Table 1.
Included studies (JAD: jet air dryer, WAD: warm air dryer, PT: paper towel, CFU: colony forming units, PFU: plaque forming units, GC: genomic copies, SD: standard deviation).
| Reference | Study characteristics | Microorganisms analysed/identified | Aerosol and droplet sampling (incl. air and deposition samples) | Other environmental sampling (incl. surface swabs and water samples) |
|---|---|---|---|---|
| Aithinne et al., 2019 |
Country: USA Setting: Laboratory Design: Toilet bowl water inoculated with Clostridium difficile; culture-based analysis Activity: Toilet flushing (seat down with open lid) Contaminated area/medium: Air, toilet bowl water, floor |
Clostridium difficile |
First 3 flushes: ~8, 3, 2.5 CFU counts, respectively; equivalent airborne droplet nuclei spore aerosol ~10.9, 3.8, 3.4 CFU/m3, respectively. Considering 5 m3toilet chamber size: droplet nuclei bioaerosol generation rate was ~54, 19, 17 CFU/flush, respectively. |
Water (>24 flushes): Spores captured in all trials, indicating persistent contamination. Approximate bowl water concentrations:
Floor: usually 1 or 2 CFU (max 4 CFU). All plates around toilet had at least 1 positive sample. Cumulative area density for all plates was 533 CFU/m2 after 24 flushes; 75% of this level attained after 4 flushes, 90% attained after 9 flushes. |
| Alharbi et al., 2016 |
Country: Saudi Arabia Setting: Academic Design: Culture-based analysis of ambient microbiome in university washrooms; Isolates identified using VITEK2R Activity: Hand drying (WAD) Contaminated area/medium: Airflow from warm air dryer |
Staphylococcus haemolyticus, Micrococcus luteus, Pseudomonas alcaligenes, Bacillus cereus and Brevundimonas diminuta/vesicularis |
Bacteria isolated per sampled dryer after exposure to airflow for 30 s:
|
N/A |
| Best et al., 2018 |
Country: UK, France, Italy Setting: Healthcare Design: 2 washrooms tested at 3 hospitals (1 each in the UK, France, Italy); 20 L air sample; culture-based analysis using both non-selective and selective media Activity: Hand drying (JAD, PT) Contaminated area/medium: Air, jet air dryer unit, paper towel dispenser, sink, door, floor, dust |
Total aerobic count; enterococci and vancomycin resistant enterococci (VRE); enterobacteria incl. Escherichia coli, Klebsiella spp., and extended spectrum β-lactamase (ESBL)-producing enterobacteria; Staphylococcus aureus and methicillin resistant S. aureus (MRSA); C. difficile |
Median counts in UK, France, and Italy, respectively:
|
Median counts in UK, France, and Italy, respectively:
Enterococci: greater recovery in floor and dust for JAD vs PT in UK; very low recovery in France and Italy. Enterobacteria: greater recovery in unit and floor for JAD vs PT in UK; greater recovery in dust for JAD vs PT in France; very low recovery in Italy. S. aureus: greater recovery in unit and floor for JAD vs PT in UK; very low recovery in France; no recovery in Italy. MRSA: very low recovery, but greater on floor in JAD vs PT in UK; no recovery in France and Italy. ESBL-producing bacteria: greater recovery on floor in JAD vs PT in UK; low recovery in France and Italy. C. difficile was not recovered from any samples in any country. |
| Best and Redway, 2015 |
Country: UK Setting: Not described Design: Gloved hands contaminated with Saccharomyces cerevisiae, or volunteers' hands naturally contaminated following toileting; culture-based analysis Activity: Hand drying (JAD, WAD, PT, textile roller towel) Contaminated area/medium: Wall and floor around hand drying unit |
Saccharomyces cerevisiae | N/A | JAD dispersed more bacteria than WAD, PT and textile roller towel. Vertical dispersal (height) during hand drying:
|
| Best et al., 2014 |
Country: UK Setting: Experimental setting not identified, 65 m3 room Design: Gloved hands contaminated with lactobacilli or black paint; culture-based analysis with lactobacillus-selective agar plates Activity: Hand drying (JAD, WAD, PT) Contaminated area/medium: Air and floor around hand drying unit |
