Toilet Seat Research Articles

Revision Of A Standard For The Test Of A Toilet-Incorporated Medical Electric Bed

We developed a toilet-incorporated electric medical bed for bedridden patients, in which a toilet basin, or a commode, is incorporated in the pelvic plate of an electric medical bed. A replaceable toilet seat is located in the mattress of the bed, and toilet basin was tightly attached on the pelvic plate the bed. The excretion slides through a storage tube that angles toward the side of the bed and is automatically collected in a disposable plastic bag. We, however, encountered a problem with testing this newly developed medical bed with the relevant international standard IEC 60601-2-52:2009, or with the corresponding Korean standard KS P 0388:2012--Electrically operated adjustable bed for home care. There was no clear indication in the scopes of the above standards as to whether this standard testing method is applicable to an electric medical bed embedded with a commode. We revised the Korean standard KS P 0388:2012 to accommodate the toilet-incorporated medical bed in the scope of the standard and successfully performed the mechanical tests including the durability, impact, and deformation test of the bed, proving that the newly developed toilet-incorporated medical bed is mechanically strong and durable enough to pass the standard tests.

Unmet Needs for Equipment to Help with Bathing and Toileting Among U.S. Older Adults

Using adapted toileting and bathing equipment, such as raised toilet seats, shower seats, and grab bars, prevents injuries and falls in older adults.

Detection of the Modifiable and Non-Modifiable Risk Factors, and the Adverse Consequences of Falling among Elderly People

Abstract: Background: Falling among elders is the most causative factor of unintentional injuries resulting in disability and hospitalization. Aim: Was to identify the modifiable and non-modifiable risk factors and the adverse consequences of falling among elderly people. Methodology: A descriptive study was conducted on 384 elderly participants at Minia governorate, Egypt. Tools: A structuredquestionnaire, Timed Up and Go Test Scale, Katz Scale, and Mini-Nutritional Assessment questionnaire were used. Results: Findings showed that 45.6% of the participants were at risk of falling based on the performed timed up and go test and 63.5 % of them had a falling history. Female gender, age, and chronic diseases were the main non-modifiable risk factors, while the detected modifiable factors of falling included; absence of toilet seats (95.9 %), absence of grab bars (76.2%), poor lighting (56.6%), and slippery floor (54.1%). Additionally, 93.4% had a lack of assistive devices, inactivity (81.6%), anemia (65.2%), and poor vision (50.8%). Likewise, 73.0%, 35.2%, 26.6%, and 100% of the fallers reported back pain, cut wounds, fractures, and fear respectivelyas adverse consequences. Conclusion: Hazardous environment, declined physical activities, walking problems, lifestyle, malnutrition, and body mass index were the most reported modifiable risk factors of falls. Recommendations: Early detection of the modifiable risk factors is essential for preventing falling and its adverse consequences among elderly people.

Unmet Need for Equipment to Help With Bathing and Toileting Among Older US Adults

Home modification through seemingly mundane equipment, such as grab bars and shower seats, mitigates injury, dependence, and reduced quality of life in older adults coping with increasing disability. However, whether these interventions are underused in the US is unclear. To estimate how many older adults who need equipment to help with bathing and toileting do not have it, describe factors associated with not having equipment, and describe how many who did not initially have equipment acquired equipment over time. This observational cohort study of participants 65 years or older used secondary data from the 2015 to 2019 waves of the US National Health and Aging Trends Study. Participants included community-dwelling older adults who would unequivocally benefit from equipment, defined as those with poor physical performance or substantial difficulty bathing, toileting, transferring, or walking. Respondents were representative of the US population 65 years and older. Data were collected from May 2015 to October 2019 and analyzed from August 1, 2019, to February 24, 2021. Population characteristics (eg, age, sex, income, health conditions, and physical performance), environmental factors (eg, home ownership and living arrangement), and health behaviors (eg, prior knee and/or hip surgery). Prevalence of any unmet need for equipment, defined as either needing bathing equipment (bath grab bars and shower seat) but having none or needing toileting equipment (toilet grab bars and raised toilet seat) but having none and the cumulative incidence of equipment acquisition during 4 years of follow-up. A total of 2614 participants representing 12 million US individuals would benefit from equipment. The mean (SD) age was 80.5 (8.2) years, and 1619 individuals (62%) were women. Of these, an estimated 5 million individuals (42%; 95% CI, 39%-44%) had an unmet need. After adjustment for age, sex, and race/ethnicity, unmet need was associated with younger age (49% if aged 65-74 years, 37% if aged 75-84 years, and 29% if aged ≥85 years; P < .001), having fewer health conditions (55% if none vs 39% if ≥3; P = .002), non-White race/ethnicity (40% if White vs 51% if Black, 54% if Hispanic, and 55% if other; P < .001), no recent hospitalization (46% vs 37% if hospitalized; P = .001), and no prior knee and/or hip fracture or surgery (46% vs 35% if prior fracture or surgery; P < .001). After 4 years of follow-up, 35% of those with bathing equipment needs and 52% of those with toileting equipment needs never received equipment. This cohort study suggests that in the US, 42% of older adults with impairments that would make bathing or toileting difficult lack equipment to assist. This situation is a missed opportunity to help 5 million individuals live independently and safely.

