CloroxPro Blog – Professional Cleaning and Disinfection Insights

It’s a discussion no one likely wants to have, but it’s a serious focus in healthcare facilities in so many ways: toilet cleaning.

In healthcare facilities and long-term care homes, toilet cleaning and disinfection plays a critical role in infection prevention and control, not only to vulnerable patients and residents but also to staff and visitors. 

It’s not surprising that toilets can host pathogenic organisms – they’re a high-touch, hard surface, potentially by multiple individuals including patients/residents, staff and visitors. Toilets can harbour a wide range of illness-causing pathogens by way of stool from an infected individual. Pathogens include bacteria, viruses, and fungi, which are transmitted through contact with contaminated surfaces or aerosolized particles after flushing. Increased potential for contamination occurs where there is no toilet lid, or where the lid is not used. These pathogens also, in general, persist longer on hard, nonporous surfaces compared to porous surfaces – so toilets provide an ideal environment.

Let’s take a look at some common pathogens, and recommended cleaning and disinfection practices to help prevent transmission.

Quick facts on typical pathogens: What are they and what is the potential impact to health?

Common toilet pathogens in healthcare and long-term care settings include bacteria such as Clostridium difficile, Escherichia coli and Salmonella, viruses including norovirus. Carbapenemase-producing Enterobacteriaceae (CPE) pose a particular threat to patients and residents. Two common features of toilet pathogens are:

• they all can persist on hard surfaces like toilets for extended periods of time
• they all pose a high risk for easy transmission – from contaminated surface to person, and from contaminated person to person.

Clostridium difficile (C. difficile)

C. difficile is the most common cause of infectious diarrhea in hospitals and long-term care facilities in Canada. The elderly, immune-compromised, and patients taking high-dose antibiotics and/or over a long period of time are at greater risk of infection.

• C. difficile bacteria and spores are found in stool.
• Infection occurs from direct hand contact on the toilet surface followed by touching the mouth. Transmission can occur directly or person-to-person – including healthcare staff and visitors. 

Escherichia coli (E. coli)

E. coli is a group of bacteria that can occupy the gut without causing illness, but others, like Shiga toxin-producing E. coli, can cause severe illness.

• E. coli  typically causes GI and urinary tract infections, but serious and potentially life-threatening infections also can occur in wounds, in the bloodstream or cause prostate infection, pelvic inflammatory disease or gallbladder infection.
• Adults who have an E. coli infection can infect others for up to a week.
• On toilets, E. coli can survive from a few hours up to a few days.

Salmonella

Salmonella bacteria can be present in the stool and spread through direct contact with the toilet or through inadequate hand hygiene.

• Salmonella can cause a range of symptoms, from chills and fever to diarrhea and vomiting. For a patient, immunocompromised or elderly person, serious illness can cause long-lasting health effects.
• An infected individual can infect others from several days to several weeks.
• Salmonella can survive on a toilet surface for several hours, but can persist in the toilet bowl biofilm for up to 50 days.

Norovirus (Norwalk virus)

Norovirus is extremely contagious and causes diarrhea and vomiting. The resulting dehydration can have a serious impact on a patient or elderly person, and in severe cases could require intravenous fluids.

• Norovirus is found in the stool or in vomit. The virus spreads by touching contaminated surfaces or contact with an ill person, then touching the mouth or eyes.
• Norovirus can survive on a hard, nonporous surface like a toilet for up to 2 weeks.
• An infected individual can continue to spread the virus for up to 2 weeks after their symptoms stop.

Carbapenemase-producing Enterobacteriaceae (CPE)

CPE are emerging bacteria that have developed resistance to antibiotics, and represent a growing threat to patients and long-term care residents.

• CPE can cause difficult-to-treat infections anywhere in the body and in vulnerable patients may cause death.
• CPE can colonize drains in the toilet room, exposing patients to infection from the toilet surface resulting from flushing.
• CPE spread primarily in healthcare settings and often through person to person transmission from the contaminated hands of healthcare personnel or contaminated equipment to patients.
• CPE can survive on surfaces for a few hours to several weeks.

