Public health and healthcare-associated risk of electric, warm water bidet toilets.

In recent years, installation of bidet toilets within hospitals in Japan has raised concerns regarding potential for cross-contamination by antimicrobial resistant bacteria from patients who are hospitalized over an extended period.To investigate the distribution of antimicrobial resistant bacteria recovered from bidet toilets at a university-affiliated hospital in Japan.All 292 electronic bidet toilets at a university hospital were sampled for contamination. Swabs for culture were used to sample water-jet nozzles, and seats.Of the 292 bidet toilet seats sampled, warm water nozzles of 254 (86.9%) were found to be contaminated by one or more of the following organisms: Staphylococcus aureus, Streptococcus spp., Enterococcus spp., Enterobacteriaceae, and non-Enterobacteriaceae Gram-negative bacteria. S. aureus was recovered from one water-jet nozzle and 9 toilet seats of which meticillin-resistant S. aureus was found in a water-jet nozzle, and a toilet seat. Both nozzle and seat of the same toilet were contaminated with a CTX-M-9 group extended-spectrum β-lactamase-producing Escherichia coli. Of the Gram-negative isolates recovered from samples, the organism with the highest frequency of isolation was Stenotrophomonas maltophilia which was recovered from 39 toilets.Warm-water nozzles of bidet toilets are contaminated with a wide range of bacteria making it a potential vehicle of cross-infection. In the hospital setting, shared use of bidet toilets must consider the clinical background of the patient. Based on our findings, these devices must be part of the risk management program and include steps for monitoring and disinfection.