Design and evaluation of a novel approach to invisible electrocardiography (ECG) in sanitary facilities using polymeric electrodes

Multiple wearable devices for cardiovascular self-monitoring have been proposed over the years, with growing evidence showing their effectiveness in the detection of pathologies that would otherwise be unnoticed through standard routine exams. In particular, Electrocardiography (ECG) has been an important tool for such purpose. However, wearables have known limitations, chief among which are the need for a voluntary action so that the ECG trace can be taken, battery lifetime, and abandonment. To effectively address these, novel solutions are needed, which has recently paved the way for “invisible” (aka “off-the-person”) sensing approaches. In this article we describe the design and experimental evaluation of a system for invisible ECG monitoring at home. For this purpose, a new sensor design was proposed, novel materials have been explored, and a proof-of-concept data collection system was created in the form of a toilet seat, enabling ECG measurements as an extension of the regular use of sanitary facilities, without requiring body-worn devices. In order to evaluate the proposed approach, measurements were performed using our system and a gold standard equipment, involving 10 healthy subjects. For the acquisition of the ECG signals on the toilet seat, polymeric electrodes with different textures were produced and tested. According to the results obtained, some of the textures did not allow the acquisition of signals in all users. However, a pyramidal texture showed the best results in relation to heart rate and ECG waveform morphology. For a texture that has shown 0% signal loss, the mean heart rate difference between the reference and experimental device was − 1.778 ± 4.654 Beats per minute (BPM); in terms of ECG waveform, the best cases present a Pearson correlation coefficient above 0.99.

Duration of SARS-CoV-2 positive in quarantine room environments: A perspective analysis

ObjectiveTo determine the duration of SARS-CoV-2 persistence in quarantine hotel environments. Methods39 Patients confirmed by RT-PCR were included. We collected clinical features, laboratory test results, smear sample information, and quarantine room information. Genome sequencing and phylogenetic analysis were conducted. We analyzed the factors associated with environmental contamination. ResultAmong 39 COVID-19 cases, 10 were asymptomatic and 37 were imported from aboard. We collected 271 swab samples from environmental surfaces related to observational patients. Eighteen swab samples from seven patients were positive. The highest contamination rates occurred on cups (100%), followed by hand sink (12.82%), toilet seat and flush (7.89%), telephone (5.56%), bedside table (5.56%), and floor drain (5.41%). The results showed that environmental surface contamination was associated with the clinical cycle threshold values for patients (P = 0.01) and the sampling interval time after the cases left their rooms (P = 0.03). The duration of environmental surface contamination was associated with the wet status of the sampling site (P = 0.01). ConclusionOur findings showed that environmental contamination might be attributed to the viral load in the respiratory tracts of patients and the sampling interval time after the cases left their rooms. Moist surfaces were more vulnerable to remaining SARS-CoV-2 RNA-positive. Our study highlights the importance of implementing strict chemical disinfection strategies in quarantine rooms.

