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1.
Am J Trop Med Hyg ; 104(3): 1045-1047, 2021 Jan 13.
Article in English | MEDLINE | ID: covidwho-1389661

ABSTRACT

Information about factors potentially favoring the spread of SARS-CoV-2 in rural settings is limited. Following a case-control study design in a rural Ecuadorian village that was severely struck by the pandemic, SARS-CoV-2 RNA were detected by real-time PCR in swabs obtained from inner and upper walls in 24/48 randomly selected latrines from case-houses and in 12/48 flushing toilets from paired control-houses (P = 0.014; McNemar's test). This association persisted in a conditional logistic regression model adjusted for relevant covariates (OR: 4.82; 95% CI: 1.38-16.8; P = 0.014). In addition, SARS-CoV-2-seropositive subjects were more often identified among those living in houses with a latrine (P = 0.002). Latrines have almost five times the odds of containing SARS-CoV-2 RNA than their paired flushing toilets. Latrines are reservoirs of SARS-CoV-2 RNA, and it cannot be ruled out that latrines could contribute to viral transmission in rural settings. Frequent disinfection of latrines should be recommended to reduce the likelihood of fecal contamination.


Subject(s)
Bathroom Equipment/virology , COVID-19/virology , RNA, Viral/analysis , RNA, Viral/genetics , Rural Population/statistics & numerical data , SARS-CoV-2/genetics , COVID-19/epidemiology , COVID-19/immunology , Case-Control Studies , Family Characteristics , Humans , Latin America/epidemiology , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Serologic Tests , Toilet Facilities , Young Adult
3.
Sci Total Environ ; 803: 149932, 2022 Jan 10.
Article in English | MEDLINE | ID: covidwho-1373256

ABSTRACT

BACKGROUND: The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments. METHODS: We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms. RESULTS: Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings. CONCLUSION: Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.


Subject(s)
COVID-19 , Communicable Diseases , Humans , Pandemics , SARS-CoV-2 , Toilet Facilities
4.
Int J Hyg Environ Health ; 236: 113807, 2021 07.
Article in English | MEDLINE | ID: covidwho-1310670

ABSTRACT

Contamination of contact surfaces with SARS-CoV-2 has been reported as a potential route for the transmission of COVID-19. This could be a major issue in developing countries where access to basic sanitation is poor, leading to the sharing of toilet facilities. In this study, we report SARS-CoV-2 contamination of key contact surfaces in shared toilets and the probabilistic risks of COVID-19 infections based on detection and quantification of the nucleic acid on the surfaces. We observed that 54-69% of the contact surfaces were contaminated, with SARS-CoV-2 loads ranging from 28.1 to 132.7 gene copies per cm2. Toilet seats had the highest contamination, which could be attributed to shedding of the virus in feces and urine. We observed a significant reduction in viral loads on the contaminated surfaces after cleaning, showing the potential of effective cleaning on the reduction of contamination. The pattern of contamination indicates that the most contaminated surfaces are those that are either commonly touched by users of the shared toilets or easily contaminated with feces and urine. These surfaces were the toilet seats, cistern handles and tap handles. The likelihood (probability) of infection with COVID-19 on these surfaces was highest on the toilet seat (1.76 × 10-4(1.58 × 10-6)) for one time use of the toilet. These findings highlight the potential risks for COVID-19 infections in the event that intact infectious viral particles are deposited on these contact surfaces. Therefore, this study shows that shared toilet facilities in densely populated areas could lead to an increase in risks of COVID-19 infections. This calls for the implementation of risk reduction measures, such as regular washing of hands with soap, strict adherence to wearing face masks, and effective and regular cleaning of shared facilities.


Subject(s)
COVID-19/transmission , RNA, Viral/isolation & purification , SARS-CoV-2/isolation & purification , Sanitation/statistics & numerical data , Toilet Facilities/statistics & numerical data , Equipment Contamination , Humans
5.
Sci Total Environ ; 792: 148341, 2021 Oct 20.
Article in English | MEDLINE | ID: covidwho-1275700

ABSTRACT

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.