Lactobacillus |
Mean counts after 15min; for 10 cm and 1 m away, respectively:
|
Mean counts under dryer,and 1 m and 2 m away, respectively:
|
| Best et al., 2012 |
Country: UK Setting: Healthcare, controlled experiment Design:C. difficile spiked faecal suspensions poured into toilet bowls to mimic diarrhoea; culture-based analysis Activity: Toilet flushing (seat down with open and closed lid) Contaminated area/medium: Air, toilet cistern, toilet seat, floor |
C. difficile |
Mean counts 0–30, 30–60, and 60–90 min after flush:
|
Droplets of varying size were ejected to the height of the seat upon flushing. Lid closed: No Clostridium difficile recovered on any surface. Lid open:Clostridium difficile recovered at all locations (mean 1–3 CFU), except floor on left-hand side. |
| Boone and Gerba, 2005 |
Country: USA Setting: Childcare and household Design: Fomites (e.g. door handles, light switches, children's toys) sampled in homes and day care centres, periodic sampling over a 2.5-year period; environmental swabs and RT-PCR analysis Activity: General toilet/station use Contaminated area/medium: Toilet seat, floor, faucet, diaper changing station |
Influenza A virus | N/A |
Seasonal Influenza A virus positive samples: 53% spring vs 23% fall. Influenza A virus positive samples on surfaces:
|
| Boxman et al., 2009a |
Country: Netherlands Setting: Restaurant Design: Outbreak investigation; clinical and environmental swabs and RT-PCR analysis Activity: General toilet use, vomiting in toilet, food handling Contaminated area/medium: Toilet seat |
Norovirus | N/A | Norovirus present in 4 of 9 samples: male and female toilet seats, grip of the knife used to cut bread, and hands of ill food handler cutting bread for restaurant guests. |
| Boxman et al., 2009b |
Country: Netherlands Setting: Restaurant Design: Outbreak investigations; clinical and environmental swabs and RT-PCR analysis Activity: General toilet use, food handling Contaminated area/medium: Toilet seat, toilet handle or tap |
Norovirus | N/A | Norovirus present in 48 of 119 (40%) samples from 14 of 27 (52%) outbreaks. Norovirus RNA was most often found on swabs taken in bathrooms (64%), with 10/18 samples positive (excl. cruise ship and summer camp). |
| Breathnach et al., 2012 |
Country: UK Setting: Healthcare Design: Outbreak investigations; clinical and environmental swabs; culture-based testing, antimicrobial susceptibility testing, and molecular typing (serotyping, PFGE, VNTR) Activity: General hospital activities Contaminated area/medium: Toilet, faucet, sink drain trap (U-bend), shower head, shower drain, water, ward sluice room, toilet brush |
Multidrug-resistant Pseudomonas aeruginosa | N/A |
Outbreak 1: Waste outlets on intensive care and haematology positive for outbreak strain indicated reservoir of organism in waste pipe system; sewer water sample yielded organism, but not known clinical case of Pseudomonas aeruginosa for several months at time of testing. Mean 391 notifications of blocked sinks, toilets or sluices in the hospital each year (2005–2010). Outbreak 2: Shower drain, toilet bowl, and toilet brush positive for outbreak strain; incoming water for drinking, hand washing, and showering negative. Pseudomonas aeruginosa not isolated from cleaning equipment, soap, and skin antiseptic preparations. Blockages partly due to paper towels and clinical wipes down toilet. |
| Carducci et al., 2016 |
Country: Italy Setting: Healthcare, workplace Design: Used previously published/collected data to develop a preliminary quantitative microbial risk assessment (QMRA) model for Human Adenovirus contaminated workplace environments. Activity: N/R Contaminated area/medium: Air |
