{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T22:31:02Z","timestamp":1786487462792,"version":"build-2736575974"},"reference-count":49,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014538","name":"Lembaga Pengelola Dana Pendidikan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014538","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019899","name":"Kementerian Keuangan Republik Indonesia","doi-asserted-by":"publisher","award":["202212222412687"],"award-info":[{"award-number":["202212222412687"]}],"id":[{"id":"10.13039\/501100019899","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Science of The Total Environment"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.scitotenv.2026.182111","type":"journal-article","created":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T19:26:53Z","timestamp":1785698813000},"page":"182111","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Aerosol and bioaerosol generation from toilet flushing: A systematic review and risk factor analysis"],"prefix":"10.1016","volume":"1048","author":[{"given":"Lira","family":"Adiyani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirstin","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Van den Akker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Whiley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"4","key":"10.1016\/j.scitotenv.2026.182111_bb0005","doi-asserted-by":"crossref","DOI":"10.1007\/s40710-025-00789-9","article-title":"Public health risks associated with aerosolised pathogens from non-potable applications of recycled water","volume":"12","author":"Adiyani","year":"2025","journal-title":"Environ. Process."},{"issue":"5","key":"10.1016\/j.scitotenv.2026.182111_bb0010","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.ajic.2018.11.009","article-title":"Toilet plume aerosol generation rate and environmental contamination following bowl water inoculation with Clostridium difficile spores","volume":"47","author":"Aithinne","year":"2019","journal-title":"Am. J. Infect. Control"},{"key":"10.1016\/j.scitotenv.2026.182111_bb0015","doi-asserted-by":"crossref","DOI":"10.1016\/j.buildenv.2022.109284","article-title":"Comparing bioaerosol emission after flushing in squat and bidet toilets: quantitative microbial risk assessment for defecation and hand washing postures","volume":"221","author":"Ali","year":"2022","journal-title":"Build. Environ."},{"issue":"part B","key":"10.1016\/j.scitotenv.2026.182111_bb0020","article-title":"Emission characteristics and quantitative health risk assessment of bioaerosols in an indoor toilet after flushing under various ventilation scenarios","volume":"207","author":"Ali","year":"2022","journal-title":"Build. Environ."},{"issue":"8","key":"10.1016\/j.scitotenv.2026.182111_bb0025","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1111\/risa.70000","article-title":"Quantitative microbial risk assessment of bioaerosol emissions from squat and bidet toilets during flushing","volume":"45","author":"Ali","year":"2025","journal-title":"Risk Anal."},{"issue":"11","key":"10.1016\/j.scitotenv.2026.182111_bb0030","doi-asserted-by":"crossref","first-page":"4000","DOI":"10.1111\/risa.70131","article-title":"Decremental volumes of toilet flushing water effects on bioaerosol emission characteristics: health risks for exposure populations with nasal\/oral breathing patterns","volume":"45","author":"Ali","year":"2025","journal-title":"Risk Anal."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0035","doi-asserted-by":"crossref","DOI":"10.1016\/j.buildenv.2026.114517","article-title":"Bioaerosol emission in public washroom under different time intervals of working day and critical exposure time for sanitary workers","volume":"296","author":"Ali","year":"2026","journal-title":"Build. Environ."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0040","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijheh.2021.113807","article-title":"Detection of SARS-CoV-2 RNA on contact surfaces within shared sanitation facilities","volume":"236","author":"Amoah","year":"2021","journal-title":"Int. J. Hyg. Environ. Health"},{"issue":"2","key":"10.1016\/j.scitotenv.2026.182111_bb0045","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/j.1365-2672.2005.02610.x","article-title":"The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet","volume":"99","author":"Barker","year":"2005","journal-title":"J. Appl. Microbiol."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0050","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jhin.2011.08.010","article-title":"Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk","volume":"80","author":"Best","year":"2012","journal-title":"J. Hosp. Infect."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0055","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.watres.2017.08.068","article-title":"Greywater reuse - assessment of the health risk induced by Legionella pneumophila","volume":"125","author":"Blanky","year":"2017","journal-title":"Water Res."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0060","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-02938-0","article-title":"Determination of murine norovirus aerosol concentration during toilet flushing","volume":"11","author":"Boles","year":"2021","journal-title":"Sci. Rep."