Evaluation of Standing-Up Motion from a Forward-Sloping Toilet Seat for Older People

(1) Background: In-home assistive systems to help people with physical disabilities stand up from toilets are necessary, and the ease of the standing-up motion should be evaluated. (2) Methods: This study investigated the ease of the standing-up motion using objective and subjective data from healthy participants to facilitate the development of a toilet-seat-tilting system. Participants were divided into younger and older age groups. Objective data concerning muscle activity (EMG), three-dimensional (3D) body motion, and center of pressure distribution (COP) were collected. The participants also provided subjective data related to standing up from a toilet tilted at three different angles. (3) Results: All participants repeated the motion 25 times for each angle and provided feedback regarding their standing-up experience under each condition. Objective EMG, COP, and 3D body motion analysis results varied across individuals and age groups. The older group exhibited a consistent pattern of head motion while standing up. Thus, older individuals prefer a forward trunk-inclination motion. (4) Conclusions: According to the collected subjective data, all participants found it easier to stand when the seat angle was 5° or 10°; objective data on the ankle dorsiflexion angle, muscle activity, and head motion may be related to the subjective ease of the standing-up motion.

Automated System for Lavatory Disinfection

Instead of that conventional method of chemical (sanitizer spray) disinfection, this paper introduces a novel idea to fight the attack of microbes causing infections and diseases from the source like lavatory and specially its seat. Here we utilize the germicidal power of ultra violet light ray’s. i.e. Ultra Violet C range of the light spectrum against the viruses (SARS-CoV-2), bacteria (E. coli) and other microbes. This system of disinfection constitutes the UV LEDs placed on the arm above the toilet seat. The range of wavelength is from 200nm to 280nm. Implementation of this technique ensures safety, by human free room with the automatic motion control using Arduino, motor and door locking gadgets. UVC light is very advantageous over other methods as it is eco-friendly, chemical free, non-corrosive, and no hazardous waste is produced and also inactivates viruses by attacking the DNA strands in the microbes ensuring that the replication does not happen further stops spreading of contagious diseases leading to pandemic. Usage of toilet paper and other methods used conventionally could come to an end. Thus an effective idea is derived for the hygiene establishment.

A REVIEW OF HAEMORRHOIDS ACCORDING TO UNANI AND MODERN SYSTEM OF MEDICINE

Haemorrhoids are variceal Dilatation of anal and perianal venous plexus. Classically situated in the 3,7,11, o'clock position (left lateral, right posterior &amp; right anterior respectively). Superior haemorrhoidal (vein) gives 2 branches on right side and 1 branch on left side. Hence, Piles are 2 on the right side and 1 on the left side. It was probably Buqrat (Hippocrates) (460 BC) who was the first to apply the name to the flow of blood from the veins of the anus. There is a detailed description of Bawaseer in classical books authored by ancient Unani physicians. Haemorrhoids are one of the most common anorectal disorders with a reported prevalence of 4.4% up to 36.4% of the general population. The peak prevalence occurs between 45 and 65 years of age. Anatomical classification of haemorrhoids includes internal and external haemorrhoids based on whether they are above or below the dentate line. Goligher's classification is the clinical staging of the prolapsing degree of internal haemorrhoids. Risk factors for hemorrhoidal disease are conditions associated with increased intra-abdominal pressures such as pregnancy, obesity, constipation and straining during defecation and sitting for a long time on the toilet seat, and chronic cough. Principal complaints of haemorrhoids include bleeding on defecation and prolapse of tissue. Haemorrhoid diagnosis involves taking a detailed history and conducting anorectal examinations (visual inspection, manipulation, digital examination, and anoscope. Report of first recorded treatment for haemorrhoids comes from the Egyptian papyrus dated 1700 BC: “… Thou shouldest give a recipe, an ointment of great protection; Acacia leaves, ground, titurated and cooked together. Conservative treatment is used in “Everyday Lifestyle Guidance. Drug therapy for haemorrhoids is typically utilized for bleeding, pain, and swelling. Operative hemorrhoidectomies are reserved mainly for third- and fourth-degree haemorrhoids.

