Transmission of COVID-19 and other infectious diseases in public washrooms: A systematic review

Vardoulakis, Sotiris; Oyarce, Daniela A. Espinoza; Donner, Erica

doi:10.1016/j.scitotenv.2021.149932

Cited by 41 publications

(28 citation statements)

References 68 publications

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“…The non-statistically significant impact of jet air dryers on bacterial load in air is consistent with results from other studies, which also obtained comparable numbers when hands were dried with jet air dryers or paper towels (16,18). Other authors have reported that drying hands with jet air dryers resulted in much higher level of virus and bacteria concentrations in air (19,20), however these experiments employed unrealistic experimental conditions (17,21).…”

Section: Discussionsupporting

confidence: 88%

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Aerosols and Bacteria From Hand Washing and Drying in Indoor Air

Gião

Vardoulakis

2022

Front. Public Health

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Effective hand drying is an important part of hand hygiene that can reduce the risk of infectious disease transmission through cross-contamination of surfaces by wet hands. However, hand drying methods may also cause aerosolisation of pathogenic microorganisms if they are present in washed hands. This study investigated experimentally the impact of washing hands and different hand drying methods on the concentration and size distribution of aerosols and bacteria in indoor air. In this experiment, aerosol and bacteria concentrations were measured in indoor air while volunteers rinsed their hands with water or washed with soap and water prior to drying them with paper towels or jet air dryers. Results showed that the concentration of aerosols and bacteria in air increased with people walking in the room and washing hands, with a further increase during the hand drying process. The concentration of aerosols decreased with particle size, with maximum concentrations after drying hands of 6.63 × 106 ± 6.49 × 105 and 2.28 × 104 ± 9.72 × 103 particles m−3 for sizes 0.3 to <0.5 and ≥5.0 μm, respectively. The concentration of bacteria in indoor air after drying hands increased to a maximum of 3.81 × 102 ± 1.48 × 102 CFU m−3 (jet air dryers) and 4.50 × 102 ± 4.35 × 101 CFU m−3 (paper towels). This study indicates that the increase of aerosols and bacteria in air after drying hands with jet air dryers or paper towels are comparable and not statistically different from concentrations associated with walking and washing hands in the same environment. This work can support the development of hand hygiene practices and guidelines for public washrooms.

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Section: Discussionsupporting

confidence: 88%

“…Aerosols and bacteria are ubiquitous in bathrooms (21). Several human activities can contribute to their increase indoors, including walking, changing clothes, and flushing the toilet (22,23).…”

Section: Discussionmentioning

confidence: 99%

Aerosols and Bacteria From Hand Washing and Drying in Indoor Air

Gião

Vardoulakis

2022

Front. Public Health

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“…Our finding indicates the fimH41 strains in the public restroom environment appear to be human origin. From the fimH type and whole-genome analysis of STc131 in our study, the possible transmission route of STc131 E. coli may include the following: (a) sharing of STc131 among dogs and human within a household or in the community ( Johnson et al, 2009 ); (b) transmission through contact transmission with the contaminated surfaces and fomites at public restroom ( Vardoulakis et al, 2022 ); and (c) the fecal-oral route transmission ( Vardoulakis et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…We do not know if it is related to more antimicrobial use in the rural area or relative to livestock animal exposure. The percentage of multi-drug–resistant E. coli in the public restrooms may be related to environmental conditions, toilet design, and appropriate hygiene practices ( Vardoulakis et al, 2022 ). This study supports the idea that bacterial surveillance in urban sewage or toilets is an economically feasible approach for continuous global surveillance and the prediction of antimicrobial resistance ( Hendriksen et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial-Resistant Escherichia coli Distribution and Whole-Genome Analysis of Sequence Type 131 Escherichia coli Isolates in Public Restrooms in Taiwan

