[HN Gopher] Aerosolization of C. difficile after flushing toilet...
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Aerosolization of C. difficile after flushing toilets: the role of
toilet lids
Author : bookofjoe
Score : 75 points
Date : 2022-06-21 19:06 UTC (3 hours ago)
(HTM) web link (www.journalofhospitalinfection.com)
(TXT) w3m dump (www.journalofhospitalinfection.com)
| c0l0 wrote:
| Full-on Baader-Meinhof here, seeing this posted while I am at
| home/in the hospital (for two days about a week ago) for the
| second week because of a C. diff infection I got from an
| antibiotics treatment for the tonsillitis prior.
|
| I do know for a fact that I _never_ want to feel this sick again.
| If that requires me to keep the toilet lid closed whenever
| flushing for all eternity, I 'll gladly do so - and I think you
| should, too. (I was actually advised to do that and flush
| 'carefully'/slowly, with the lid down, by my doctors, and took
| care to comply.)
| ars wrote:
| > flush 'carefully'/slowly
|
| How does one flush "carefully/slowly"? The speed you press the
| handle doesn't change the pressure of the flush - at most it
| might extend it and waste water, by keeping the flapper open
| longer than necessary.
|
| Instead press the handle rapidly and briefly to save water and
| still have a proper flush.
| calt wrote:
| Extend it, use more water, and get fewer aerosols into the
| air. That's the point of his post.
|
| If you have C. diff. and don't want to spread it, it's
| probably worth it to spend (not waste, spend) the extra water
| for a slower flush if your toilet will work that way.
| ars wrote:
| That's .... not what will happen.
|
| Instead you'll get the exact same regular violent flush,
| and then water will pour into the tank extending the time
| that water can aerosolsize, and worse, pushing any existing
| aerosols farther out into the room.
|
| So basically that's the opposite of what you should do, if
| that's your goal.
|
| Instead, reduce the flush time.
|
| Try it: hold down the flush lever and time how long it
| takes before you can smell the water.
| calt wrote:
| > hold down the flush lever
|
| That's not what's being suggested. Slowly open the valve
| by slowly pressing the lever to let some water in before
| the valve pop all of the way open.
| ars wrote:
| I don't understand what goal that will accomplish. You
| might wash the walls of the toilet slightly, but that's
| not where the bacteria are, they would be in the center,
| in the bulk of the material.
|
| Plus toilets are designed to prevent you from doing that,
| they try very hard to be either fully closed, or fully
| open.
|
| And, even if you succeeded, by releasing some water in
| advance, you reduce the pressure of the flush, which
| would elongate it, instead of rapidly removing the
| material, and time with water flowing = amount of
| aerosol.
|
| This plan seems counterproductive.
| iudqnolq wrote:
| I suspect you're used to much more modern toilets than
| the person you're replying to. Toilets from at least a
| decade ago in the USA don't feel like they're designed to
| try very hard to do anything contrary to the direct
| mechanical effect of you pushing down a lever.
| OliverJones wrote:
| Interesting observations. Some obvious consequences:
|
| Hospital visitors and staff should never use patient toilets,
| ever.
|
| Patients should use their own toilets only.
|
| Staff gets clean scrubs after any visit to a toilet, helping a
| patient or on their own behalf. Yeah, sterile workers (surgery,
| etc) have to scrub in again after a bathroom break.
|
| Clean patient bathrooms, including toilets, often, especially if
| infectious disease is present.
|
| Design facilities to minimize the need to share bathrooms.
|
| "Employees must wash hands before returning to work."
|
| For what it's worth, hospitals already try to do this stuff.
| nextos wrote:
| Some Japanese toilets have a system to create negative pressure
| so that no aerosols escape even when the lid is down.
|
| AFAIK, shower heads are also problematic. I recall NHS
| conducted a study and they concluded many vulnerable patients
| get infected by aerosols during showering. Shower heads that
| are not cleaned periodically get very nasty biofilm buildup
| inside the head.
|
| I think that as a consequence some NHS trusts switched to some
| showerheads that get cleaned and rotated periodically.
| dekken_ wrote:
| Legionnaires' disease can come from shower heads that are not
| cleaned/maintained.
| Spooky23 wrote:
| Hospitals make a big show of a few things. Any hospital I've
| been to is filthy in most departments as they slash and burn
| overheads like aides and cleaning staff.
