{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:48:32Z","timestamp":1788896912340,"version":"build-2803163510"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T00:00:00Z","timestamp":1580428800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X20000112_as1\"><jats:title>Background:<\/jats:title><jats:p><jats:italic>Clostridioides difficile<\/jats:italic> infection (CDI) is the most frequently reported hospital-acquired infection in the United States. Bioaerosols generated during toilet flushing are a possible mechanism for the spread of this pathogen in clinical settings.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20000112_as2\"><jats:title>Objective:<\/jats:title><jats:p>To measure the bioaerosol concentration from toilets of patients with CDI before and after flushing.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20000112_as3\"><jats:title>Design:<\/jats:title><jats:p>In this pilot study, bioaerosols were collected 0.15 m, 0.5 m, and 1.0 m from the rims of the toilets in the bathrooms of hospitalized patients with CDI. Inhibitory, selective media were used to detect <jats:italic>C. difficile<\/jats:italic> and other facultative anaerobes. Room air was collected continuously for 20 minutes with a bioaerosol sampler before and after toilet flushing. Wilcoxon rank-sum tests were used to assess the difference in bioaerosol production before and after flushing.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20000112_as4\"><jats:title>Setting:<\/jats:title><jats:p>Rooms of patients with CDI at University of Iowa Hospitals and Clinics.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20000112_as5\"><jats:title>Results:<\/jats:title><jats:p>Bacteria were positively cultured from 8 of 24 rooms (33%). In total, 72 preflush and 72 postflush samples were collected; 9 of the preflush samples (13%) and 19 of the postflush samples (26%) were culture positive for healthcare-associated bacteria. The predominant species cultured were <jats:italic>Enterococcus faecalis<\/jats:italic>, <jats:italic>E. faecium<\/jats:italic>, and <jats:italic>C. difficile<\/jats:italic>. Compared to the preflush samples, the postflush samples showed significant increases in the concentrations of the 2 large particle-size categories: 5.0 \u00b5m (<jats:italic>P<\/jats:italic> = .0095) and 10.0 \u00b5m (<jats:italic>P<\/jats:italic> = .0082).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20000112_as6\"><jats:title>Conclusions:<\/jats:title><jats:p>Bioaerosols produced by toilet flushing potentially contribute to hospital environmental contamination. Prevention measures (eg, toilet lids) should be evaluated as interventions to prevent toilet-associated environmental contamination in clinical settings.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2020.11","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T09:18:42Z","timestamp":1580462322000},"page":"517-521","source":"Crossref","is-referenced-by-count":30,"title":["Bioaerosols generated from toilet flushing in rooms of patients with <i>Clostridioides difficile<\/i> infection"],"prefix":"10.1017","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3850-7689","authenticated-orcid":false,"given":"Geneva M.","family":"Wilson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virgil B.","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda D.","family":"Boyken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marin L.","family":"Schweizer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Diekema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine A.","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Breheny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Nonnenmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli N.","family":"Perencevich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the CDC Prevention Epicenter Program","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,1,31]]},"reference":[{"key":"S0899823X20000112_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2012.04.330"},{"key":"S0899823X20000112_ref7","doi-asserted-by":"publisher","DOI":"10.1017\/S095026880005696X"},{"key":"S0899823X20000112_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(96)90008-X"},{"key":"S0899823X20000112_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(81)90553-2"},{"key":"S0899823X20000112_ref15","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.026385-0"},{"key":"S0899823X20000112_ref14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2672.2005.02610.x"},{"key":"S0899823X20000112_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.resmic.2015.02.002"},{"key":"S0899823X20000112_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/143.1.42"},{"key":"S0899823X20000112_ref20","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-8-7"},{"key":"S0899823X20000112_ref3","doi-asserted-by":"publisher","DOI":"10.1086\/652648"},{"key":"S0899823X20000112_ref2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0178007"},{"key":"S0899823X20000112_ref17","doi-asserted-by":"publisher","DOI":"10.1086\/591861"},{"key":"S0899823X20000112_ref19","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-018-0301-9"},{"key":"S0899823X20000112_ref9","unstructured":"9. Nearly half a million Americans suffered from Clostridium difficile infections in a single year. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/media\/releases\/2015\/p0225-clostridium-difficile.html. Published 2015. Accessed January 14, 2020."},{"key":"S0899823X20000112_ref5","doi-asserted-by":"publisher","DOI":"10.1038\/emi.2013.62"},{"key":"S0899823X20000112_ref8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1801550"},{"key":"S0899823X20000112_ref18","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.248"},{"key":"S0899823X20000112_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2011.08.010"},{"key":"S0899823X20000112_ref16","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12762"},{"key":"S0899823X20000112_ref13","doi-asserted-by":"publisher","DOI":"10.1086\/424667"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X20000112","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T09:17:56Z","timestamp":1604567876000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X20000112\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,31]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020,5]]}},"alternative-id":["S0899823X20000112"],"URL":"https:\/\/doi.org\/10.1017\/ice.2020.11","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,31]]}}}