Major Article
Impacts of lid closure during toilet flushing and of toilet bowl cleaning on viral contamination of surfaces in United States restrooms

https://doi.org/10.1016/j.ajic.2023.11.020Get rights and content
Under a Creative Commons license
open access

Highlights

  • Viral aerosols from toilet flushing pose a possible route of pathogen transmission.

  • Toilet lid closure prior to flushing is believed to mitigate cross-contamination.

  • We show toilet lid closure prior to flushing does not mitigate cross-contamination.

  • Brushing toilet bowl without disinfectant results in contamination of surfaces.

  • The use of a disinfectant during bowl cleaning reduces cross-contamination of surfaces.

Background

Viral aerosols generated during toilet flushing represent a potential route of pathogen transmission. The goal of this study was to determine the impact of toilet lid closure prior to flushing on the generation of viral aerosols and cross-contamination of restroom fomites.

Methods

A surrogate for human enteric viruses (bacteriophage MS2) was added to household and public toilet bowls and flushed. The resulting viral contamination of the toilet and other restroom surfaces was then determined.

Results

After flushing the inoculated toilets, toilet seat bottoms averaged >107 PFU/100 cm2. Viral contamination of restroom surfaces did not depend on toilet lid position (up or down). After toilet bowls were cleaned using a bowl brush with or without a commercial product (hydrochloric acid), a >4 log10 (>99.99%) reduction in contamination of the toilet bowl water was observed versus no product. Bowl brush contamination was reduced by 1.6 log10 (97.64%) when the product was used versus no product.

Conclusions

These results demonstrate that closing the toilet lid prior to flushing does not mitigate the risk of contaminating bathroom surfaces and that disinfection of all restroom surfaces (ie, toilet rim, floors) may be necessary after flushing or after toilet brush used for the reduction of virus cross-contamination.

Key Words

Aerosol generation
Infection prevention and control
Infection transmission
Environmental surface hygiene intervention
Virus dissemination

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Conflicts of interest: Drs. Julie McKinney and M. Khalid Ijaz are engaged in R&D at Reckitt Benckiser LLC. The other authors declare no competing interests.

Funding/support: This study was funded by a grant to the University of Arizona from Reckitt Benckiser.