|
| Half the people at the Starbucks across the street from a
| hospital are in scrubs.
| diego wrote:
| Obvious business idea: toilets that slide a containing partition
| before flushing. There's no need to use the seat for that, or to
| require the person to get up.
|
| There might be easier mechanical ways to accomplish the same.
| rpmisms wrote:
| Until someone flushes while sitting and chops their nuts off.
| marginalia_nu wrote:
| Castrating reverse poopers may seem harsh, but it's necessary
| to limit their spread.
| synu wrote:
| Are there really so many people who don't want to have to get
| up after pooping that this is a business and needing powered
| toilets would be worth the trade-offs?
| xxpor wrote:
| If it gets builders in the US to add an electrical outlet
| near toilets, I'll selfishly advocate for it. Then I could
| install a Japanese electric bidet much more easily :)
| oh_sigh wrote:
| I have something slightly better, with less of a chance of
| unwanted castration: Just make the bowl an area of low pressure
| so particles are less likely to be flung out of it. You could
| have a fan pulling air through a tube from the bowl, and then
| running it through some filters.
|
| I had this idea mostly for smell control - why remove all the
| air from the room instead of just dealing with smell where it
| is created?
| benmanns wrote:
| I think that would be really difficult to keep clean.
| elicash wrote:
| > There might be easier mechanical ways to accomplish the same.
|
| You could probably rig a chain that connected from the front of
| the lid to inside the tank that disabled flushing if it wasn't
| fully extended -- given the handle itself is connected to a
| chain.
| moduspol wrote:
| Sure, and I guess that'd be fine for commercial applications.
| When you have a potential clog, though, you certainly want to
| be able to visibly verify the flush is working as expected
| before leaving.
|
| Of course, that could be solved with a see-through toilet
| lid, but I can only imagine the absurdity of trying to pitch
| that to consumers.
| elicash wrote:
| I was thinking more that people here might be interested in
| rigging something up for their families just to tinker with
| the idea. Maybe to encourage habits for kids. But really
| just for the fun of making it.
| robocat wrote:
| Vacuum toilet like on planes? An extractor fan? I want an
| extractor fan anyway (well, my family does).
|
| Edit: retrofit by sucking air through toilet cistern overflow
| pipe e.g. https://www.panfan.co.nz/ (great name) but heaps of
| similar (loofloo, odourvac, airaway, toiletfriend, expella,
| clo-vent, etcetera) but probably want a Japanese toilet with it
| inbuilt so designed to suck air from all around the rim, not
| just the downpipe? Disclaimer: first time I've heard of any of
| those products.
| Hnrobert42 wrote:
| My dad was a dentist and thought it would be unseemly for
| patients to become aware of any emanations from his private
| bathroom. He had exhaust fans rigged up that he claimed could
| changeover the whole room in 2 minute. They were unnervingly
| loud but did the trick.
| [deleted]
| ciconia wrote:
| Just use composting toilets, avoids the whole issue, and better
| for the environment. AMA if this interests you.
| sumy23 wrote:
| I don't see that working in a hospital.
| TedDoesntTalk wrote:
| My parents taught me to always close the lid before flushing
| because of the generic "germs" argument. I taught it to my kids.
| Takes 2 seconds.
| ouid wrote:
| This is nonsense. C diff in hospital settings is not a reason
| to close the lid when you flush in your home. The lid on a
| hospital toilet is designed to close a lot more than the lid on
| your home toilet. The amount that your home toilet lid can
| "reduce germs" is less than a factor of 2. There are basically
| no pathogens whose infectious innoculum is so close to dose of
| the average toilet plume that a factor of 2 makes any
| difference at all. Moreover, those are _your_ germs. you are
| colonized with them already.
| seszett wrote:
| > There are basically no pathogens whose infectious innoculum
| is so close to dose of the average toilet plume that a factor
| of 2 makes any difference at all. Moreover, those are your
| germs. you are colonized with them already.
|
| That's only true if you're living alone. If someone else is
| living with you, then it's always good to try and avoid
| sharing germs, especially when they're sick.