Subject(s)
Bathroom Equipment , COVID-19 , Aerosols , Humans , SARS-CoV-2 , Toilet Facilities
6.
Int J Environ Res Public Health ; 18(12)2021 Jun 12.
Article in English | MEDLINE | ID: covidwho-1270042

ABSTRACT

BACKGROUND: The ongoing novel coronavirus (COVID-19) global pandemic has resulted in significant levels of morbidity and mortality worldwide, particularly among the elderly and immuno-suppressed groups. Although adequate hand hygiene (HH) behaviour and compliance is widely accepted as being the most effective self-protective measure in preventing the spread of diseases like COVID-19, previous research suggests that normal hand hygiene compliance is poor, but generally improves during a disease pandemic. This research aimed to evaluate the hand hygiene behaviour and compliance of the general public in the initial weeks of the COVID-19 pandemic in Northern Ireland (NI). METHODS: This cross-sectional study involved the use of infrared-imaging cameras to observe the hand hygiene behaviour and compliance of the general public when using one set of male and female public restrooms. RESULTS: The findings of this study indicated that the level of hand hygiene compliance of the general public was poor in the initial weeks, with 82.93% overall not washing their hands adequately. CONCLUSIONS: Inadequate HH behaviour and compliance may have added significantly to the rapid rate of spread of COVID-19 in the initial weeks of the pandemic in NI. Current public health campaigns do not appear, based on this study, to have the desired impact and may need to be reviewed or re-enforced in order to achieve the levels of hand hygiene compliance required to slow the spread of COVID-19 and other communicable diseases in the future.


Subject(s)
COVID-19 , Cross Infection , Hand Hygiene , Aged , Cross-Sectional Studies , Female , Guideline Adherence , Hand Disinfection , Humans , Male , Northern Ireland/epidemiology , Pandemics , SARS-CoV-2 , Toilet Facilities
7.
J Environ Public Health ; 2021: 2672491, 2021.
Article in English | MEDLINE | ID: covidwho-1241059

ABSTRACT

Faecal sludge (FS) management is pertinent to the achievement of sustainable development goal 6.2 around the world; yet it is constrained by urbanisation challenges, waste management complexities, and defective attitudes. These deny communities of the plausible supply of resources from FS. This paper assesses the perception underpinning the occurrence of nonfaecal matter in FS in Ghana. Primary data were obtained from 400 respondents in four communities in Brong Ahafo and Greater Accra Regions of Ghana, using a structured questionnaire. Data were analysed by using STATA software version 15. Chi-square test and multiple logistic regression were conducted on all independent variables and statistical significance was accepted at p < 0.05. The study identified the following as the most perceived frequently disposed nonfaecal matter into FS: sanitary pads and diapers (38.5%), fabrics/rags (23.2%), toilet rolls (20.8%), razor/shaving sticks (10.3%), and others (7.2%). Gender, state of toilet facility (roof or unroofed), presence of container for collecting other types of waste in the toilet room, and state of container in toilet room either covered or uncovered were the factors found to be significantly associated with the disposal of solid waste (SW) into FS at 95% confidence level. The fear of exposing used sanitary materials for rituals, the use of fabric as an alternative to toilet rolls, and the desire to conceal aborted pregnancies from the public were some of the reasons alluded to the disposal acts. Education and awareness campaigns on proper SW disposal practices, appropriate use of toilet facilities, and the resource potentials of FS were found to be the best way forward to discourage indiscriminate disposal of SW into FS.


