Re: Toilet lids

04/12/2017 at 4:39 pm #74178 Quote

Participant

Author:
Michael Wishart

Position:

Organisation:

State:
NSW

Our hospital architect raised an interesting point. We had disabledaccess toilets installed in our new day oncology unit. With these toilets, they had to have a certain backrest fitted. We found that toilet lids wouldnt stay up on these toilets because of the back rest, but the oncology staff were adamant that the toilets in the unit had to have lids. So, even though the toilets are now non-compliant for disabled access, the back rest was removed as it was considered the risk of plume contain chemotherapeutic agents was greater than the risk of not having a back rest.

Just another piece in this puzzle to ponder.

Cheers
Michael

Michael Wishart
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Juraja, Marija (Health)
Sent: Monday, 4 December 2017 3:22 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Toilet lids

Hi Leah,

We have toilet lids in both our newly built hospital and our sister hospital TQEH on all toilets, including bariatric.
The rationale we used for retaining them was exactly that with regard to plume and risk of transmission.
The commode/shower chair we use allows for the chair to sit over the toilet without causing any issues to the lid.
Its being selective and trying out the chair and pan base to make sure they fit so that you can still use the lid once the chair is pulled away.
Several articles below that highlight the potential for cross contamination from the plume when flushing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692156/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666014/
https://www.ncbi.nlm.nih.gov/pubmed/23040490
https://www.ncbi.nlm.nih.gov/pubmed/22137761

Kind Regards

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Terri Cripps (SCHN)
Sent: Monday, 4 December 2017 12:12 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Toilet lids

I think that the lack of toilet lids is due to them being attributed to increased falls in the toilet when the patient is opening and closing the lids. The act of opening and closing the lids cause the patient to become unsteady and lead to falls. So to reduce the falls risk, the lids have been removed.

It also is easier to get commodes over the toilet if there is no lid.

I agree with you all about the plume when flushing be of concern but it seems that falls outweigh infection prevention and control issues.

Interesting point of discussion.
Thanks,
Terri Cripps | Clinical Nurse Consultant – Infection Prevention and Control | SCHN Medical Diagnostics and HIV/Immunology
t: (02) 9382 1876 | f: (02) 9382 2084 | e: TERRI.Cripps@health.nsw.gov.au | w: http://www.schn.health.nsw.gov.au
p: 47140
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High Street, Randwick 2031, NSW Australia
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Kelly Barton
Sent: Monday, 4 December 2017 11:49 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Toilet lids

I think the lack of toilet lids is very widespread. After advising staff to put the lid down to flush during an outbreak I was advised there were no lids. I have been taking note when I am in other facilities in the last few years and have found that most places I have seen do not have them. Considering what we now know about plume and MROs becoming more difficult to treat I am surprised this has not come up more often. Current design of over toilet chairs and equipment would make it difficult for lids to close for flushing.

I have seen toilet systems overseas where there is a vacuum system of evacuating contents with minimal water used. I would assumes that there would be less plume generated with these, but have not seen any research/study on them.

Keen to hear of other approaches also.

Kelly

Kelly Barton
Infection Prevention & Control Officer
Monday- Friday
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Fax: 03 5751 9396

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Van Someren, Leah M (THS)
Sent: Monday, 4 December 2017 10:02 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Toilet lids

Hi everyone,

We are currently building a 10 storey hospital here in Hobart. The redevelopment team have recommended against installing lids on the toilets.

The Infection Prevention and Control team have recommended that all toilets have lids. We have based this decision on the evidence of toilet plume and the potentially increased risk of transmitting pathogenic organisms through environmental contamination.

We are interested in the approach taken in other hospitals.

If you are working in a newly developed hospital that has recommended toilets lids on all toilets we would particularly like to hear from you including what influenced your decision making.

Furthermore, we have heard that there are a number of new hospitals built or being built around Australia where toilet lids are either not installed, or installed only in specific locations. If you are working in a facility that did not recommend installing toilet lids in all locations, can you please share your rationale for this?

Thank you in advance.

Leah

Leah Van Someren
Clinical Nurse Consultant
Infection Prevention and Control Service

THS- Southern Region
PH: 61662704
Mobile: 0417 986 084
Email: leah.vansomeren@ths.tas.gov.au
Intranet page: http://www.dhhs.tas.gov.au/intranet/stho/cccs/infection_prevention_and_control

Level 3 I Marine Board Building I 1 Franklin Wharf I Hobart 7000

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