The impact of an air sanitizer spray on the risk of virus transmission by aerosols generated by toilet flushing

Background: Toilet flushing has been reported to result in pathogen contamination of restroom fomites and air. The goal of this study was to investigate the effectiveness of an air sanitizing spray on reducing cross-contamination of restroom fomites and air after toilet flushing. Methods: Bacteriophage MS2 was added to toilet bowl water, then flushed, and cross-contamination of restroom fomites and air was determined. Subsequently, the procedure was replicated to determine the interventional role of using either an air sanitizer spray or surface disinfectant spray after toilet flushing. Results: A 90 to 99.99% reduction of cross-contamination on fomites occurred with the use of the air sanitizer, depending on the fomite location and sanitizer spray duration. Use of the air sanitizer significantly reduced viral contamination only on the toilet seat after spraying for 8 seconds, but after a 30-second spray, cross-contamination was significantly reduced on 4 of 5 restroom surfaces. Air contamination was also reduced by almost 99% after the use of air sanitizer. In contrast, when a hard surface disinfectant spray was sprayed in the air, its impact on post-flushing cross-contamination of surfaces was negligible. Conclusions: The air sanitizer significantly reduced airborne pathogen exposure from toilet flushing, including the risk of norovirus transmission in the restroom.