Great #UTI session just starting in Hall A2-1. D Neofytos talking now, Barbara Trautner @bwtrautner.bsky.social up next.
#ESCMIDGlobal2026
#IDSky #UTISky

@1healthau.bsky.social presenting the results of the HAPPEN study showing significant reduction in pneumonia through oral hygiene at #ESCMIDGlobal2026. Study already picked up by New Scientist www.newscientist.com/article/2523...

Surgical Site Infections, Risk Factors, and Outcomes After Liver Transplant This cohort study examines the frequency and outcomes associated with surgical site infections in patients who have undergone liver transplant.

In #ESCMIDGlobal2026 session Surgical Site Infection in Solid Organ Transplant session, Nicolas Mueller presented his teams @jamanetworkopen.com cohort study. SSIs were independently associated with graft loss and/or death (hazard ratio [HR], 3.24; P < .01)
jamanetwork.com/journals/jam...

SUMMARY:

Pilot study on the decontamination efficacy of an installed 222-nm ultraviolet disinfection device (Care222™), with a motion sensor, in a shared bathroom Toilet surfaces are contaminated with pathogens, and they may be a vector for disease transmission. In this study, we investigated the efficacy of an …

Kitagawa et al. 2021: In a pilot study, an automated 222-nm UVC system in shared bathrooms significantly reduced bacterial contamination on high-touch toilet surfaces (seat, control panel, paper holder), though effects were less on shaded areas, supporting UVC as an adjunct IPC measure.

Jolivet et al. 2021: a prolonged OXA-48 CPE outbreak showed clonal spread from contaminated toilets to patients, with room exposure to positive toilets strongly associated with acquisition; control required intensive cleaning plus full toilet replacement (e.g. rimless systems).

Successful termination of a multi-year wastewater-associated outbreak of NDM-5-carrying E. coli in a hemato-oncological center - Antimicrobial Resistance & Infection Control Background In May 2018, an outbreak of NDM-5-carrying Escherichia coli (NDM-5-EC) was detected at the hemato-oncology department of a tertiary care center in Austria. This report details the outbreak ...

Kerschner et al. 2025: NDM-5 E. coli persisted despite repeated cleaning and disinfection, causing a multi-year outbreak with patient infections and deaths; control required mechanical interventions (pipe disassembly, high-pressure cleaning, component replacement) plus IPC measures.

Control of Multidrug-Resistant Pseudomonas aeruginosa in Allogeneic Hematopoietic Stem Cell Transplant Recipients by a Novel Bundle Including Remodeling of Sanitary and Water Supply Systems Summary. Through major reconstruction of the water and sanitary system, we were able to significantly reduce the burden of Pseudomonas aeruginosa infection

Kossow et al. 2017 @cidjournal.bsky.social: redesigning sanitary systems, including rimless toilets, covered drains, and disinfecting water systems, reduced MDR P. aeruginosa in toilets and patient cases with mortality dropping to 0%, highlighting the impact of structural interventions.

Intensive Care Unit Wastewater Interventions to Prevent Transmission of Multispecies Klebsiella pneumoniae Carbapenemase–Producing Organisms The role of the wastewater environment in nosocomial transmission of carbapenemase-producing organisms is increasingly recognized. We demonstrated that env

Mathers et al. 2018 @cidjournal.bsky.social : although not a direct toilet study, installing hopper covers significantly reduced patient acquisition of KPC organisms, supporting the role of covering high-energy flush systems to limit environmental dispersion from wastewater sources.

Study on the air gap effect when closing toilet lid on droplet and pathogen escaping from flushing Closing the toilet lid before flushing is widely recommended to minimize the dispersal of pathogen-laden aerosols. However, an often-overlooked issue …

Zhang et al. 2025: 92% of droplets are <1 μm, and even with the lid closed, bioaerosols escape via seat gaps; escape rises sharply with gap size (up to ~24–57% at 6 mm, higher for viruses), lid closure reduces but does not eliminate transmission risk.

Closing the toilet lid reduces aerosol generation and environmental contamination, particularly for larger particles. Fine aerosols can still escape through lid-seat gaps (up to ~24% leakage), meaning the lid provides partial protection but is not a complete IPC solution.

Whole-genome sequencing reveals two prolonged simultaneous outbreaks involving Pseudomonas aeruginosa high-risk strains ST111 and ST235 with resistance to quaternary ammonium compounds Water-bearing systems are known as frequent Pseudomonas aeruginosa (PA) outbreak sources. However, many older buildings continue to have sanitary facilities in high-risk departments such as the ICU. W...

Rath et al. 2024 @thejhi.bsky.social: MDR Pseudomonas aeruginosa persisted in all toilets over years (79 events; biofilm reservoir), but toilet to patient transmission was rare under a strict IPC bundle (incl. bromination + H₂O₂); control reduces risk, not contamination

Toilet drain water as a potential source of hospital room-to-room transmission of carbapenemase-producing Klebsiella pneumoniae Carbapenemase-producing Enterobacterales (CPE) have rapidly emerged in Europe, being responsible for nosocomial outbreaks.Following an outbreak in the…

Heireman et al. 2020 @thejhi.bsky.social: outbreak OXA-48 K. pneumoniae found in toilet and drain water with genomic evidence of room-to-room spread via shared plumbing; bleach outperformed acetic acid but neither eradicated contamination.

Chemical disinfection is an adjunct outbreak control measure, but effects are often transient. Limitations include biofilm persistence, rapid re-seeding from plumbing, and variable compliance; reduced susceptibility to may further constrain effectiveness.