},{"issue":"8","key":"10.1016\/j.scitotenv.2026.182111_bb0065","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.ajic.2025.04.008","article-title":"The impact of an air sanitizer spray on the risk of virus transmission by aerosols generated by toilet flushing","volume":"53","author":"Boone","year":"2025","journal-title":"Am. J. Infect. Control"},{"issue":"7","key":"10.1016\/j.scitotenv.2026.182111_bb0070","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph13070733","article-title":"Quantitative microbial risk assessment in occupational settings applied to the airborne human adenovirus infection","volume":"13","author":"Carducci","year":"2016","journal-title":"Int. J. Environ. Res. Public Health"},{"issue":"12","key":"10.1016\/j.scitotenv.2026.182111_bb0075","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1016\/j.ajic.2016.07.004","article-title":"Efficacy of an automated ultraviolet C device in a shared hospital bathroom","volume":"44","author":"Cooper","year":"2016","journal-title":"Am. J. Infect. Control"},{"issue":"7","key":"10.1016\/j.scitotenv.2026.182111_bb0080","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.3201\/eid2607.190941","article-title":"Transmission of legionnaires\u2019 disease through toilet flushing","volume":"26","author":"Couturier","year":"2020","journal-title":"Emerg. Infect. Dis."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0085","doi-asserted-by":"crossref","first-page":"20493","DOI":"10.1038\/s41598-022-24686-5","article-title":"Commercial toilets emit energetic and rapidly spreading aerosol plumes","volume":"12","author":"Crimaldi","year":"2022","journal-title":"Sci. Rep."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0090","author":"EPA"},{"issue":"2","key":"10.1016\/j.scitotenv.2026.182111_bb0095","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ajic.2023.11.020","article-title":"Impacts of lid closure during toilet flushing and of toilet bowl cleaning on viral contamination of surfaces in United States restrooms","volume":"52","author":"Goforth","year":"2024","journal-title":"Am. J. Infect. Control"},{"issue":"5","key":"10.1016\/j.scitotenv.2026.182111_bb0100","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1111\/ina.12797","article-title":"Aerosol and bioaerosol particle size and dynamics from defective sanitary plumbing systems","volume":"31","author":"Gormley","year":"2021","journal-title":"Indoor Air"},{"key":"10.1016\/j.scitotenv.2026.182111_bb0105","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.watres.2017.12.022","article-title":"Health risks from exposure to Legionella in reclaimed water aerosols: toilet flushing, spray irrigation, and cooling towers","volume":"134","author":"Hamilton","year":"2018","journal-title":"Water Res."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0110","article-title":"A Quantitative Microbial Risk Assessment (QMRA) framework for exposure from toilet flushing using experimental aerosol concentration measurements","volume":"2","author":"Higham","year":"2025","journal-title":"Indoor Environ."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0115","series-title":"Aerosol Technology","author":"Hinds","year":"1999"},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0120","doi-asserted-by":"crossref","first-page":"68","DOI":"10.2166\/wh.2015.057","article-title":"Bidet toilet seats with warm-water tanks: residual chlorine, microbial community, and structural analyses","volume":"14","author":"Iyo","year":"2016","journal-title":"J. Water Health"},{"issue":"9","key":"10.1016\/j.scitotenv.2026.182111_bb0125","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1080\/02786826.2013.814911","article-title":"Aerosol generation by modern flush toilets","volume":"47","author":"Johnson","year":"2013","journal-title":"Aerosol Sci. Technol."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0130","doi-asserted-by":"crossref","DOI":"10.1186\/s13756-018-0301-9","article-title":"Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting","volume":"7","author":"Knowlton","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"issue":"10","key":"10.1016\/j.scitotenv.2026.182111_bb0135","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1002\/alr.22661","article-title":"Review of indoor aerosol generation, transport, and control in the context of COVID-19","volume":"10","author":"Kohanski","year":"2020","journal-title":"Int. Forum Allergy Rhinol."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0140","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.scitotenv.2019.02.398","article-title":"Source specific exposure and risk assessment for indoor aerosols","volume":"668","author":"Koivisto","year":"2019","journal-title":"Sci. Total Environ."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0145","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/ina.12406","article-title":"Emission strength of airborne pathogens during toilet flushing","volume":"28","author":"Lai","year":"2018","journal-title":"Indoor Air"},{"key":"10.1016\/j.scitotenv.2026.182111_bb0150","doi-asserted-by":"crossref","DOI":"10.1016\/j.buildenv.2022.108948","article-title":"Measuring the flushing-generated flow and aerosols in lavatory of commercial aircraft","volume":"214","author":"Li","year":"2022","journal-title":"Build. Environ."},{"issue":"2","key":"10.1016\/j.scitotenv.2026.182111_bb0155","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1021\/acsestwater.2c00521","article-title":"Virus emissions from toilet flushing: comparing urine-diverting to mix flush toilets","volume":"3","author":"Li","year":"2023","journal-title":"ACS EST Water"},{"issue":"8","key":"10.1016\/j.scitotenv.2026.182111_bb0160","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1007\/s12273-023-1031-3","article-title":"CFD modeling of dynamic airflow and particle transmission in an aircraft lavatory","volume":"16","author":"Li","year":"2023","journal-title":"Build. Simul."