Best practices for cleaning and disinfection

IPAC (Infection Prevention and Control Canada) recommends a multi-step process for toilet cleaning in hospitals, emphasizing both cleaning and disinfection, and prioritizing high-touch surfaces. Here is a checklist for disinfectant choices to keep the toilet and toilet room surfaces clean to protect the patient environment, at least daily and when visibly soiled: 

• Use a Health Canada-registered disinfectant (identified by DIN #) that is effective against common pathogens including those discussed above.
• Use a product specifically suited for use on toilet materials, which generally include porcelain for the bowl and tank and stainless steel or brass for the flush handle.
• Follow product instructions for proper contact time.
  • Contact time plays a critical role in the cleaning and disinfection process. As noted above, many pathogens can survive on surfaces for considerable lengths of time. 
  • Required contact time is determined by a) the pathogen and b) the active ingredient(s) in the disinfectant.  
• Ensure that all components and surfaces of the toilet bowl, rim, lid, tank and flush mechanism are cleaned and disinfected.

Critical steps to a clean and disinfected toilet:

• Perform hand hygiene.
• Use personal protective equipment appropriately and consistently: gloves, mask.
• Remove gross soil if present.
• Pay attention to high-touch surfaces including the flush handle, toilet seat and lid.
• Wipe the surface with the disposable wipe until completely wet.
• Follow the product label for the correct contact time.
• Allow to air dry.
• Discard the wipe.

The Public Health Agency of Canada recommends choosing double-duty products: those that clean and disinfect at the same time. A one-step product makes good sense, in efficiency of staff time as well as in cost-effectiveness of purchasing and stocking a single product.   

Knowing which active ingredient(s) will effectively target the infectious pathogens is a vital component of infection prevention. For inner toilet bowl disinfection, a pull-top liquid cleaner disinfectant and applicator brush/wand like Clorox Healthcare® Germicidal Disinfecting Cleaner or Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectant is generally used in the hospital environment. For hard, nonporous toilet surfaces – the outer bowl, tank and flush mechanism – ready-to-use wipes offer effective cleaning and disinfection along with convenience and ease of use. Clorox Healthcare™ disposable disinfectant wipes are available in a variety of active ingredients that can quickly kill typical pathogens.

Disinfect the toilet environment to protect patients – choose CloroxPro™

The following CloroxPro™ cleaner disinfectants have demonstrated effectiveness on hard, nonporous surfaces when used according to directions.

For toilet bowl disinfection

Clorox Healthcare® Germicidal Disinfecting Cleaner (DIN 02469278)

• Liquid format in a pull-top bottle, 946 mL.
• Eliminates 50 or more microorganisms including C. difficile, all in 3 minutes or less.
• Gentle odour-masking scent.

Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectant (02403528)

• Liquid format in a pull-top bottle, 946 mL.
• Fast kill times on over 44 pathogens including E. coli, Salmonella and Norovirus.
• Designed for daily use with no added fragrances or harsh odours for a better patient experience.

For toilet surfaces disinfection

Ready-to-use wipes:

Clorox Healthcare™ Bleach Germicidal Disinfectant Wipes (DIN: 02465671)

A bleach-based formula in an easy-to-use wipe format, with fast disinfection efficacy, favourable surface compatibility and residue profile. 

• Health Canada registered to kill 66 pathogens.
• Kills C. difficile in 3 minutes, E. coli and Salmonella in 30 seconds and Norovirus in 1 minute.
• Kills viruses in 1 minute and bacteria in 30 seconds.
• C. difficile sporicidal efficacy tested in the presence of 3-part organic soil load.
• Available in clinical canister and EVS bucket wipe size formats.

Clorox Healthcare™ VersaSure® Alcohol-Free Cleaner Disinfectant Wipes (DIN: 02473151)

Alcohol-free quat formula with broad-spectrum disinfection; contact times from 30 seconds to 2 minutes.

• Kills 50 pathogens in 30 seconds to 2 minutes.
• Kills E. coli, Norovirus and Salmonella in 2 minutes.
• Kills SARS-CoV-2, measles and mumps virus, HIV and Influenza A virus in 30 seconds.
• Non-abrasive, very low residue on surfaces.
• No harsh chemical odour.
• Stays wet for contact time.

Spray:

Clorox Healthcare® Fuzion® Cleaner Disinfectant (DIN 02459744)

946 mL spray bottle – A powerful, next-generation bleach with broad surface compatibility and little to no residue.

• Suitable for everyday use.
• Low odour that disappears in minutes.
• Kills 64 microorganisms in 1 minute including C. difficile,Salmonella, E. coli and Norovirus.

Learn more about CloroxPro™ products that can help safeguard your facility.

Interested in speaking to a representative about customized solutions and a free demo and training? Contact us today.