Comparative Study between Excision with Primary Closure versus Flap Reconstruction in Management of Sacrococcygeal Pilonidal Sinus

Introduction and aim: Pilonidal sinus (PNS) is a common inflammatory condition of the gluteal region. Different methods were introduced for treatment. However, recurrence is still a significant problem after surgery and different approaches were described to lower the recurrence rate. But controversy exist regarding the standard surgical intervention. The current work aimed to compare between excision with off midline primary closure versus Limberg flap procedure in the treatment of sacrococcygeal PNS.&#x0D; Methodology: Sixty patients with PNS were included and divided into two equal groups, the first for primary midline excision with closure, and the second treated by Limberg flap. Patients were assessed by clinical evaluation and after surgery, the recurrence rate was documented through the first year. In addition, complications rate and times to restore the normal daily activities were documented and compared between groups.&#x0D; Results: Both groups were comparable regarding all preoperative variables. The operative time was significantly short among group I than group II (31.6± 6.5 vs 51.6± 6.4 minutes). The duration of hospital stay, time to return to work, drainage amount, time to stitch removal, time to walk pain-free and time to painless toilet seat were significantly shorter in group I. However, cosmetic score was significantly higher in group I than group II. Finally, the recurrence rate was significantly higher in group I than group II (20.0% vs 0.0%). The recurrence was significantly associated with hairy skin, positive family history, diabetes mellitus, higher BMI, and history of previous PNS.&#x0D; Conclusion: Primary midline closure of PNS is superior than the Limberg flap in operative time and times to return to normal daily activities. However, it had a higher recurrence rate. Thus, Limberg flap is advocated for PNS.

Is convention hip precaution necessary after total hip arthroplasty?

Background: Dislocation is one of the most common causes of revision after total hip arthroplasty (THA). Standard hip precautions are thought to enhance soft-tissue healing and reduce dislocations. However, lifestyle restrictions affect a patient’s rehabilitation, quality of life (QOL), and satisfactions. We aim to compare conventional (CP) and minimal hip precautions (MP) after THA. Methods: Retrospective review of prospectively collected data in posterolateral approach THA. Chief surgeon assigns patients to CP or MP group. CP group had to sleep supine, used elevated toilet seats and chairs, avoid hip flexion greater than 90°, and no internal rotation or adduction for 6 weeks. MP group had no restrictions in hip movements, except for the combined flexion, adduction and internal rotation. All had a minimum 1-year follow-up. The number of dislocations, length of stay (LOS), time to independent toileting, Harris Hip Scores, QOL, and health perceptions, assessed by EuroQol 5D-5L, was compared between CP and MP groups. Results: Fifty-five THAs were included. CP group consisted of 17 primary and 12 revision THAs; MP group consisted of 21 primary and 5 revision THAs. There were two dislocations and both are revisions in CP group. Overall rate of dislocation was 6.9% in CP group and no dislocation in MP group (p-value &gt; 0.05). MP group had shorter LOS (12 vs 19 days, p-value 0.04), higher EQ5D-5L health perception scores at 1-year (81.7 vs 70.9, p-value 0.01). Conclusion: MP group had shorter LOS and better health perceptions 1-year after THA with no increase in dislocation rates.

Anthropometric Analysis to Build Ergonomic Equipment

Body dimensions such as hip breadth, knee height, and chest circumference are important measurements required to build items such as car seats and toilets. However, recent studies strongly point towards a questionable existence or absence of female data in the anthropometric database. Furthermore, many of these databases are dated or are derived from dated models. The objective of this study is to identify an ideal size designation for better fitting choices including both female and male populations for important everyday equipment such as toilet seats.

A new UVC-LED system for disinfection of pathogens generated by toilet flushing.

A new disinfection system utilizing UVC‐LED irradiation was developed. The system was affixed to the toilet seat, and it was challenged by three bacteria strains. Different configurations were tested: 3‐LEDs, 5‐LEDs (two variants), and 8‐LEDs. To determine the arrangement designs of LEDs with the optimum efficacy, two variants of 5‐LEDs configurations were additionally considered—uniform and concentrated (2‐sided) distributions. It was noticed that disinfection efficacy initially increased with the number of LEDs, but with 8‐LEDs, the trend became almost non‐obvious for surface disinfection and just marginally increased for airborne disinfection. The mean efficiencies for the surface disinfection ranged from 55.17 ± 23.89% to 72.80 ± 4.13% for E. coli; 36.65 ± 2.99% to 50.05 ± 13.38% for S. typhimurium; and 8.81 ± 3.23% to 39.43 ± 9.33% for S. epidermidis. Likewise, the mean efficiencies for airborne disinfection ranged from 42.17 ± 8.18% to 70.70 ± 4.80%; 40.40 ± 17.90% to 58.31 ± 13.87%; and 24.16 ± 3.81% to 42.79 ± 10.20% for E. coli; S. typhimurium; and S. epidermidis, respectively. Furthermore, the efficacy of the uniform irradiation was nearly twice that of the concentrated irradiation for surface disinfection and 17.70% higher for airborne disinfection, when tested against E coli. Collectively, these very promising results showcased that this compact, sustainable, and localized disinfection system has a high potential for the next generation of disinfection devices.