Subject(s)
Attitude , Refuse Disposal/standards , Sewage/statistics & numerical data , Toilet Facilities/standards , Feces , Ghana , Humans , Male , Refuse Disposal/statistics & numerical data , Solid Waste/statistics & numerical data , Surveys and Questionnaires , Toilet Facilities/statistics & numerical data
9.
J Appl Microbiol ; 131(6): 2705-2714, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1202334

ABSTRACT

The goal of good toilet hygiene is minimizing the potential for pathogen transmission. Control of odours is also socially important and believed to be a societal measure of cleanliness. Understanding the need for good cleaning and disinfecting is even more important today considering the potential spread of emerging pathogens such as SARS-CoV-2 virus. While the flush toilet was a major advancement in achieving these objectives, exposure to pathogens can occur from failure to clean and disinfect areas within a restroom, as well as poor hand hygiene. The build-up of biofilm within a toilet bowl/urinal including sink can result in the persistence of pathogens and odours. During flushing, pathogens can be ejected from the toilet bowl/urinal/sink and be transmitted by inhalation and contaminated fomites. Use of automatic toilet bowl cleaners can reduce the number of microorganisms ejected during a flush. Salmonella bacteria can colonize the underside of the rim of toilets and persist up to 50 days. Pathogenic enteric bacteria appear in greater numbers in the biofilm found in toilets than in the water. Source tracking of bacteria in homes has demonstrated that during cleaning enteric bacteria are transferred from the toilet to the bathroom sinks and that these same bacteria colonize cleaning tools used in the restroom. Quantitative microbial risk assessment has shown that significant risks exist from both aerosols and fomites in restrooms. Cleaning with soaps and detergents without the use of disinfectants in public restrooms may spread bacteria and viruses throughout the restroom. Odours in restrooms are largely controlled by ventilation and flushing volume in toilet/urinals. However, this results in increased energy and water usage. Contamination of both the air and surfaces in restrooms is well documented. Better quantification of the risks of infection are needed as this will help determine what interventions will minimize these risks.


Subject(s)
Bathroom Equipment , COVID-19 , Humans , Hygiene , SARS-CoV-2 , Toilet Facilities
10.
Clin J Oncol Nurs ; 25(2): 151-156, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1190123

ABSTRACT

BACKGROUND: Many hazardous drugs (HDs) are excreted in urine and feces, and evidence has shown that bathrooms of patients receiving chemotherapy at home are contaminated with HDs. However, little information exists on bathroom contamination in ambulatory clinics where HDs are administered. OBJECTIVES: This project aimed to determine the presence of HD residue in the patient and staff bathrooms of an ambulatory cancer center. METHODS: A quality improvement project was initiated to examine potential contamination by the HDs 5-fluorouracil and oxaliplatin in a patient bathroom and a secured badge-access staff bathroom in the infusion department of an ambulatory comprehensive cancer center. Twice-daily wipe testing was conducted on the floor in front of the toilet and the flush handle for five consecutive days. FINDINGS: Sixty-five percent of the samples from the floor of the patient bathroom were positive for at least one of the HDs. In the staff bathroom, 35% of the floor samples were positive for at least one HD. None of the flush handle samples were above the level of detection.


Subject(s)
Antineoplastic Agents , Neoplasms , Antineoplastic Agents/toxicity , Drug Contamination , Fluorouracil/toxicity , Humans , Neoplasms/drug therapy , Oxaliplatin/toxicity , Toilet Facilities
11.
Am J Infect Control ; 49(9): 1186-1188, 2021 09.
Article in English | MEDLINE | ID: covidwho-1171488

ABSTRACT

Hand drying is the critical, final step of handwashing. A cross-sectional survey of U.S. adults assessed self-reported hand drying practices in public bathrooms and found increased preference for using electric hand dryers, wiping hands on clothing, and shaking hands and decreased preference for using paper towels during the COVID-19 pandemic relative to before. Respondents expressed concerns about contacting SARS-CoV-2 when touching surfaces in public bathrooms which may be influencing self-reported drying method preference.