Human Adenovirus | Human Adenovirus detected in all settings, with highest concentration in indoor environments. Average concentration range: 2 log10 GC/m3 outside landfill to 8 log10 GC/m3 in hospital toilets. Human Adenovirus concentration in toilets:
|
N/A |
| Cooper et al., 2016 |
Country: Canada Setting: Healthcare Design: Air and surface samples, culture-based analysis Activity: Toilet flushing Contaminated area/medium: Air, toilet seat, sink counter |
Anaerobic and aerobic bacteria |
Aerobic bacterial concentration (GM):
Anaerobic bacterial concentration (GM):
|
Bacterial concentration UVC-treated vs control (GM):
|
| Flores et al., 2011 |
Country: USA Setting: Academic Design: Surface sampling in public washrooms, culture-independent analysis; 16S rRNA sequencing Activity: General toilet use Contaminated area/medium: Door handle, stall handle, faucet handle, soap dispenser, toilet seat, toilet handle, floor |
Actinobacteria, Bacteroidetes, Firmicutes, Proteobacteria dominated the 19 phyla identified | N/A | 19 phyla observed across all surfaces, most sequences (<92%) as Actinobacteria, Bacteriodetes, Firmicutes, or Proteobacteria. Environmental source of bacteria on surfaces:
|
| Gerhardts et al., 2012 |
Country: Germany Setting: Laboratory Design: Transmission experiments; hand > non-porous surface > hand (x4); culture-based analysis Activity: Surface contact transmission model Contaminated area/medium: Toilet brush, plastic tube (representing door handle), acrylic glass rod (representing faucet handle) |
Escherichia coli, Bacillus subtilis (atrophaeus), MS2 bacteriophage | N/A |
Amount of bacteria transferred onto the toilet brush, door handle, handle, and hand of person 4, respectively:
|
| Gormley et al., 2017 |
Country: UK Setting: Laboratory Design: Model organism inoculated into a pilot test rig to investigate within-building transmission potential due to defective plumbing (dry U-traps); culture-base analysis Activity: Toilet flushing Contaminated area/medium: Air, toilet bowl, toilet seat |
Pseudomonas putida |
Passive airsampling: Cross-transmission of viable bacteria can occur between adjacent floors of a sanitary plumbing system: toilet flushing with wastewater on a lower floor contaminated the room on the upper floor with aerosols. This occurred both with an induced upward airflow and without; however, cross-contamination was less severe in absence of airflow. Active airsampling: Cross-transmission of bacteria through entire sanitary plumbing test-rig: from flushing contaminated wastewater at lower floor, into test chamber, and then into extract ventilation system. |
With upward airflow: Bacterial CFU on top, right and front walls of test chamber. With no induced airflow: Bacterial CFU only on bottom surface; thus cross-transmission even in absence of applied airflow. With partially-filled U-trap: Bacterial CFU on toilet, test chamber surfaces, and duct connected to extract fan; toilet contamination higher than test chamber, and focused towards front of toilet bowl probably influenced by draw of extract fan. |
| Halabi et al., 2001 |
Country: Austria Setting: Healthcare Design: water quality analysis; membrane filtration method; culture-based analysis; total CFU and selective media Activity: N/R Contaminated area/medium: Water from conventional and non-touch faucets |
Pseudomonas aeruginosa, Legionella spp. | N/A |
Faucet water samples contaminated withPseudomonas aeruginosa:
Faucet water samples contaminated with Legionella spp.:
|
| Harrison et al., 2003 |
Country: UK Setting: Laboratory Activity: Hand drying (PT) Contaminated area/medium: Paper towel dispenser, used paper towel |
Micrococcus luteus, Serratia marcescens | N/A |
Average bacterial transfer from contaminated hand to dispenser:
Average transfer rate from contaminated dispenser to hand and towel:
|
| Huesca-Espitia et al., 2018 |
