Abstract
BackgroundIn the health care setting, infection control actions are fundamental for containing the dissemination of multidrug-resistant bacteria (MDR). Carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (CR-KP), can spread among patients, although the dynamics of transmission are not fully known. Since CR-KP is present in wastewater and microorganisms are not completely removed from the toilet bowl by flushing, the risk of transmission in settings where toilets are shared should be addressed. We investigated whether urinating generates droplets that can be a vehicle for bacteria and explored the use of an innovative foam to control and eliminate this phenomenon.MethodsTo study droplet formation during urination, we set up an experiment in which different geometrical configurations of toilets could be reproduced and customized. To demonstrate that droplets can mobilize bacteria from the toilet bowl, a standard ceramic toilet was contaminated with a KPC-producing Klebsiella pneumoniae ST101 isolate. Then, we reproduced urination and attached culture dishes to the bottom of the toilet lid for bacterial colony recovery with and without foam.ResultsRebound droplets invariably formed, irrespective of the geometrical configuration of the toilet. In microbiological experiments, we demonstrated that bacteria are always mobilized from the toilet bowl (mean value: 0.11 ± 0.05 CFU/cm2) and showed that a specific foam layer can completely suppress mobilization.ConclusionsOur study demonstrated that droplets generated from toilets during urination can be a hidden source of CR-KP transmission in settings where toilets are shared among colonized and noncolonized patients.
Highlights
Antimicrobial resistance (AMR) is emerging worldwide in hospital and community settings
Different geometrical configurations of toilets cannot prevent droplet formation Using the previously described experimental toilet bowl with variations in the inclination angle of the solid surfaces and the height of the liquid level inside the bowl, we demonstrated the constant production of droplets by the toilet
Even if some toilet bowl configurations were better than others at reducing droplet generation, they cannot completely eliminate urine dispersion
Summary
Antimicrobial resistance (AMR) is emerging worldwide in hospital and community settings. Klebsiella pneumoniae is an especially serious threat for hospitalized patients, patients admitted to. Arena et al Antimicrob Resist Infect Control (2021) 10:149 long-term acute care facilities and those in rehabilitation settings due to its profile of multidrug resistance and its ability to cause life-threatening infections (mainly of the respiratory system and bloodstream) [4,5,6]. The major risk factor for carbapenem-resistant K. pneumoniae (CR-KP) infection in the hospital setting is prior gut colonization. The dynamics of transmission underlying the acquisition of intestinal colonization by CR-KP in the hospital, long-term acute care and rehabilitation settings are not fully known. In the health care setting, infection control actions are fundamental for containing the dissemination of multidrug-resistant bacteria (MDR). Carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (CR-KP), can spread among patients, the dynamics of transmission are not fully known. We investigated whether urinating generates droplets that can be a vehicle for bacteria and explored the use of an innovative foam to control and eliminate this phenomenon
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