Subject(s)
COVID-19 , Pandemics , Adult , Cross-Sectional Studies , Hand Disinfection , Health Knowledge, Attitudes, Practice , Humans , Pandemics/prevention & control , SARS-CoV-2 , Surveys and Questionnaires , Toilet Facilities , United States/epidemiology
12.
BMC Public Health ; 21(1): 502, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1136220

ABSTRACT

BACKGROUND: There is a lack of research investigating the confluence of risk factors in urban slums that may make them accelerators for respiratory, droplet infections like COVID-19. Our working hypothesis was that, even within slums, an inverse relationship existed between living density and access to shared or private WASH facilities. METHODS: In an exploratory, secondary analysis of World Bank, cross-sectional microdata from slums in Bangladesh we investigated the relationship between intra-household population density (crowding) and access to private or shared water sources and toilet facilities. RESULTS: The analysis showed that most households were single-room dwellings (80.4%). Median crowding ranged from 0.55 m2 per person up to 67.7 m2 per person. The majority of the dwellings (83.3%), shared both toilet facilities and the source of water, and there was a significant positive relationship between crowding and the use of shared facilities. CONCLUSION: The findings highlight the practical constraints on implementing, in slums, the conventional COVID19 management approaches of social distancing, regular hand washing, and not sharing spaces. It has implications for the management of future respiratory epidemics.


Subject(s)
COVID-19/transmission , Crowding , Family Characteristics/ethnology , Poverty Areas , Bangladesh/epidemiology , Cross-Sectional Studies , Humans , Hygiene/standards , Risk Factors , SARS-CoV-2 , Sanitation/standards , Toilet Facilities/standards , Urban Population
13.
Asia Pac J Public Health ; 33(4): 378-387, 2021 05.
Article in English | MEDLINE | ID: covidwho-1085196

ABSTRACT

Toilet hygiene is an important preventive measure for infectious diseases, including severe acute respiratory syndrome (SARS) and COVID-19. This study explored public's opinions on improving toilet environment and hygiene practices in Hong Kong. A mixed-method approach was applied. We conducted 4 focus groups plus 3 individual interviews among the Hong Kong Chinese, followed by a questionnaire survey with 300 respondents recruited from various districts. Difference in response distributions between groups with different demographics was tested by Pearson χ2 test. Instead of advocating for advanced toilet facilities, respondents were mostly concerned about basic hygiene issues. Malfunctioning facilities resulting from poor toilet management, such as clogged toilets, stained facilities, and problematic flushing systems, were most cited as barriers to toilet hygiene practices. Three quarters of the survey respondents expressed concerns over worn and poorly maintained toilets, shortage of janitors, and cleansing supplies. However, respondents who were older (P < .001), less educated (P < .001), and had lower income (P = .001) were significantly more likely to find hygiene conditions in public toilets satisfactory. The findings reflected the substandard of the current provisions as a developed city in Asia. Enhanced efforts by the government to maintain basic toilet supplies and facilities is the key to improving public compliance to toilet hygiene practices.


Subject(s)
Hygiene/standards , Public Opinion , Toilet Facilities/standards , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , Cities , Communicable Disease Control , Female , Focus Groups , Hong Kong , Humans , Male , Middle Aged , Qualitative Research , Socioeconomic Factors , Surveys and Questionnaires , Young Adult
14.
Ecotoxicol Environ Saf ; 208: 111438, 2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-1049770

ABSTRACT

Roles of environmental factors in transmission of COVID-19 have been highlighted. In this study, we sampled the high-touch environmental surfaces in the quarantine room, aiming to detect the distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the environmental surfaces during the incubation period of coronavirus disease 2019 (COVID-19) patients. Fifteen sites were sampled from the quarantine room, distributing in the functional areas such as bedroom, bathroom and living room. All environmental surface samples were collected with sterile polyester-tipped applicator pre-moistened in viral transport medium and tested for SARS-CoV-2. Overall, 34.1% of samples were detected positively for SARS-CoV-2. The positive rates of Patient A, B and C, were 46.2%, 0% and 61.5%, respectively. SARS-CoV-2 was detected positively in bedroom and bathroom, with the positive rate of 50.0% and 46.7%, respectively. In contrast, living room had no positive sample detected. Environmental contamination of SARS-CoV-2 distributes widely during the incubation period of COVID-19, and the positive rates of SARS-CoV-2 on environmental surfaces are relatively high in bathroom and bedroom.