Country: USA Setting: Academic Design: Investigated the effect of retrofitting HEPA filters to warm air hand dryers; agar plates exposed to hand dryer air in bathroom settings; culture-based analysis with isolate identification by MALDI-TOF Biotyper Activity: Hand drying (WAD) Contaminated area/medium: Airflow from dryer, washroom air, inner surface of warm air drier nozzle |
Bacterial CFU, Acinetobacter baumannii, Acinetobacter radioresistens, Bacillus cereus, Bacillus infantis, Bacillus licheniformis, Bacillus marisflavi, Bacillus megaterium, Bacillus pumilus, Bacillus simplex, Bacillus subtilis, kanamycin-resistant Bacillus subtilis, Erwinia sp., Exiguobacterium aurantiacum, Kocuria rhizophila, Micrococcus luteus, Pantoea septica, Paracoccus yeei, Pseudomonas luteola, Roseomonas mucosa, Staphylococcus aureus, Staphylococcus capitis, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus pasteuri, Staphylococcus simulans |
Bacterial counts from hand dryer vs environmental air:
|
Hand dryer nozzles with and without HEPA filters:
Bacterial deposition by hand dryers:
Bacteria recovered following exposure to hand dryers or washroom air:
|
| Inkinen et al., 2017 |
Country: Finland Setting: Healthcare, childcare, workplace, retirement home Design: Investigated bacterial loads on copper surfaces vs chromed, plastic or wooden surfaces; surface swabs and culture-based analysis; selective plating for indicator bacteria Activity: N/R Contaminated area/medium: Toilet support rail, toilet flush button, door handle, floor drain |
Bacterial CFU, Enterobacteriaceae, coagulase positive Staphylococcus, Staphylococcus aureus | N/A |
Total bacterial counts across different types of materials:
Enterobacteriaceaeand Gram-negative rods positive samples across different types of materials:
Enterococcipositive samples across different types of materials:
Staphylococcus aureuspositive samples across different types of materials:
|
| Kanayama Katsuse et al., 2017 |
Country: Japan Setting: Healthcare Design: surface swabs and culture-based analysis to investigate bacterial loads on toilet seat and bidet nozzles; antimicrobial susceptibility testing; PCR antimicrobial resistance gene screening; PFGE; and sequencing Activity: General bidet-toilet use Contaminated area/medium: Toilet seat, warm-water bidet nozzle |
Enterobacteriaceae, Enterobacter spp., Enterococcus spp., Streptococcus spp., Klebsiella spp., Citrobacter spp., Acinetobacter spp., non-glucose fermenting rods, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, extended-spectrum β-lactamase (ESBL)-Escherichia coli, Stenotrophomonas maltophilia, Pseudomonas aeruginosa | N/A |
Number of toilets sampled positive for bacteria on bidet nozzle and toilet seat:
|
| Katano et al., 2014 |
Country: Japan Setting: Public restroom, residential Design: water sampling and culture-based analysis to investigate bacterial loads in bidet lavage water; selective media Activity: Bidet-toilet use Contaminated area/medium: Water from bidet lavage tanks |
Pseudomonas aeruginosa, Escherichia coli | N/A |
Mean total bacteria counts in different settings:
|
| Kimmitt and Redway, 2016 |
Country: UK Setting: Laboratory Design: Gloved hands contaminated with MS2 bacteriophage; culture-based analysis Activity: Hand drying (JAD, WAD, PT) Contaminated area/medium: Air, vertical board/wall |
MS2 bacteriophage |
Mean total viral plaques after 0–2.5, 2.5–5, 5–7.5, 7.5–10, 10–12.5, and 12.5–15 min of drying device use:
|
Mean total viral plaques across all heights (0.15–1.65 m) at 0.4m vs plaques set at 0.71m height across all distances (0–3 m) from drying units:
|
| Knowlton et al., 2018 |
Country: USA Setting: Healthcare Design: Bioaerosol sampling; culture-based analysis Activity: Toilet flushing (with and without waste) Contaminated area/medium: Air |
Bacterial CFU |
Mean bioaerosol concentration at different conditions:
|
N/A |
| Kouadri, 2020 |
