What happens when you flush a toilet?

Many of you know that I'm not a fan of the uncovered toilet in hospital rooms or anywhere for that matter. Over at Fast Company, they have an amazing post with high-speed video (included above) from Lydia Bourguiba, an MIT professor who studies fluid dynamics and disease. The focus of this 1000-2000 frame per second video is the small particle or aerosol transmission that occurs after a toilet is flushed, think C. difficile. Enjoy! Oh, and sorry to ruin your breakfast or lunch.

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