‘Innovative alternatives’ to cistern-flush WCs

One of the primary concerns in mental healthcare facilities is keeping the users comfortable, safe, and infection-free during treatment. They may be experiencing a wide range of differing symptoms, and it is important that they be afforded space and privacy during recovery. For this reason, it is important that intervention be kept to a minimum. Is it possible to limit infection risk, while also reducing maintenance?

First of all, it is important to assess where the risks are presented. Typically, infection control in mental health facilities, and in healthcare in general, is concentrated on taps and showers, and there is little awareness of other contamination sources. Toilet cisterns must also now be recognised as a potential source of infection, as they contain around 9 litres of water stagnating at room temperature. Scale and rust build-up results in biofilm, providing an ideal environment for bacterial proliferation.

In mental healthcare facilities this risk intensifies if the toilet is also used to dispose of vomit and faecal deposits when a resident becomes unwell. Until recently, very few studies have been able to provide an accurate picture of the situation, and there has been a lack of viable alternatives to the cistern-flush system. Received wisdom suggests that when we flush the toilet harmful pathogens are flushed away, and that regular cleaning will remove any bacteria from contaminated surfaces. However, in 2015 an American study reinforced the hypothesis that flush toilets play a role in the airborne transmission of infectious disease by producing microbe-contaminated bioaerosols when flushed.¹