Country: Saudi Arabia Setting: Academic Design: Bathroom handwashing conditions; Selective media; culture-based; antimicrobial susceptibility testing of 16 isolates Activity: Hand drying (WAD, PT) Contaminated area/medium: Airflow from dryer, air around warm air dryer, inner surface of dryer nozzle |
Bacterial CFU, multi-drug resistant Escherichia coli, Klebsiella spp., Staphylococcus aureus, Bacillus cereus, coagulase-negative Staphylococcus spp. |
Mean bacterial number recovered in different settings:
|
Swabs from WAD nozzle found 43 bacterial colonies. |
| Kurgat et al., 2019 |
Country: USA Setting: Workplace Design: Used viral tracers (MS2 phage) to identify office environment fomites and evaluate hygiene intervention; culture-based analysis Activity: General toilet use Contaminated area/medium: Soap dispenser, faucet handle, restroom door handle |
MS2 bacteriophage | N/A |
Mean concentration on surfaces across different conditions:
|
| Margas et al., 2013 |
Country: UK Setting: Laboratory Design: Settle plates, air sampling and surface swabs; culture-based analysis Activity: Hand drying (JAD, PT) Contaminated area/medium: Air, floor, wall, sink, soap dispenser, jet air dryer unit, paper towel dispenser |
Coliform bacteria CFU | No significant difference between drying method; however, bacterial level increased rapidly after starting hand washing and drying. Bacterial counts after 3 min vs end of trial by distance from device:
|
Mean bacterial counts on settle plates exposed to washroom air for 1 h by distance from device:
Mean bacterial counts on surfaces after 100 people washed and dryed hands according to JAD or PT use:
|
| Mkrtchyan et al., 2013 |
Country: UK Setting: Public restroom Design: Selective culture-based analysis; 16S rRNA sequencing and MALDI-TOF for identification; culture-based antimicrobial susceptibility testing; PCR for mec and ccr genes Activity: General toilet use Contaminated area/medium: Hand dryer unit, toilet seat, stall door surface, tap, soap dispenser, urinal floor |
Staphylococcus, Bacillus, Micrococcus, Escherichia, Proteus, Citrobacter, Morganella, Acinetobacter, Corynebacterium, Delftia, Sphingobacteria, Campylobacter, Pseudomonas, Korucia, Rothia, Arthrobacter, Anaerococcus, Rhodococcus | N/A | Most contaminated surfaces were hand dryer, toilet seat, inner door, tap, soap dispenser, and urinal floor. Number of isolates identified by genera:
|
| Mohamed et al., 2015 |
Country: USA Setting: Healthcare, restaurant, shopping centre, supermarket, public park, gas station Design: Culture-based; isolates subject to virulence genotyping, phylotyping, clonal typing, PFGE, and disc diffusion AST Activity: General toilet/station use Contaminated area/medium: Toilet seat, toilet surfaces, toilet water, floor near toilet, in-stall sanitary napkin receptacle, stall handle, sink drain, faucet tap, diaper changing station handle |
Escherichia coli, extraintestinal pathogenic Escherichia coli (ExPEC), antimicrobial-resistant Escherichia coli | N/A | 25/1120 (2.2%), or 14.9% of fluorescent cultures, from 18/56 (32%) washrooms had confirmed Escherichia coli isolates. 10/1120 (0.9%), or 40% of confirmed Escherichia coli samples, from 9/56 (16%) washrooms had presumptive ExPEC; 8 samples with confirmed ExPEC. Prevalence ofEscherichia coliand ExPC isolates by washroom category:
Prevalence ofEscherichia coliand ExPC isolates by washroom gender:
|
| Patrick et al., 2010 |
Country: New Zealand Setting: Childcare Design: Culture-based Activity: Hand drying (WAD, PT, cloth towel) Contaminated area/medium: Chamois cloth (representing skin), liquorice straps (representing food), pipette tip (representing toy) |
Bacterial CFU | N/A |
Mean bacterial counts across different surfaces at baseline, usual practice, and dual hand drying, respectively:
|
| Pitt et al., 2018 |
Country: UK Setting: Academic Design: Culture-based Activity: Hand drying (JAD, WAD, PT) Contaminated area/medium: Wall, floor under dryer or paper towel dispenser, trough of jet air dryer unit, side and underside of warm air dryer, paper towel dispenser knob |