Multidrug-Resistant Organisms and Resistance Genes Contaminating Shared Restroom

Aerosol generation in public restrooms Aerosolized droplets play a central role in the transmission of various infectious diseases, including Legionnaire's disease, gastroenteritis-causing norovirus,

Schreck et al. 2021: flushing generates large numbers of aerosols (0.3–3 μm) that can reach ≥1.52 m (breathing height) within seconds. Lid reduces larger droplets but does not prevent escape of fine aerosols, and repeated flushes lead to progressive accumulation in the room despite ventilation

Measuring the flushing-generated flow and aerosols in lavatory of commercial aircraft Lavatory use on commercial aircraft may present a risk of contagion, especially on long-haul flights. Flushing the toilet can induce a strong sweeping…

Li et al. 2022: Commercial aircraft. Lid open, a single flush generates ~8,500 aerosols, ~92% submicron, with measurable spikes not just in the bowl but also near the floor and in the breathing zone

Commercial toilets emit energetic and rapidly spreading aerosol plumes - Scientific Reports Scientific Reports - Commercial toilets emit energetic and rapidly spreading aerosol plumes

Crimaldi et al. 2022: flushing generates a high-energy turbulent jet that rapidly propels aerosols upwards, reaching ~1.5 m (breathing zone) within ~8 seconds; particle counts increase markedly post-flush (especially <1 µm), highlighting rapid exposure potential rather than slow diffusion

The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet Abstract. Aims: To determine the level of aerosol formation and fallout within a toilet cubicle after flushing a toilet contaminated with indicator organis

Barker & Jones 2005: flushing generates substantial bioaerosols, peaking immediately and remaining detectable for up to 60 minutes; importantly, aerosols arise from both bowl water and contaminated sidewalls, with subsequent fallout leading to contamination of surrounding surfaces.

The plume is dominated by small particles and reaches the 1.5 m breathing zone within ~8 seconds. So forget about flushing and running. Aerosols can persist in the environment for up to 60 minutes.

Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting - Antimicrobial Resistance & Infection Control Background In the United States, 1.7 million immunocompromised patients contract a healthcare-associated infection, annually. These infections increase morbidity, mortality and costs of care. A relati...

Antimicrobial Resistance & Infection Control(Knowlton et al. 2018): flushing significantly increases bioaerosols (especially with fecal waste), dominated by <3 μm particles, but no reduction across distance or time, indicating a persistent, well-mixed plume rather than localized exposure.

Wilson et al. 2020 @ichejournal.bsky.social : flushing doubles culture positivity (13% → 26%), with pathogens (e.g. Enterococcus spp.) detected up to 1 m; concentrations increase post-flush at all distances, and larger particles (5–10 μm) rise significantly, supporting airborne spread potential.

Understanding horizontal spread, vertical spread, and plume persistence is critical for effective IPC measures.
Horizontal spread: Toilet flushing generates bioaerosols spreading ≥1 m with no drop-off (p≈0.91). Mostly <3 μm (respirable) and fecal-origin (e.g. C. difficile, Enterococcus).

Here’s a thread on the talk I gave at #ESCMIDGlobal 2026:
“Toilets: Flushing and Spread of Pathogens” — nicknamed “You can’t outrun the plume.” Using published studies, I covered the key components shown below. There’s a surprising amount of data, but still a lack of high-quality intervention trials

Picture of Tresor, a health worker, checks on two-year-old Ibrahim, who is being treated for mpox, at the Nyiragongo General Referral Hospital, north of Goma in the Democratic Republic of the Congo (DRC) on 14 August 2024.

New guideline on the clinical management and infection prevention and control of #mpox.

This guidance is designed to support:
✅ Patients with mpox — whether at home, in the community, or in healthcare facilities
✅ The health workers and caregivers supporting them

🔗 bit.ly/43YOzjf

Epidemiology of Healthcare Facility-Associated Nontuberculous Mycobacteria From 2012 Through 2020 in a 10-Hospital Network in the United States Incidence rates of hospital-onset nontuberculous mycobacteria (NTM) episodes decreased from 2014 through 2020 within a hospital network, but rates varied s

New CID study out from Art Baker & team: 12,855 NTM episodes across 10 hospitals over 8 years

💥 1 in 4 were hospital-onset!
📉 HO rates ⏬ 38% over time but varied 15x btwn hospitals
▶️ They used a clean, simple definition for HO NTM (day 3+)

NTM = underestimated #IDSky

🔗 doi.org/10.1093/cid/...

Target Trial Emulation for Antibiotic Use in Acute COVID-19 This study by Pulia and colleagues1 reports results from a large population-based cohort using target trial emulation to examine the associations of antibiotic treatment with clinical outcomes in pati...

Honoured to be invited to write this commentary with @steventong.bsky.social, on an excellent target trial emulation study which showed that antibiotic use was not associated with improved outcomes in non-severe COVID-19.

jamanetwork.com/journals/jam...

#IDSky

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💡Key takeaway: Patient safety demands a zone-based, proactive, multidisciplinary approach to managing both water and wastewater in hospitals.
Redefining “water safety” may be one of the most important moves in the AMR era.

🧵/end

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📊 Whether it’s clinical handwash stations, shower design, or cleaning workflows, each part of the system needs integrated thinking.
“Clinically integrated water/wastewater safety” is the new north star—tying engineering, IPC & clinical workflows together.

7/
📉 The authors warn against a reactive mindset. Retrofitting drains after AMR outbreaks is costly—and sometimes impossible.
New builds must proactively bake in safety. Hospitals designed today will serve during peak AMR eras. We can’t afford to get it wrong.