197097 Open refillable bulk soap dispensers in public restrooms: A public health risk?

Wednesday, November 11, 2009: 1:24 PM

Carrie A. Zapka, MS , Research & Development, GOJO Industries, Incorporated, Akron, OH
Sheri L. Maxwell , Soil, Water & Environmental Science, University of Arizona, Tucson, AZ
Jennifer L. Cadnum, BS , Cleveland VA Medical Center, Cleveland, OH
David R. Macinga, PhD , Research & Development, GOJO Industries, Incorporated, Akron, OH
Curtis J. Donskey, MD , Cleveland VA Medical Center, Cleveland, OH
Michael J. Dolan, BS , Research & Development, GOJO Industries, Incorporated, Akron, OH
Charles P. Gerba, PhD , Soil, Water & Environmental Science, University of Arizona, Tucson, AZ
Soap in public restrooms from open refillable dispensers is known to be prone to bacterial contamination. The objectives of this study were to assess the factors contributing to contamination and to test for the presence of organisms of public health concern. Bacteria in the soap samples were quantified using standard microbiological methods, E. coli enrichment was performed according to water quality standard methods, and antibiotic resistance was assessed using selective media. Contamination was found in 21% (32/155) of facilities and averaged 6.3x106 bacteria/ml. E. coli was detectable in 28% (7/25) of the contaminated soaps tested. Resistance to quinilones or ceftazidime was observed in 28% (22/78) of the isolates, most frequently in species of Pseudomonas, 68% (15/22), but also in Klebsiella, Serratia, Burkholderia and Enterobacter species. Five percent (4/78) of the isolates were resistant to both antibiotics. Contamination was found in both bland and antimicrobial soaps and in all types of bulk dispensers tested (including both plastic and metal wall-mounted as well as the through the counter types). Contamination of bulk liquid soap in public restrooms appears to be a fundamental and widespread problem associated with the open design of the dispensers as it is not limited to any particular soap or dispenser type. The organisms found in this study included several species of Gram-negative opportunistic pathogens such as E. coli as well as antibiotic resistant bacteria. Further research is warranted to determine the extent to which contaminated bulk soap in public restrooms poses an unnecessary public health risk.

Learning Objectives:
1. Describe how to identify open refillable bulk soap dispensers 2. Explain why open refillable soap dispensers are more susceptible to bacterial contamination than sealed dispensing systems 3. Discuss why contaminated bulk soap in community settings could be a public health risk for susceptible populations

Keywords: Pathogens, Indoor Environment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Ph.D Environmental Microbiology. Over 500 journal and book articles in Health related environmental microbiology
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Clorox Hygiene Consultant
PUR Drinking Water Consultant
Kimberely Clark Paper towel Advisory Committee/Board
Oreck Vaccuum cleaners Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.