Understanding the Short-Term Dynamics of MRSA Between Patients and Their Immediate Environment

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization of patients and contamination of their immediate environmental surfaces is common in the acute care setting, but there is much to be learned about the dynamics of MRSA transmission over a short period of time. Methods: A prospective, observational time-motion qualitative study was conducted at 2 hospitals: 1 in Michigan (hospital 1) and 1 in Zurich, Switzerland (hospital 2)—between November 2018 and July 2019. Hospitalized patients with a MRSA infection or colonization were enrolled. Microbiologic cultures for MRSA were collected from patient nares, axilla, groin and hands and several high-touch surfaces in their room (bed controls, call button, tray table, etc) at the first visit, and patient hands and high-touch surfaces continued to be swabbed every 90 minutes over the course of 5 hours. Patient hands and environment were disinfected after each swabbing. Clinical data were collected from patient’s medical chart. Results: We recruited 10 MRSA colonized or infected patients for the study with 50 hours of observation and obtained 360 patient and environmental swabs. Most were women (7 of 10); the average age was 52.8 years (Table 1). At the first visit, 8 (80%) patients were MRSA-colonized (at 1 or more body sites) and 5 (50%) rooms were MRSA-contaminated (at 1 or more surfaces). Also, 6 patients (60%) had an active MRSA infection and were actively receiving an anti-MRSA agent (eg, Vancomycin). Among those 6 patients receiving an anti-MRSA agent, 4 patients (67%) and 2 rooms (33%) were contaminated at the first visit. Among those 4 patients not receiving an anti-MRSA agent, all 4 patients (100%) and 3 rooms (75%) were contaminated at the baseline visit. Acquisitions (ie, MRSA recovered from a site it was not previously recovered from) occurred on 3 of 7 patient hands (43%) and on 6 occasions in the room (among 5 patients), most commonly at the toilet seat (2 of 6 times). MRSA prevalence on patient and room surfaces for the 5 patients enrolled at hospital 2 are illustrated in Figure 1, which shows colonization of patient and contamination of environment as well as activities performed by the patient in between culturing. Conclusions: We evaluated transmission of MRSA over brief periods of time; our results show that transmission of MRSA depended on patient activity in the room. Furthermore, degree of patient colonization is reflected by environmental contamination and supports the notion of constant transmission of MRSA from patients to environment.Funding: NoneDisclosures: None

Microbiological assessment of environmental surfaces in a healthcare facility

Hospital-acquired infections (HAIs) are infections occurring within 48 hours of hospital admission, 3 days of hospital discharge or 30 days after a surgical procedure. HAIs are a major cause of death and disability within the hospital. Inanimate surfaces can serve as sources of HAIs and can significantly contribute to the spread of pathogens within hospitals. Swab samples were obtained from 53 inanimate surfaces such as air, bed pan, ward doorknob, nurses’ glove, sink, sink tap, cistern lever, toilet seat and wheel chairs located in the various wards of the Accident and Emergency Unit as well as Plastic and Burn unit of, University of Port Harcourt Teaching Hospital (UPTH). The samples obtained were screened for the presence of pathogenic microorganisms and their susceptibility to frequently prescribed antibiotics using disc diffusion method. Our findings showed highest level of contamination was the cistern lever (15 %), and the least was from nurses’ gloves (6 %). Microbial identification revealed the presence of 161 microorganisms comprising Pseudomonas aeruginosa (27 %), Staphylococcus spp. (22 %), Salmonella spp. (16 %), Klebsiella spp. (13 %), and Candida spp. (21 %). Interestingly, 83 % of isolated staphylococci were resistant to cefoxitin, 57 % of Pseudomonas spp. was resistant to levofloxacin, and both Klebsiella spp. and Salmonella spp. were most resistant to ceftriaxone (81 % and 77 % respectively). The observed high prevalence of pathogenic and antibiotic resistant microorganisms calls for implementation of regular surveillance and effective infection control measures within the hospital.

