Toilet lids for infection prevention

Back on clinical service again and having more thoughts on poor hospital design. Last month I wondered why there were no stethoscope wipes available outside of every patient room. This month while caring for patients with C. difficile and viral gastroenteritis infections, I looked over and noticed toilets without lids. Of course most toilets in hospitals (and many public spaces) lack lids. Reasons given for lack of lids are (a) lids might be hard to lift for some folks and (b) lids would be another surface to clean. But lids also prevent the aerosolization of pathogens into the environment, as Mike discussed three years ago.

Lack of toilet lids in hospitals is a patient safety issue and there should be no excuse for not having and using them. First, most patients can and will close the lid before flushing if reminded to do so. In fact, there should be public services announcements in the media that remind us all to close the lid and kids should be taught to do this in school. Second, if a small minority of patients can't or won't close the lid, it's not a reasonable excuse for going lidless in hospitals. This would be like not providing seat belts because some folks can't or won't use them!

So here are my recommendations:

1) Put a plastic, cleanable lid on every toilet and train hospital staff to clean the lid daily
2) Create education campaigns to get patients and staff to close the lid before they flush
3) Put a big "CLOSE BEFORE YOU FLUSH" sign on both sides of the toilet seat in every bathroom in hospitals, including public spaces
4) Help start local "CBYF" campaigns in your cities
5) If hospitals are worried about patients not being able to open or close the lid, they should spend $6400 on this toilet that automatically opens and closes, among other features. Given the cost of HAI and the amount we spend on other HAI prevention interventions, the $6400 will easily be cost-effective or there's even a touch-free sensor toilet seat for ~$100.

It's time we give a crap about having and closing toilet lids.

image source: http://www.dudeiwantthat.com/household/bathroom/friendly-toilet-seat-reminder.asp

A compendium of awesomeness

Posting has been light this month, for several good reasons. My own schedule has been full with seeing patients, attending HICPAC, and most recently riding a bike across northwest Iowa during the first couple days of RAGBRAI with my mom (the route this year went through her hometown of Hull, Iowa). The photo above was taken on Sunday during a stop in beautiful Boyden, Iowa. 

I’m back at work now, and marveling at the complete online release of the SHEA/IDSA Compendium of Strategies to Prevent Healthcare Associate Infections. The Google tells me that a compendium is “a collection of concise but detailed information about a particular subject”. This compendium is about HAI prevention, and it is required reading for anyone in the field. I could go on at length about the work that went into this practical guide to prevention, but suffice it to say that it makes me very proud to be a SHEA member. For those not yet familiar with the compendium, I’d suggest starting with this introduction, which describes the approach, the key contributors and the partner and sponsoring societies. Then read the executive summary, and the infection prevention viewpoint. Finally, refer to the individual documents for more detailed information. They make great beach reading!