| rimunroe wrote:
| > If someone else is living with you, then it's always good
| to try and avoid sharing germs
|
| I feel like this is a ridiculous enough question that I
| don't expect a source-though if you do have one or know how
| this sort of thing would be studied I'd love to hear it--
| but is that always true? I certainly try to reduce my
| exposure when someone's noticeably sick, but I wouldn't be
| surprised if some degree of exposure turned out to be
| beneficial. I also wouldn't be surprised if it turned out
| to be harmful. I would be least surprised to find out that
| doing this simply doesn't make a measurable difference in
| most home environments.
| seszett wrote:
| When your loved one is emptying from both sides every
| other hour, you generally just want to avoid it for
| yourself.
| rimunroe wrote:
| Of course, but you said that it's always a good idea to
| avoid sharing germs. I'm specifically asking about the
| common scenario where no one is noticeably sick
| TedDoesntTalk wrote:
| Using UV light to see the plume of a flush
|
| https://www.youtube.com/watch?v=1Tg7i66GGMI
| ouid wrote:
| We know about the pathogens which are likely to make you
| sick from fecal-oral transmission. We have studied them
| pretty well because they are common. The most likely
| candidate for a pathogen that could be spread through
| toilet plumes is called norovirus, and it is extremely
| studied. We have so far not found any clinical evidence of
| infection through toilet plume from norovirus. This
| includes in cases where water jet toilets produce many
| times more aerosolization in public bathrooms where lids
| are not even an option.
| slowmovintarget wrote:
| What of droplet spread to exposed surfaces in the bathroom
| like... a toothbrush drying on the rack beside the sink?
|
| Granted, the way to reduce that possibility is to keep the
| toothbrush in a cabinet.
| _benedict wrote:
| If you read the article:
|
| > 12-fold greater counts than when lidded
|
| How did you source your "factor of 2" assertion?
| ouid wrote:
| The same article. Look at the data. for aerosols one hand
| width above the surface of the toilet, the numbers are a
| factor of two different lidded vs unlidded. The 12 times
| claim is only for samples collected at "seat height".
| TedDoesntTalk wrote:
| > when you flush in your home
|
| I did not say "in my home". Everywhere.
| mise_en_place wrote:
| I tend to agree, it also adds another pain in the ass step
| and is not as efficient. I want to finish my business (no pun
| intended) as quickly as possible and move on to the next
| thing, not have to do pointless additional steps that have
| specious benefits at best. Also I highly recommend a bidet,
| it has made cleaning very fast and efficient and more
| hygienic.
| krylon wrote:
| > another pain in the ass step ... > finish
| my business (no pun intended)
|
| So that first pun _was_ intended, I presume? Well done!
|
| I wonder why those fancy high-tech Japanese toilets haven't
| caught on over here ("here" == Germany, but I suspect the
| situation is very similar in most places that aren't
| Japan). From what I heard they are like a toilet with a
| builtin bidet.
| cycomanic wrote:
| > I tend to agree, it also adds another pain in the ass
| step
|
| I am not sure I want to know what your doing with the
| toilet lid, but it certainly is not what the article is
| talking about. SCNR ;)
| mise_en_place wrote:
| Toilet seat tends to be hard plastic material. I have
| never found a toilet that was pleasant to sit on for more
| than a few minutes. There is padding but that doesn't
| help too much. Squat toilet is ideal but requires holding
| squat position for many minutes.
| Hnrobert42 wrote:
| But what's the harm in closing it?
| whizzter wrote:
| Depending on the toilet (and esp with "water saving
| toilets"), floating remains left behind for the next person
| to discover?
|
| The problem is that many toilets seems to be designed so
| that the flowing water is supposed to create a vacuum pull
| effect in the piping dragging with it water and the heavier
| materials from a toilet.
|
| However with a closed lid the lower air pressure within the
| bowl is going to create a suction effect in the other
| direction thus lowering the flushing effect, leaving
| heavier brown materials still within the toilet ready for
| the next customer to discover.
| dtgriscom wrote:
| I've never seen a toilet lid that seals well enough to
| affect the flushing action.
| ouid wrote:
| It takes 2 seconds. Why spend 2 seconds doing something
| useless?
| mulmen wrote:
| As established, it is not useless.
| ouid wrote:
| That is not, in fact, established. And the question was
| "what's the harm?"
| [deleted]
| mulmen wrote:
| > a factor of 2
|
| So, half? Is there some benefit to blasting literal shit into
| the air I am missing?
