is mounting evidence that specific pathogens such as C-Difficile, norovirus or SARS coronavirus can be spread by toilet aerosols. By either inhaling them directly or touching them on a landed surface; and subsequently touching the eyes or mouth. These aerosolized infectious particles that go on to be deposited throughout a bathroom onto items such as hand towels and Toothbrushes. It has been hypothesized that dispersal of pathogens may be slightly reduced by closing the toilet lid before flushing. Keeping in mind that aerosols still escape through gaps between the lid, seat and the rim. Other recommendations include using toilets with lower flush energy to help reduce the spread of human pathogens.

Possible effects on disease transmission

There is evidence that toilet aerosols can be a vector for disease transmission that involves acute gastroenteritis with the shedding of large numbers of pathogens through feces and vomit. Normal use of a toilet by healthy individuals, although disgusting breathing in or sitting in another persons Urine, Faeces or Menstrual Fluid Particles, it remains a lower risk than infected particles. [1] For example, some epidemiological studies indicate transmission of norovirus in passenger airplanes[2] and ships,[3] and SARS coronavirus through a contaminated building sewage system,[4] via contaminated toilets rather than other routes.[5] The feces and vomit of infected people can contain high concentrations of pathogens, many of which are known to survive on surfaces for weeks or months, and toilets may continue to produce contaminated toilet plumes over multiple successive flushes. Some other pathogens speculatively identified as being of potential concern for these reasons include gram-positive MRSA, Mycobacterium tuberculosis, and the pandemic H1N1/09 virus commonly known as "swine flu".[5]

Pathogens such as Salmonella have been isolated in an air sample taken immediately after flushing a seeded toilet. The combination of cleaning and disinfecting surfaces is usually effective at removing contamination, although some pathogens such as norovirus[6] have an apparent resistance to these techniques. [5] In the case of C-Difficile, it remained in the toilet bowl after 24 Flushes. Demonstrating the ability to infect each subsequent user of that Toilet, unaware that there was a deadly pathogen lurking in the toilet bowl between cleanings.

Mechanism

Aerosol droplets produced by flushing the toilet can mix with the air of the room,[7] larger droplets will settle on a surface before they can dry,[5][8] and can contaminate surfaces such as the toilet seat, flush handle, which can be contacted by the hands and brought up to the eyes or mouth. Or travel several feet and land on a toothbrush. [1] Smaller aerosol particles can become droplet nuclei as a result of evaporation of the water in the droplet; these have negligible settling velocity and are carried by natural air currents.[8] Disease transmission through droplet nuclei is a concern for many fecal-oral pathogens like SARS-CoV-2, because they are excreted in feces, urine & vomit, or are susceptible to drying.[5] The critical size dividing these dispersal modes depends on the evaporation rate and vertical distance between the toilet and the surface in question.[8]

Experiments to test bioaerosol production usually involve seeding a toilet with bacteria or virus particles,[5] or fluorescent microparticles,[8] and then testing for their presence on nearby surfaces and in the air, after varying amounts of time.[5][8] The amount of bioaerosol varies with the type of flush toilet. Older wash-down toilet designs produce more bioaerosol than modern siphoning toilets.[5] Among modern toilets, bioaerosol production increases as qualitative flush energy increases, from low-flush gravity-flow toilets common in residences, to pressure-assisted toilets, to vigorous flushometer toilets often found in public restrooms.[8]

One study found that lowering the toilet lid helped prevent dispersion of larger droplets, instead allowing them to concentrate on the toilet seat itself. Closing the lid reduced the airborne bacteria concentrations by a factor of 12. The study recommended discouraging the use of lidless toilets, and thus contradicts the US Uniform Plumbing Code specifications for public toilets.

In a Hospital setting, patients run the risk of catching a Nosocomial Infection from sharing a Lidless toilet with multiple other sick patients, shedding diseases in their effulence.

[5][9]

History

Experiments on the bioaerosol content of toilet plumes were first performed in the 1950s.[5] A 1975 study by Charles P. Gerba popularized the concept of disease transmission through toilet plumes.[10] The term "toilet plume" was in use before 1999.[11]

References

  1. Barker, J.; Jones, M. V. (2005). "The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet". Journal of Applied Microbiology. 99 (2): 339–347. doi:10.1111/j.1365-2672.2005.02610.x. ISSN 1364-5072. PMID 16033465. S2CID 25625899.
  2. Widdowson, Marc-Alain; Glass, Roger; Monroe, Steve; Beard, R. Suzanne; Bateman, John W.; Lurie, Perrianne; Johnson, Caroline (20 April 2005). "Probable transmission of norovirus on an airplane". JAMA. 293 (15): 1859–1860. doi:10.1001/jama.293.15.1859. ISSN 1538-3598. PMID 15840859.
  3. Ho, Mei-Shang; Monroe, Stephan S.; Stine, Sarah; Cubitt, David; Glass, Roger I.; Madore, H. Paul; Pinsky, Paul F.; Ashley, Charles; Caul, E.O. (21 October 1989). "Viral Gastroenteritis Aboard a Cruise Ship". The Lancet. 334 (8669): 961–965. doi:10.1016/s0140-6736(89)90964-1. ISSN 0140-6736. PMID 2571872. S2CID 29429652.
  4. "Outbreak of Severe Acute Respiratory Syndrome (SARS) at Amoy Gardens, Kowloon Bay, Hong Kong: Main Findings of the Investigation" (PDF). Hong Kong Special Administrative Region Department of Health. 29 March 2011. Archived (PDF) from the original on 20 April 2017.
  5. Johnson, David L.; Mead, Kenneth R.; Lynch, Robert A.; Hirst, Deborah V.L. (March 2013). "Lifting the lid on toilet plume aerosol: A literature review with suggestions for future research". American Journal of Infection Control. 41 (3): 254–258. doi:10.1016/j.ajic.2012.04.330. PMC 4692156. PMID 23040490.
  6. Barker, J.; Vipond, I. B.; Bloomfield, S. F. (1 September 2004). "Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces". The Journal of Hospital Infection. 58 (1): 42–49. doi:10.1016/j.jhin.2004.04.021. ISSN 0195-6701. PMID 15350713.
  7. Jones, RM; Brosseau, L. M. (May 2015). "Aerosol transmission of infectious disease". Journal of Occupational and Environmental Medicine. 57 (5): 501–8. doi:10.1097/JOM.0000000000000448. PMID 25816216. S2CID 11166016.
  8. Johnson, David; Lynch, Robert; Marshall, Charles; Mead, Kenneth; Hirst, Deborah (1 September 2013). "Aerosol Generation by Modern Flush Toilets". Aerosol Science and Technology. 47 (9): 1047–1057. Bibcode:2013AerST..47.1047J. doi:10.1080/02786826.2013.814911. ISSN 0278-6826. PMC 4666014. PMID 26635429. Archived from the original on 15 April 2017.
  9. Best, E. L.; Sandoe, J. a. T.; Wilcox, M. H. (1 January 2012). "Potential for aerosolization of Clostridium Difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk in Hospitals". The Journal of Hospital Infection. 80 (1): 1–5. doi:10.1016/j.jhin.2011.08.010. ISSN 1532-2939. PMID 22137761.
  10. Ray, C. Claiborne (26 November 2012). "Does Flushing a Toilet Release Germs Into the Air?". The New York Times. ISSN 0362-4331. Archived from the original on 23 June 2016. Retrieved 15 July 2016.
  11. Adams, Cecil (15 April 1999). "The Straight Dope". Chicago Reader. Archived from the original on 20 April 2017. Retrieved 20 April 2017.
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