Toilets dominate environmental detection of severe acute respiratory syndrome coronavirus 2 in a hospital

Respiratory and fecal aerosols play confirmed and suspected roles, respectively, in transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An extensive environmental sampling campaign of both toilet and non-toilet environments was performed in a dedicated hospital building for patients with coronavirus disease 2019 (COVID-19), and the associated environmental factors were analyzed. In total, 107 surface samples, 46 air samples, two exhaled condensate samples, and two expired air samples were collected within and beyond four three-bed isolation rooms. The data of the COVID-19 patients were collected. The building environmental design and the cleaning routines were reviewed. Field measurements of airflow and CO2 concentrations were conducted. The 107 surface samples comprised 37 from toilets, 34 from other surfaces in isolation rooms, and 36 from other surfaces outside the isolation rooms in the hospital. Four of these samples were positive, namely two ward door handles, one bathroom toilet seat cover, and one bathroom door handle. Three were weakly positive, namely one bathroom toilet seat, one bathroom washbasin tap lever, and one bathroom ceiling exhaust louver. Of the 46 air samples, one collected from a corridor was weakly positive. The two exhaled condensate samples and the two expired air samples were negative. The fecal-derived aerosols in patients' toilets contained most of the detected SARS-CoV-2 in the hospital, highlighting the importance of surface and hand hygiene for intervention.

Bacteriological Assessment of Hospital Air and Selected Surfaces in Three Referral Hospitals in Makurdi Middle Belt Nigeria

Hospital environment needs more attention because of the influx of people into the environment for medical checkup and other services. This study unveils the incidence of bacteria isolated from air and selected surfaces in three referral hospitals (City hospital, Federal Medical Centre, Wadata and Saint Theresa Hospital) in Makurdi Middle Belt Nigeria. Fifty (50) bacteria were isolated; hospital air (26%), bed rails (16%), door knobs (2%), floor (4%), nurse table top (10%), operation table (4%), sink (18%), stretchers (2%) and toilet seat (12%). In City Hospital, the bacteria isolated include Escherichia coli (6%), Pseudomonas aeruginosa (2%), Staphylococcus aureus and Staphylococcus spp (2%), from Federal Medical Centre, bacteria isolated were Klebsiella spp (10%), Staphylococcus aureus (4%), Staphylococcus spp (8%), Pseudomonas aeruginosa (12%) and E. coli (6%). In STH, bacteria isolated include E. coli (8%), Pseudomonas aeruginosa (4%), Staphylococcus spp (8%) and Staphylococcus aureus (14%). The invitro antibiotics susceptibility pattern shows that Pseudomonas aeruginosa showed highest resistant to the antibiotics while Klebsiella spp was susceptible to majority of the antibiotics but resistant to cloxacillin and erythromycin. The study reveals Klebsiella spp, Escherichia coli, Pseudomonas aeruginosa, S. aureus and other Staphylococcus spp as bacteria commonly associated with hospital environment. This study affirms the presence of resistant bacteria strains and highlighted world-wide problem of hospital borne infections as it concerns the study area and population. This report will create awareness and be a good guide to health care workers, patients and the public about the likeliness of contracting nosocomial infection and how to treat such infection. Major recommendations offered suggests that, healthcare workers should be more careful in carrying out their duty to avoid chance of being infected in the course of their work. Also, the in-vitro antibiotics susceptibility testing on the bacterial pathogens in the study will assist the clinicians in making improvement on the management of nosocomial infections.

