Reducing the particles generated by flushing institutional toilets. Part II: Assessing a portable and reusable toilet cover in U.S. hospitals.

IF 1.5 4区 医学 Q4 ENVIRONMENTAL SCIENCES Journal of Occupational and Environmental Hygiene Pub Date : 2024-12-01 Epub Date: 2024-10-01 DOI:10.1080/15459624.2024.2398752
Seth Eisenberg, Changjie Cai
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引用次数: 0

Abstract

Flushing uncovered toilets in hospitals has been shown to produce toilet plume aerosols (TPA) in a wide size ranging from nanometers to micrometers. Studies have shown that TPA can carry infectious pathogens and hazardous drugs used in cancer treatment. To mitigate the risk of exposure, some researchers have recommended covering the toilet during flushing, and guidelines from the Oncology Nursing Society have specifically recommended covering the toilet when flushing excreta from patients receiving chemotherapy. Because existing literature primarily focused on controlled laboratory settings or small case studies, there has been a need for a real-world, multi-center study in clinical settings to measure TPA by flushing both covered and un-covered toilets. To address this gap, the authors initiated a multicenter study to measure TPA in clinical settings and to assess the effectiveness of a commercially available, portable, and reusable toilet cover. The study enrolled 15 hospital centers (145 toilets) in nine U.S. states which included seven National Cancer Institute (NCI)-designated comprehensive cancer centers. The particle number concentrations were measured using a TSI optical particle counter (TSI 9306) with six size bins (0.3 to 25.0 µm) positioned 22 inches above the floor. The results showed that the ambient particle number concentrations in the HEPA-filtered floor bathrooms (376 ± 857#/L) are significantly lower than the non-HEPA-filtered ones (7,432 ± 9,207#/L). The mean particle number concentrations generated by flushing are 3,951 ± 8,606#/L with a median of 1,916#/L, ranging from 136#/L to 71,959#/L. Results with cover demonstrated a reduction in the total number of particles of 101 ± 11% regardless of the HEPA filter usage (p = 0.0002 in the Mann-Whitney U test). Mixed-effects modeling revealed that the overall level of particle reduction is substantial regardless of state (nine total), floor levels, flush volumes, and inpatient versus outpatient. This study provides evidence supporting the use of the tested portable toilet cover as an intervention to reduce healthcare workers', patients', and visitors' exposure to toilet plume aerosols in clinical settings.

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减少机构厕所冲水产生的颗粒。第二部分:评估美国医院的便携式可重复使用马桶盖。
研究表明,在医院冲洗无盖厕所时会产生大小从纳米到微米不等的厕所烟羽气溶胶(TPA)。研究表明,TPA 可携带传染性病原体和用于癌症治疗的危险药物。为了降低接触风险,一些研究人员建议在冲水时盖上马桶盖,肿瘤护理学会的指南特别建议在冲洗化疗患者的排泄物时盖上马桶盖。由于现有文献主要集中在实验室对照环境或小型病例研究中,因此需要在临床环境中进行真实的多中心研究,通过冲洗有盖和无盖马桶来测量 TPA。为了填补这一空白,作者启动了一项多中心研究,以测量临床环境中的 TPA,并评估市售便携式可重复使用马桶盖的效果。美国九个州的 15 家医院中心(145 个厕所)参加了这项研究,其中包括七家美国国家癌症研究所(NCI)指定的综合癌症中心。使用 TSI 光学粒子计数器 (TSI 9306) 测量了粒子数浓度,该计数器有六个粒径分区(0.3 至 25.0 µm),距离地面 22 英寸。结果表明,经过 HEPA 过滤的地面浴室的环境粒子数浓度(376 ± 857#/L)明显低于未经 HEPA 过滤的浴室(7,432 ± 9,207#/L)。冲洗产生的颗粒数浓度平均值为 3,951 ± 8,606#/L ,中位数为 1,916#/L ,范围从 136#/L 到 71,959#/L 不等。覆盖结果表明,无论使用哪种高效过滤器,颗粒总数都减少了 101 ± 11%(曼-惠特尼 U 检验 p = 0.0002)。混合效应模型显示,无论状态(共九种)、楼层高低、冲洗量以及住院病人与门诊病人,颗粒减少的总体水平都很可观。本研究提供的证据支持使用测试过的便携式马桶盖作为干预措施,以减少医护人员、病人和访客在临床环境中接触马桶烟羽气溶胶的机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Occupational and Environmental Hygiene
Journal of Occupational and Environmental Hygiene 环境科学-公共卫生、环境卫生与职业卫生
CiteScore
3.30
自引率
10.00%
发文量
81
审稿时长
12-24 weeks
期刊介绍: The Journal of Occupational and Environmental Hygiene ( JOEH ) is a joint publication of the American Industrial Hygiene Association (AIHA®) and ACGIH®. The JOEH is a peer-reviewed journal devoted to enhancing the knowledge and practice of occupational and environmental hygiene and safety by widely disseminating research articles and applied studies of the highest quality. The JOEH provides a written medium for the communication of ideas, methods, processes, and research in core and emerging areas of occupational and environmental hygiene. Core domains include, but are not limited to: exposure assessment, control strategies, ergonomics, and risk analysis. Emerging domains include, but are not limited to: sensor technology, emergency preparedness and response, changing workforce, and management and analysis of "big" data.
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