},{"issue":"7813","key":"10.1016\/j.scitotenv.2026.182111_bb0165","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1038\/s41586-020-2271-3","article-title":"Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals","volume":"582","author":"Liu","year":"2020","journal-title":"Nature"},{"issue":"3","key":"10.1016\/j.scitotenv.2026.182111_bb0170","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1007\/s11356-020-11297-8","article-title":"The bioaerosols emitted from toilet and wastewater treatment plant: a literature review","volume":"28","author":"Lou","year":"2021","journal-title":"Environ. Sci. Pollut. Res. Int."},{"issue":"7","key":"10.1016\/j.scitotenv.2026.182111_bb0175","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med."},{"issue":"Suppl. 7","key":"10.1016\/j.scitotenv.2026.182111_bb0180","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/j.1600-0668.2004.00286.x","article-title":"Indoor particle dynamics","volume":"14","author":"Nazaroff","year":"2004","journal-title":"Indoor Air"},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0185","doi-asserted-by":"crossref","first-page":"10665","DOI":"10.1038\/s41598-024-61039-w","article-title":"Exploring toilet plume bioaerosol exposure dynamics in public toilets using a Design of Experiments approach","volume":"14","author":"Paddy","year":"2024","journal-title":"Sci. Rep."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0190","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jhin.2025.02.012","article-title":"Evaluating the risk of Clostridioides difficile infection from toilet flushing: a quantitative microbial risk assessment and implications for infection control","volume":"159","author":"Paddy","year":"2025","journal-title":"J. Hosp. Infect."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0195","series-title":"Analysis of Australian Opportunities for more Efficient Toilets, [Prepared for the Australian Government Department of the Environment, Water, Heritage and the Arts]","author":"Schlunke","year":"2008"},{"issue":"3","key":"10.1016\/j.scitotenv.2026.182111_bb0200","doi-asserted-by":"crossref","DOI":"10.1063\/5.0040310","article-title":"Aerosol generation in public restrooms","volume":"33","author":"Schreck","year":"2021","journal-title":"Phys. Fluids"},{"key":"10.1016\/j.scitotenv.2026.182111_bb0205","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1016\/j.scitotenv.2018.04.197","article-title":"Quantitative microbial risk assessment of greywater on-site reuse","volume":"635","author":"Shi","year":"2018","journal-title":"Sci. Total Environ."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0210","doi-asserted-by":"crossref","first-page":"42601","DOI":"10.1038\/s41598-025-26663-0","article-title":"Respiratory deposition of particulate matter in Delhi: a five-year assessment of exposure patterns and health risks","volume":"15","author":"Singh","year":"2025","journal-title":"Sci. Rep."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0215","series-title":"Targeting Chronic Inflammatory Lung Diseases Using Advanced Drug Delivery Systems","first-page":"475","article-title":"Mucoadhesive drug delivery systems in respiratory diseases","author":"Thakur","year":"2020"},{"key":"10.1016\/j.scitotenv.2026.182111_bb0220","series-title":"Quantitative Microbial Risk Assessment: Application for Water Safety Management","author":"WHO","year":"2016"},{"issue":"5","key":"10.1016\/j.scitotenv.2026.182111_bb0225","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1017\/ice.2020.11","article-title":"Bioaerosols generated from toilet flushing in rooms of patients with Clostridioides difficile infection","volume":"41","author":"Wilson","year":"2020","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0230","doi-asserted-by":"crossref","DOI":"10.1016\/j.buildenv.2024.111736","article-title":"Rapid evolution of indoor primary and secondary organic aerosols from human activities","volume":"261","author":"Yang","year":"2024","journal-title":"Build. Environ."},{"key":"10.1016\/j.scitotenv.2026.182111_bb0235","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1415157","article-title":"A review of Legionella transmission risk in built environments: sources, regulations, sampling, and detection","volume":"12","author":"Yao","year":"2024","journal-title":"Front. Public Health"},{"key":"10.1016\/j.scitotenv.2026.182111_bb0240","doi-asserted-by":"crossref","DOI":"10.1016\/j.buildenv.2024.111162","article-title":"Experimental study on droplet and bioaerosol emissions from flushing a squat toilet","volume":"250","author":"Zhang","year":"2024","journal-title":"Build. Environ."},{"issue":"1","key":"10.1016\/j.scitotenv.2026.182111_bb0245","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ajic.2025.10.002","article-title":"Study on the air gap effect when closing toilet lid on droplet and pathogen escaping from flushing","volume":"54","author":"Zhang","year":"2026","journal-title":"Am. J. Infect. Control"}],"container-title":["Science of The Total Environment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0048969726007771?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0048969726007771?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T22:10:13Z","timestamp":1786486213000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0048969726007771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":49,"alternative-id":["S0048969726007771"],"URL":"https:\/\/doi.org\/10.1016\/j.scitotenv.2026.182111","relation":{},"ISSN":["0048-9697"],"issn-type":[{"value":"0048-9697","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Aerosol and bioaerosol generation from toilet flushing: A systematic review and risk factor analysis","name":"articletitle","label":"Article Title"},{"value":"Science of The Total Environment","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.scitotenv.2026.182111","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"182111"}}