et al. 2022

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The threat of antibiotic-resistant bacteria to public health may originate from public restrooms. To better understand the community burden of antimicrobial-resistant Escherichia coli and sequence type complex 131 E. coli (STc131) in the public restroom, we performed a surveillance in public restrooms in southern Taiwan. Swabs were sampled from randomly selected public restrooms in Tainan, Taiwan in 2019. Antimicrobial susceptibility, phylogenetic grouping, and multiplex PCR were performed for the major ST complex in the B2 phylogenetic group. If STc131 isolates were identified, the whole-genome sequencing was performed. A total of 613 collection sites found 132 sites (21.5%) positive for E. coli. The most common phylogenetic group was A (30.9%) followed by B2 (30.3%). Ceftriaxone-resistant E. coli and extended-spectrum β-lactamases–producing E. coli were found in 2.4 and 1.0% of total public restrooms, respectively. The isolates in rural areas had higher ceftriaxone non-susceptibility than those in the city centers (3.9 vs. 1.2%, P = 0.038). Nine STc131 isolates were found in public restrooms, and most (77.8%) belonged to the subtype fimH41, whereas 22.2% belonged to fimH30. With the inclusion of STc131 isolates from human and dog fecal colonization in Taiwan, whole-genome sequencing was performed in 35 isolates. A large cluster of fimH41 in SNP-tree and GrapeTree was found from different sources (human, dog, and environment) and geographical areas. In conclusion, our surveillance of antimicrobial-resistant E. coli showed a higher prevalence of E. coli detected in public restrooms in the rural areas compared to those in city centers. The whole-genome sequence implies that fimH41 STc131 strains are successfully circulated in the community in Taiwan.

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“…As separations generally exist between installations, this association cannot be explained by droplet transmission. This leaves aerosol-transmission, indirect fomite transmission, fecal-oral and fecal-aerosol transmission as possible underlying mechanisms [20][21][22] . Alternatively, it could imply that shared use of sanitary facilities constitutes a proxy for overall exposure to an index case living in the same residence unit.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for SARS-CoV-2 transmission in student residences: a case-ascertained study in Leuven, Belgium from October 2020 until May 2021

Vanbesien

Molenberghs

Geenen

et al. 2022

Preprint

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Background Student residences are at high risk for rapid COVID-transmission due to crowding and frequent close contact. Aim We aimed to investigate the overall secondary attack rates (SAR) in student residences and to discern risk factors for higher transmission in order to improve the evidence base for screening efforts and preventive measures. Methods In this retrospective case-ascertained study, we analysed data from student residences screened in Leuven, Belgium between October 2020 and May 2021, following detection of a COVID-19 case in the residence. We investigated the impact on the SAR in the living units screened of delay-time until follow-up, shared use of kitchen or sanitary facilities, presence of an external infection source and occurrence of social gatherings attended by the index case. Results We included 200 residence units, representing 2326 screened residents, of which 68 units showed secondary transmission. The overall SAR was estimated at 0.0813 (95%CI 0.0705-0.0936). Both sharing sanitary facilities (p=0.04) and social gatherings attended by the index case (p=0.033) significantly impacted SAR, which increased from 3% to 13% when both risk factors were present compared to absent. Conclusions We identify risk factors which should be considered when selecting students for screening during an outbreak of COVID-19 in student residences to improve comprehensiveness and proportionality of testing. The identified risk factors improve the evidence base for preventive measures aimed at limiting social gatherings and improving ventilation of shared spaces in outbreak-prone settings. Lastly, they should be considered when designing student accommodation and other shared households.

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Transmission of COVID-19 and other infectious diseases in public washrooms: A systematic review

Cited by 41 publications

References 68 publications

Aerosols and Bacteria From Hand Washing and Drying in Indoor Air

Aerosols and Bacteria From Hand Washing and Drying in Indoor Air

Antimicrobial-Resistant Escherichia coli Distribution and Whole-Genome Analysis of Sequence Type 131 Escherichia coli Isolates in Public Restrooms in Taiwan

Risk factors for SARS-CoV-2 transmission in student residences: a case-ascertained study in Leuven, Belgium from October 2020 until May 2021

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