Quantitative microbial risk assessment of human norovirus infection in environmental service workers due to healthcare-associated fomites

Overbey, Katie; Nachman, Keeve E.; Rock, Clare; Schwab, Kellogg J.

doi:10.1016/j.jhin.2021.08.006

Cited by 2 publications

(3 citation statements)

References 62 publications

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“…In addition to effecting transfer efficiency, the excreta may introduce varying concentrations of pathogens, depending upon how pathogens are shed by infected individuals. For example, through modeling, Overbey et al ( 2021 ) demonstrated that exposure to diarrhea in the restroom of symptomatic patients increased probability of infection by four orders of magnitude, relative to exposure to vomit, based on pathogen concentration data. Inclusion of transfer efficiencies that best model different human excreta, as shown by Abney et al ( 2022 ), with the addition of concentration data for viruses in excreta/bodily fluids (i.e., sputum, diarrhea, vomit, saliva) which are not yet available, would increase the specificity for a particular pathogen of QMRA models for identifying risk, not only in the restroom, but for fomite-mediated transmission models in general.…”

Section: Discussionmentioning

confidence: 99%

“…Morter et al ( 2011 ) conducted a study in a hospital setting and found norovirus genome copies on 31.4% of swabs for surfaces, including surfaces related to hand hygiene (46.2% of swabs for soap dispensers, 42.9% for alcohol dispensers) and 12.9% of swabs for door handles. The risk of infection from a single fomite in the restroom can be relatively high for norovirus and is affected by the shedding of virus in the diarrhea or vomit of symptomatic patients (Overbey et al, 2021 ). Norovirus has been found to spread widely to other surfaces within the confined spaces within a houseboat, causing outbreaks (Jones et al, 2007 ).…”

Section: Introductionmentioning

confidence: 99%

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Transmission of Viruses from Restroom Use: A Quantitative Microbial Risk Assessment

Abney,

Higham,

Wilson

et al. 2024

Food Environ Virol

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Restroom use has been implicated in a number of viral outbreaks. In this study, we apply quantitative microbial risk assessment to quantify the risk of viral transmission by contaminated restroom fomites. We estimate risk from high-touch fomite surfaces (entrance/exit door, toilet seat) for three viruses of interest (SARS-CoV-2, adenovirus, norovirus) through eight exposure scenarios involving differing user behaviors, and the use of hand sanitizer following each scenario. We assessed the impacts of several sequences of fomite contacts in the restroom, reflecting the variability of human behavior, on infection risks for these viruses. Touching of the toilet seat was assumed to model adjustment of the seat (open vs. closed), a common touch point in single-user restrooms (home, small business, hospital). A Monte Carlo simulation was conducted for each exposure scenario (10,000 simulations each). Norovirus resulted in the highest probability of infection for all exposure scenarios with fomite surfaces. Post-restroom automatic-dispensing hand sanitizer use reduced the probability of infection for each virus by up to 99.75%. Handwashing within the restroom, an important risk-reduction intervention, was not found to be as effective as use of a non-touch hand sanitizer dispenser for reducing risk to near or below 1/1,000,000, a commonly used risk threshold for comparison.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transmission of Viruses from Restroom Use: A Quantitative Microbial Risk Assessment

Abney,

Higham,

Wilson

et al. 2024

Food Environ Virol

View full text Add to dashboard Cite

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“…A limited number of QMRAs have been conducted on virus emissions from toilet flushing. They suggest that this exposure route can create a significant risk of virus infection. − For context, a study on the risks of HAdV infection from inhaling contaminated bioaerosols in different settings estimated that the exposure to aerosols from toilet flushing is higher than that of a faulty drain in a sewer pipe and from working at a wastewater treatment plant and a municipal solid waste landfill …”

Section: Introductionmentioning

confidence: 99%

Virus Emissions from Toilet Flushing: Comparing Urine-Diverting to Mix Flush Toilets

Cai

Eisenberg

et al. 2023

ACS EST Water

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High levels of viruses can be found in human excrement from infected individuals, a fraction of which can be emitted from toilet flushing. Unlike the common mix flush toilet (MFT), the urine-diverting toilet (UDT) separates urine from the toilet water. Specific focus on urine-associated viruses is needed because the UDT can emit different levels of urine-associated and fecal-borne viruses and urine has different properties compared to feces that can affect emission levels (e.g., protein content). In this work, we quantified emission levels of surrogate bacteriophages for urine-associated and fecal-borne viruses, MS2 and T3, from flushing a UDT and an MFT, with and without protein in the water. Emission levels of viruses in the water of the UDT were lower than that of the MFT by up to 1.2-log 10 and 1.3-log 10 for T3 and MS2, respectively. If urine is completely diverted in the UDT, virus emissions can be reduced by up to 4-log 10 . Based on these results and typical levels in urine and feces, we estimate that up to 10 7 and 10 8 gene copies of human viruses per flush can be released from the UDT and MFT, respectively. Lower emissions observed with the UDT suggest reduced exposure to viruses from flushing the UDT.

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Quantitative microbial risk assessment of human norovirus infection in environmental service workers due to healthcare-associated fomites

Cited by 2 publications

References 62 publications

Transmission of Viruses from Restroom Use: A Quantitative Microbial Risk Assessment

Transmission of Viruses from Restroom Use: A Quantitative Microbial Risk Assessment

Virus Emissions from Toilet Flushing: Comparing Urine-Diverting to Mix Flush Toilets

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