| ouid wrote:
| Yes, you save, according to OP, 2 seconds, 4, since you
| then have to open the lid every time. Since it has no
| impact on your health, you should prefer to save the time.
|
| There is literal shit everywhere all the time. There's shit
| inside of you, right now. The bacteria that comprise that
| shit are basically the same as the bacteria on your skin.
| Performing little rituals to reduce the amount of perceived
| shit in your life is a symptom of, and perhaps even a
| pathway to, crippling neurosis.
| mulmen wrote:
| > crippling neurosis.
|
| Well that escalated quickly.
|
| You are ignoring the actual benefit of halving exposure
| with a couple of seconds of effort. Worrying about that
| kind of time is itself crippling neurosis.
|
| I reject your analysis.
| ouid wrote:
| I am not ignoring that effect. I am dismissing it with
| two arguments. The first is that this extremely unlikely
| to ever be your largest exposure to a pathogen. The
| reason that it is important in a hospital is because they
| essentially autoclave these room to try to eradicate C
| Diff. The second reason is that even if it is your
| largest exposure to that pathogen, and that is enough to
| make you ill, it is almost certain that a dose of half of
| that size will also be sufficient to make you ill.
|
| It is notable that there are no studies to the effect of
| "do people who close their toilet lids at home get sick
| less often". The scientific journalism of this "effect"
| is always about the quantity of germs, or conflating home
| and hospital settings, where again, the objective is
| literally zero C diff. It riles up the germophobes.
| TedDoesntTalk wrote:
| > It is notable that there are no studies to the effect
| of "do people who close their toilet lids at home get
| sick less often".
|
| There are also no studies proving that people who jump
| out of an airplane with a parachute live longer than a
| control. I guess we should not trust our instinct in this
| case.
|
| Using UV light to see the plume of a flush
|
| https://www.youtube.com/watch?v=1Tg7i66GGMI
|
| Search youtube for many other demonstrations.
| ouid wrote:
| I think you think that the only kind of study that
| confirm this hypothesis is some kind of RCT, where we
| give one group a placebo toilet flush, and the other I
| try to get infect with norovirus. The point of
| "https://www.bmj.com/content/363/bmj.k5094" which is more
| or less making the same tongue in cheek argument as you,
| is that there are limitations to what can be counted
| through an RCT.
|
| I am, however, _not_ talking about an RCT. I am talking
| about the conspicuous lack of _observational_ study of
| the clinical phenomenonology of toilet plume, rather than
| some secondary observation about scary germs.
|
| Epidemiologists must find ways to study illness without
| actually making people ill, but they still, for the most
| part, manage. Moreover, observational study is not, in
| any way, lacking, about what happens when you jump out of
| a plane with a parachute. It's not merely common sense,
| it has been observed to happen. Moreover, this is
| reflected pretty fucking well in the literature https://w
| ww.ncbi.nlm.nih.gov/pmc/articles/PMC1478603/pdf/brj....
| TedDoesntTalk wrote:
| I am simply amazed that you cannot see adverse risk in
| certain activities without a study - observational, RCT,
| or otherwise - confirming it. I wonder how people 500
| years ago lived with risk without the proliferation of
| studies that we have today. Maybe risk simply did not
| exist back then since no studies confirmed it?
| doliveira wrote:
| Yeah, at first scan I thought it was going to be some
| ironic comment. Which it was, just not intentionally
| hgomersall wrote:
| Is it a benefit to reduce exposure in a household, or
| even non-hospital setting? We're only just beginning to
| understand the gut biome, and too much historical advice
| that seemed sensible turned out to be problematic when
| understood better.
| 256bit wrote:
| But how do you use the toilet brush at the same time? Even if
| you use the toilet brush before flushing, you have to clean the
| brush somehow...
| mulmen wrote:
| Uh, I never put the toilet brush into "used" water. Yes,
| rinse it with a flush. That's a lot different than flushing
| dirty toilet water with the lid up.
| Cerium wrote:
| Does it even cost two full seconds? I put the lid down as I
| stand and turn to press the flush. Not only is it more sanity,
| but every time I drop something in the bathroom and have it
| bounce off the toilet lid I'm happy it's not in the bowl.