Bacterial CFU, Staphylococcus spp., Staphylococcus aureus, Staphylococcus epidermis, Staphylococcus haemolyticus, Pantoea agglomerans, Bacillus spp. | N/A | Fewer organisms recovered underneath and to the right of PT dispenser; highest counts underneath WAD. Notable counts at 20 cm to the right of JAD in vertical line down the wall. Sampling of PT dispenser knobs, sides of WAD and trough of JAD yielded high bacterial counts (‘too many to count’) in all cases. Bacterial colonies: Most isolates either Staphylococcus spp. (Staphylococcus epidermidis or Staphylococcus aureus) or non-pathogenic Bacillus spp.; organisms from trough in JADs included Staphylococcus haemolyticus in female washroom and Pantoea agglomerans in male washroom. |
| Repp et al., 2013 |
Country: USA Setting: Workplace Design: Outbreak investigation; surface swabs, RNA extraction, and PCR Activity: General toilet use Contaminated area/medium: Diaper changing station |
Norovirus | N/A | Corporeal brown matter found inside and underneath diaper changing station; swabs were positive for Norovirus, although sequencing was not possible. |
| Sassi et al., 2018 |
Country: USA Setting: Laboratory Design: MS2 phage inoculation; culture-based analysis Activity: Toilet flushing Contaminated area/medium: Toilet handle, cistern, toilet seat, toilet bowl, toilet water, wall behind toilet, floor near toilet, toilet paper dispenser |
MS2 bacteriophage | N/A |
Geometric mean bacteriophage concentration on washroom surfaces after flushing:
Disinfectant evaluation on bacteriophage concentration: At 15 min contact time, all disinfectants showed reduction when compared with no disinfectant; at 30 min contact time, all disinfectants except hydrogen peroxide showed reduction when compared with no disinfectant. Chlorine bleach was the only treatment to show significant reduction between 15 and 30 min contact time. Peracetic acid showed greatest reduction of all treatments for all contact times; hydrogen peroxide exhibited the least reduction for all contact times. |
| Snelling et al., 2011 |
Country: UK Setting: Laboratory Design: Hands contaminated by handling chicken prior to washing and drying experiment; culture-based analysis Activity: Hand dying (JAD, WAD, PT) Contaminated area/medium: Aluminium foil (representing surfaces) |
Bacterial CFU | N/A |
Mean bacterial transfer to aluminium foil after hand drying procedure:
JAD vs WAD drying procedure: 21 instances of no bacteria transferred, most often (7 times) with JAD, followed by WAD Turbodry (5 times, at 35 s). Effect of rubbing hands when using WAD: Rubbing increased bacteria transferred in many instances. No statistical difference between any of the dryers when hands still, and bacterial reduction comparable to PT for middle of fingers. Rubbing with PT proved effective and to be the best means of reducing bacterial loading on fingertips. |
| Suen et al., 2019 |
Country: Hong Kong Setting: Healthcare, restaurant, food market, shopping centre, public library, sport centre, tourist spot, hotel, public housing state Design: Surface swabs, culture-based analysis; MALDI-TOF and disc diffusion AST of isolates Activity: General toilet use Contaminated area/medium: Paper towel dispenser, dryer unit, air outlet of air dryers, exit door handle, paper towel |
Bacterial CFU, Escherichia coli, Proteus mirabilis, Moraxella spp., Staphylococcus aureus, Staphylococcus epidermis, Staphylococcus saprophyticus, methicillin resistant Staphylococcus epidermis, methicillin resistant Staphylococcus saprophyticus | N/A |
Highest bacterial counts in washroom surfaces:
