I think at some point we have all been in the argument as to who should be the responsible party for putting down the toilet seat. My stance is of course, that it is the responsibility of the man who lifted it in the first place! As I am now the only female at home, I think I will be running into a losing battle where 2 votes beat 1 vote every time.... I think however, after reading a study that was published last January in the Journal of Hospital Infection (JHosp Infect. 2012;80:1-5) that I may have found an ace that will give me the upper hand.
The researchers (Best, Sandhoe, and Wilcox) sought to quantify the level of contamination of environmental surfaces, particularly with Clostridium difficile spores, caused by the flushing of a lidless toilet. Toilet facilities in healthcare settings vary widely, but patient/resident toilets are commonly shared and typically do not have lids. When a toilet is flushed without the lid closed, aerosol production may lead to surface contamination within the toilet environment.
Using an inoculum of C. difficile spores representative of the average bacterial load present in Clostridium difficile infection (CDI), they study investigated the level of contamination in the environment after flushing. As one would expect, the highest levels of C. difficile were recovered immediately following flushing, and then declined significantly after 60 minutes and continued to decline over time. The highest bacterial counts were detected at the level of the toilet seat. But perhaps most interesting they were able to find C.diff at heights of up to 25cm above the toilet seat, and also on the floor and other surfaces surrounding the toilet, demonstrating that water turbulence during flushing can force droplets out of the toilet bowl and into the air. YUCK!
While only one toilet was used for the study, I think it clearly shows the ability for environmental contamination associated with toilet flushing and highlights not only the imperative for hand washing after toilet use, but also the need for frequent cleaning of bathrooms to remove contamination. There will certainly be differing results based on the type of toilet, but regardless, I think the study demonstrates that when planning renovations or designing new facilities we may want to consider adding toilets that do not create aerosols to the check list for items to consider!
As the study demonstrated, lidless conventional toilets may increase the risk of C. difficile environmental contamination, leading the authors to suggest that their use is discouraged, particularly in settings where CDI is common. Certainly, if lids are fitted to current toilet models they will help limit the environmental contamination, but will very likely become contaminated themselves up on flushing.
I'm all for minimizing environmental transmission, but I'm not sure I can handle having to lift the lid of a public toilet now that I know it is going to be contaminated with someone else's stuff. It puts an on-going family joke over pee-pee water to a whole new level!
PS - The Association for Professionals in Infection Control and Epidemiology (APIC) is hosting a 2-day conference on March 11th & 12th in Baltimore on Clostridium difficile. Check it out! I know I'm attending!