title: Viral contamination of aerosol and surfaces through toilet use in health care and other settings.
abstract: BACKGROUND
  The airborne spreading of enteric viruses can occur through the aerosol and droplets produced by toilet flushing. These can contaminate the surrounding environment, but few data exist to estimate the risk of exposure and infection. For this reason environmental monitoring of air and selected surfaces was carried out in 2 toilets of an office building and in 3 toilets of a hospital before and after cleaning operations.
  
  
  METHODS
  To reveal the presence of norovirus, enterovirus, rhinovirus, human rotavirus, and Torque teno virus and to quantify human adenovirus and bacteria counts, molecular and cultural methods were used.
  
  
  RESULTS
  On the whole, viruses were detected on 78% of surfaces and in 81% of aerosol. Among the researched viruses, only human adenovirus and Torque teno virus were found in both surface and air samples. In several cases the same adenovirus strain was concurrently found in all matrices. Bacterial counts were unrelated to viral presence and cleaning did not seem to substantially reduce contamination.
  
  
  CONCLUSIONS
  The data collected in our study confirm that toilets are an important source of viral contamination, mainly in health care settings, where disinfection can have a crucial role in preventing virus spread.
authors.affiliation: Laboratory of Hygiene and Environmental Virology, Department of Biology, University of Pisa, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Verani
authors.affiliation: Nephrology Unit, Hospital of Leghorn, Tuscany, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bigazzi
authors.affiliation: Laboratory of Hygiene and Environmental Virology, Department of Biology, University of Pisa, Pisa, Italy. Electronic address: annalaura.carducci@unipi.it.
authors.forename: Annalaura
authors.initials: A
authors.lastname: Carducci
mesh_terms: D000336:Aerosols; D000391:Air Microbiology; D001419:Bacteria / Q000302:isolation & purification; D058491:Bacterial Load; D004783:Environmental Microbiology; D006761:Hospitals; D006801:Humans; D014038:Toilet Facilities; D014780:Viruses / Q000145:classification* / Q000302:isolation & purification*
chemical_list: D000336:Aerosols
keywords: Aerosol; Enteric viruses; Surfaces; Toilet flushing