| standardUser wrote:
| I'm in my 40's and my entire life I've had between 0-2 minor
| illness every year. Mostly mild head colds. I wonder if I was
| to adopt a rigid routine of taking extra precautions (like
| closing toilet lids, more diligent hand washing, using paper
| towels on bathroom door handles, etc) if I would ever notice a
| change in that pattern.
|
| Or, is the idea that these extra precautions potentially
| protect against a more serious illness that might actually
| concern me?
|
| Either way, my current method of existing in the world seems to
| result in very few acute health issues, so it's hard to be
| motivated to change.
| mrlonglong wrote:
| That's great but when you get to my age you need vaccination
| as the immune system starts to weaken the older you get.
| TedDoesntTalk wrote:
| You are not consciously aware for every foreign organism your
| body fights.
| wry_discontent wrote:
| How am I supposed to know if my poop is fully flushed? I'm just
| supposed to repeatedly open and close the lid to flush my toilet?
| ars wrote:
| Get a new toilet. The modern (good ones - not all are good),
| pretty much never fail to do a proper flush, and they hardly
| ever clog.
|
| I got the TOTO CST743S, and it basically never fails or clogs -
| the handful of times a year that it does clog, you just wait 5
| minutes, and then flush again and it's clear.
| purplerabbit wrote:
| Eat more fiber maybe
| mrlonglong wrote:
| See, my mother was right to insist on closing the loo seat before
| flushing.
| changoplatanero wrote:
| Didn't they test this on mythbusters at some point?
| Hnrobert42 wrote:
| Yes. I remember they found the bacteria did spread to
| toothbrushes in the room.
| bradyd wrote:
| They also found it spread to toothbrushes in other rooms as
| well.
| Aachen wrote:
| But it was much much more on the in-room brushes right?
| Just comparitively I mean. Guess imma have to watch that
| episode again.
| robonerd wrote:
| Are courtesy flushes safe?
| taeric wrote:
| With all of the press that "COVID in sewage" got, I'm curious if
| this same mechanism could be a better explainer for spread of
| covid in some areas than others. Specifically, my hypothesis
| would be that places that typically have non fitted lids on
| toilettes are a large part of why some super spreader gatherings
| turn into super spreaders.
|
| Would love if someone has thoughts/suggestions on how to disprove
| this general idea.
| sandyarmstrong wrote:
| Why would this be necessary to explain spread when COVID is
| aerosolized on every exhale?
| taeric wrote:
| It would more explain lack of spread in other large
| gatherings.
|
| Edit: As an example, it could also go a long way to explain
| why more teachers don't get covid from students. They don't
| typically have shared restrooms. Big caveat, I've not seen a
| reliable quantification of that spread.
| gjs278 wrote:
| olalonde wrote:
| I flush while still sitting on the bowl, problem solved I guess?
| marginalia_nu wrote:
| Plus, you're sticking it to Big Bidet.
| olalonde wrote:
| I actually use a bidet which is why I don't have to stand up
| until ass and toilet water are both clean.
| smm11 wrote:
| The bidet would like to have a talk with you.
| mulmen wrote:
| Bidets don't spray dirty water.
| what-imright wrote:
| Someone sells toilet lids for a living. 25 cm is meaningless. But
| touching a toilet seat every time you go is very meaningful....
| _Microft wrote:
| Are you insinuating that the researchers have undeclared
| conflicts of interest?
| what-imright wrote:
| That was humor but, based on the shred of evidence they claim
| to have, their conclusion and recommendation are simply
| bullshit.
| mulmen wrote:
| You are going to wash your hands anyway, touching the seat
| makes no difference.
| what-imright wrote:
| Depends how long how you wash your hands and with what
| mulmen wrote:
| Soap and water for at least 20 seconds. This is basic
| hygiene.
| [deleted]
| IE6 wrote:
| Completely tangential and anecdotal observation: modern
| commercial toilets with their "strong" pressurized flush and
| often no covering lid tend to launch water droplets everywhere
| when flushed. If you're flushing a visibly clean toilet this is
| maybe not such a relevant problem (although perhaps the journal
| of hospital infection is claiming otherwise here) but if you're
| prepping to use a soiled toilet this is pretty unsanitary and
| frustrating.
| repler wrote:
| people like to argue about seat up/down, but it's really just
| everybody close the lid, please. easy.
| trhway wrote:
| Sounds like the spouse/GF putting those plush lid covers there
| takes care of your health by the plush reducing air exchange.
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