Subject(s)
Bathroom Equipment/virology , COVID-19/transmission , Environmental Microbiology , Environmental Pollution , Infectious Disease Incubation Period , Latent Infection/transmission , COVID-19/epidemiology , COVID-19/prevention & control , Disinfection , Environmental Pollution/analysis , Environmental Pollution/prevention & control , Female , Humans , Latent Infection/epidemiology , Latent Infection/prevention & control , Male , Quarantine/standards , SARS-CoV-2 , Surface Properties , Toilet Facilities/standards
16.
Sci Total Environ ; 761: 143283, 2021 Mar 20.
Article in English | MEDLINE | ID: covidwho-894208

ABSTRACT

According to the latest reports, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which caused coronavirus disease 2019 (COVID-19), was successfully isolated from the excreta (stool and urine) of COVID-19 patients, suggesting SARS-CoV-2 could be transmitted through excreta contaminated water. As pit latrines and the use of untreated excreta as fertilizer were common in rural China, we surveyed 27 villages of Jiangxi and Hubei provinces and found that pit latrines could be a potential source of SARS-CoV-2 water pollution. Recently, bats have been widely recognized as the source of SARS-CoV-2. There were many possible intermediate hosts of SARS-CoV-2, including pangolin, snake, bird and fish, but which one was still not clear exactly. Here, we proposed a hypothesis to illustrate the mechanism that SARS-CoV-2 might spread from the excreta of infected humans in pit latrines to potential animal hosts, thus becoming a sustainable source of infection in rural China. Therefore, we believe that abolishing pit latrines and banning the use of untreated excreta as fertilizer can improve the local living environment and effectively prevent COVID-19 and other potential waterborne diseases that could emanate from the excreta of infected persons. Although this study focused on rural areas in China, the results could also be applied to low-income countries, especially in Africa.


Subject(s)
COVID-19 , Toilet Facilities , Africa , Animals , China , Humans , Poverty , Risk , Rural Population , SARS-CoV-2
17.
Am J Trop Med Hyg ; 103(5): 2012-2018, 2020 11.
Article in English | MEDLINE | ID: covidwho-808958

ABSTRACT

In countries without adequate access to improved sanitation, government-imposed restrictions during the COVID-19 pandemic can impact toilet usage. In India, where millions have recently transitioned to using a toilet, pandemic-related barriers to use might increase open defecation practices. We assessed changes in reported defecation practices in peri-urban communities in Tamil Nadu. Field assistants conducted phone surveys in 26 communities in two districts from May 20, 2020 to May 25, 2020. They asked respondents about their access to a toilet, whether they or a family member left their house to defecate in the past week, and whether specific practices had changed since the lockdown. Among 2,044 respondents, 60% had access to a private toilet, 11% to a public or community toilet, whereas 29% lacked access to any toilet facility. In our study, 92% of the respondents did not change their defecation behaviors in the 2 months following the pandemic-related lockdown. About a third (27%) reported that they or a family member left their house daily to defecate amid lockdown measures. A majority of those with private toilets (91%) or with public toilets (69%) continued using them. Respondents with private toilet access were more likely to report an increased frequency of handwashing with soap (prevalence ratio [PR]: 1.78, 95% CI: 1.04-3.05) since the lockdown. The lack of private toilets contributes to the need to leave the house amid a lockdown. Maintaining shared toilets require disinfection protocols and behavioral precautions to limit the risk of fomite transmission. Robust urban COVID-19 control strategies should include enhanced sanitation facility management and safe usage messaging.


Subject(s)
Coronavirus Infections/prevention & control , Hygiene , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Sanitation/methods , Toilet Facilities/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Bathroom Equipment/supply & distribution , Betacoronavirus , COVID-19 , Cross-Sectional Studies , Defecation , Female , Hand Disinfection , Humans , India , Male , Middle Aged , SARS-CoV-2 , Young Adult
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