Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting
Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting
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DOI：
10.1186/s13756-018-0301-9
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发表时间：
2018-01-26
影响因子：
5.5
通讯作者：
Nonnenmann, Matthew W.
中科院分区：
文献类型：
--
作者：
Knowlton, Samantha D.;Boles, Corey L.;Nonnenmann, Matthew W.
背景：在美国，每年有170万免疫功能低下的患者感染与医疗保健相关的感染。这些感染增加了发病率、死亡率和护理费用。一种相对未被探索的传播途径是在病人护理期间产生生物气雾剂。生物气雾剂的吸入或表面污染可能导致病原微生物的传播。病人排泄物的冲厕可能是生物气溶胶的来源之一。到目前为止，还没有研究调查病人护理期间冲厕粪便中的生物气溶胶浓度。方法：在三种采样条件下测量医院卫生间中的颗粒物和生物气溶胶浓度；没有垃圾不冲水，没有垃圾冲水，以及粪便垃圾冲水。分别在距厕所0.15、0.5、1m处的冲厕前和冲厕后5、10、15min用颗粒物计数器生物气溶胶采样器测量颗粒物和生物气溶胶浓度。结果：冲厕前后颗粒物浓度有显著差异(0.3~10µm)。冲洗粪便时的生物气溶胶浓度显著高于本底浓度(p值=0.005)。然而，生物气溶胶浓度在距离厕所不同的时间(p值=0.977)或距离(p值=0.911)没有差异，这表明产生的气溶胶可能会在冲水后停留30分钟以上。厕所冲水时会产生气溶胶颗粒，大部分颗粒直径为0.3微米。被雾化的颗粒物包括以前使用过的或粪便中残留的微生物。不同条件下生物气溶胶浓度的差异也表明，冲厕所是生物气溶胶的一个来源，可能导致致病微生物的传播。结论：这项研究首次量化了常规病人护理期间冲医院厕所产生的颗粒物和生物气溶胶。未来的研究需要针对与胃肠道疾病相关的病原体，并评估减少气雾剂暴露的干预措施。
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 relatively unexplored route of transmission is the generation of bioaerosols during patient care. Transmission of pathogenic microorganisms may result from inhalation or surface contamination of bioaerosols. The toilet flushing of patient fecal waste may be a source of bioaerosols. To date, no study has investigated bioaerosol concentrations from flushing fecal wastes during patient care.Methods: Particle and bioaerosol concentrations were measured in hospital bathrooms across three sampling conditions; no waste no flush, no waste with flush, and fecal waste with flush. Particle and bioaerosol concentrations were measured with a particle counter bioaerosol sampler both before after a toilet flushing event at distances of 0.15, 0.5, and 1 m from the toilet for 5, 10, 15 min.Results: Particle concentrations measured before and after the flush were found to be significantly different (0.3-10 mu m). Bioaerosol concentrations when flushing fecal waste were found to be significantly greater than background concentrations (p-value = 0.005). However, the bioaerosol concentrations were not different across time (p-value = 0.977) or distance (p-value = 0.911) from the toilet, suggesting that aerosols generated may remain for longer than 30 min post flush. Toilets produce aerosol particles when flushed, with the majority of the particles being 0.3 mu m in diameter. The particles aerosolized include microorganisms remaining from previous use or from fecal wastes. Differences in bioaerosol concentrations across conditions also suggest that toilet flushing is a source of bioaerosols that may result in transmission of pathogenic microorganisms.Conclusions: This study is the first to quantify particles and bioaerosols produced from flushing a hospital toilet during routine patient care. Future studies are needed targeting pathogens associated with gastrointestinal illness and evaluating aerosol exposure reduction interventions.