Bacterial colonies: Potentially pathogenic Escherichia coli, Proteus mirabilis, Moraxella spp., Staphylococcus aureus, and Staphylococcus saprophyticus isolated from outlets of PT dispenser, hand dryer, and/or door handle. Antibiotic susceptibility assay: Swabs from PT dispensers, JAD, WAD and internal door handles showed 87.1% (27/31) of Staphylococcus spp. samples resistant to at least one first-line antimicrobial agent; 23% (7/31) exhibited co-resistance to ≥3 antimicrobial agents, most common combination penicillin, erythromycin, and clindamycin. Methicillin-resistant Staphylococcus epidermidis found in PT dispenser and Methicillin-resistant Staphylococcus saprophyticus found in WAD. Both strains additionally resistant to erythromycin and clindamycin. |
| Taylor et al., 2000 |
Country: UK Setting: Laboratory, workplace Design: Selective culture-based analysis Activity: Hand drying (WAD, PT) Contaminated area/medium: Air, air from dryer inlet, air from dryer outlet nozzle, inside dryer inlet, inside/outside dryer outer nozzle, dryer sensor/switch, top of dryer unit, wall below dryer, faucet tap, restroom door handle, floor, wall away from dryer |
Bacterial CFU, Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus |
Production of airborne bacteria after hand drying: No significant difference when drying hands with WAD or PT. Bacterial recovery from WAD without and with heater, respectively:
Reduction in recovery was greater for Pseudomonas aeruginosa. Air emitted from the outlet of the driers contained significantly fewer microorganisms than air entering the driers. |
Mean bacterial counts on different surfaces:
Microbiological testing of paper towels: bacteria transferred from hand to towels; if disposal not managed correctly, paper towels could act as bacteriological reservoir. |
| Tsunoda et al., 2019 |
Country: Japan Setting: Healthcare Design: Surface swabs and water samples, selective media targeting extended-spectrum beta lactamase and metallo-beta-lactamase producing bacteria, and vancomycin resistant Enterococci; isolate identification by MALDI-TOF Activity: General bidet-toilet use Contaminated area/medium: Warm-water bidet nozzle, water from nozzle |
Klebsiella spp., Enterococcus spp., Staphylococcus spp., Acinetobacter spp., Sphingomonas spp., Escherichia coli, extended-spectrum β-lactamase (ESBL)-Escherichia coli, Stenotrophomonas maltophylia | N/A |
Bacterial contamination in bidet toilet:
Mean counts of thin colonies recovered:
Bacterial species identified:
Tap water assessment: 1/123 sample contaminated with Sphingomonas paucimobilis in toilet in inpatient ward. |
| Verani et al., 2014 |
Country: Italy Setting: Healthcare, workplace Design: Surface swabs, air and water samples; culture-based analysis for surface and air samples; water samples analysed by isolating DNA with QIAamp DNA mini Kit Activity: Toilet flushing Contaminated area/medium: Air, toilet seat, toilet lid, toilet handle/button, internal door handle, water from toilet |
Bacterial CFU, Norovirus, Torque teno virus, Human Adenovirus | Viruses were detected in 35 (81%) of total aerosol samples tested. Frequency positive samples of bacteria and virus in offices:
|
Viruses were detected on 135 surfaces (78%), and in 17 (89%) water samples tested. The surface total positivity was 71% in offices, and 82% in hospital. Frequency positive samples of bacteria and virus in offices:
Geometric mean concentration before vs after disinfection in offices:
|
| Zapka et al., 2011 |
Country: USA Setting: Laboratory, academic Design: Controlled studies to assess bacterial hand contamination and transfer post-hand washing with contaminated or uncontaminated soap; culture-based analysis Activity: Hand washing Contaminated area/medium: Soap dispenser, contaminated and un-contaminated soap |
Bacterial CFU, Serratia marcescens, Klebsiella pneumoniae | N/A | Bulk-soap-refillable dispensers: all (14/14) soap dispensers used in an elementary school were contaminated with bacteria, ranging from 6.0 to 7.0 log10 CFU/ml of soap. Gram-negative species included Citrobacter, Providencia, Pseudomonas, Serratia genera. |