Bathroom contamination by antibiotic-resistant Enterobacterales (ESBLPE and CPE): an experimental study

Extended-spectrum β-lactamase-producing Enterobacterales (ESBLPE) and carbapenemase-producing Enterobacterales (CPE) cause serious infections. Their presence in urine may lead to environmental contamination potentially responsible for cross-transmission. To evaluate the level of spraying and contamination after emptying urine in the toilet and rinsing in the sink, a common practice in the healthcare setting. For each test, the procedure was similar: seat raised, emptying urinal bottle into the toilet at the height of the bowl, rinsing in the sink and flushing. To study splash-drops, water and fluorescein were mixed in the urinal bottle. In each area, the splash-drops frequency and level were assessed with UV. To study contamination, three ESBLPE and one CPE were diluted in saline, 106/mL. Contamination was assessed by sampling before, immediately after and 3 h after the test. The swabs were cultured and the colonies counted and identified. The areas at the highest risk of spraying were the toilet bowl contour (N= 36/36), the underside of the toilet seat (N= 34) and the inside of the sink (N= 34). Except for gloves (N= 14), there was low clothing contamination. The most frequently contaminated areas were inside the sink (40/48), where the highest levels of contamination were found (14/48). Emptying the urinal bottles in the toilet followed by sink rinsing is associated with a significant risk of projection and contamination, depending on the area (highest risk at the sink), but the bacteria did not survive beyond 3 h. This practice, which carries a risk of cross-transmission, should be reviewed.

Room Contamination by Patients Colonized with Clostridiodes Difficile

<h3>Background</h3> Clostridioides difficile (CD) infection is a major cause of infectious diarrhea among Bone Marrow Transplant (BMT) patients. Previous research showed asymptomatic colonized patients with CD may confer a risk for nosocomial transmission. We found that 14% of patients admitted to our BMT unit were colonized with toxigenic CD. The objective of this study is to determine patient room contamination by asymptomatic patients colonized with CD. <h3>Methods</h3> The BMT unit implemented CD colonization screening upon admission using polymerase chain reaction (PCR) CD testing on formed stools. Screening was performed on patients undergoing BMT, experiencing complications, or patients with a hematology diagnosis. PCR CD testing was performed on the first formed stool. Three surfaces: toilet, bathroom sink, and in-room computer keyboard were sampled by swabbing the surface with a sponge moistened with buffer. The sponge was mechanically stomached to release recovered microorganisms. Samples were dilution plated onto agar plates and incubated anaerobically at 37°C for two days. Sample cutoffs are reported as < 10 colony forming units (CFUs) as the lower limit of detection. Samples with < 10 CFUs are considered negative. <h3>Results</h3> Six hundred ninety eight patients had specimens submitted for screening. One hundred one (14%) patients screened positive for CD toxin. Of the 101 patients who screened positive, thirty eight rooms were cultured. Seventeen of the rooms were negative at all sites for CD spores, while 6 rooms were positive at all sites. The remaining fifteen rooms had a least one site positive. Seventeen toilet seats were positive for CD spores, followed by 14 keyboards and 8 bathroom sinks. <h3>Conclusions</h3> Room contamination from asymptomatic BMT patients colonized with CD does occur. Further analysis of the data may delineate the environmental risk from asymptomatic colonized patients. These findings may have implications for infection control measures needed to mitigate the risk of healthcare-associated CD infection.

Open tendoachilles injuries due to squatting type of toilet seats: Five-year prospective observational study from a tertiary care center in India

BackgroundOpen traumatic tendoachilles injuries due to toilet seats are least reported. The exact mechanism of such injuries is debatable. None of the studies have reported associated neurovascular injuries and the need for microvascular tissue transfer. MethodsIt is a 5-year prospective observational study from Sep 2013 – Aug 2018 at a tertiary care center on 26 patients who had sustained foot injuries due to squatting type toilet seats. All the patients were managed by thorough wound irrigation and debridement followed by repair of cut tendoachilles, other tendons and neurovascular structures. All the complications and secondary procedures required were recorded. Functional outcome was assessed by Boyden clinical outcome score. Follow up ranged from 1 to 5 years. ResultsAll the 26 patients reported a particular mechanism of injury. Complete transection of tendoachilles was seen in 23 (88.5%) patients and partial transection in three (11.5%) patients. Microvascular repair of cut posterior tibial artery was undertaken in three and posterior tibial nerve in two cases and microvascular parascapular flap in one case for soft tissue reconstruction. Twenty-three (88.5%) patients had good to excellent Boyden score while three patients (11.5%) had fair to poor score at 1 year. Such severe injuries due to toilet seats have never been reported in literature. ConclusionsSquatting toilet seats can cause devastating foot injuries involving tendons and neurovascular structures and may require microvascular tissue transfer for definitive wound management. The risk of such injuries will continue unless some modifications are undertaken in the design of the seat.