Drainage systems, an occluded source of sanitation related outbreaks

Blom, Kristina

2) Current architectural designs should be evaluated if constructed from an infection reduction perspective. 3) Also, the different maintenance practices should be evaluated and explored how to optimize. Possibly, the GMP guideline in food industry and their demands from an infection reduction perspective could be a good start to learn from. Also, the building and facility sectors should be involved to develop what actions are required to maintain a safe sanitation system and with what detection methods maintenance can be surveyed. One detection method that could meet the demands for accurate monitoring of the status in the drainage systems is a technique based on sonar technology, developed by Gormley et al. [70] . The need for guidance is especially urgent within healthcare owing to that at hospitals the majority are patients that are sick with less fit immune system and therefore more receptive to infections and thus in need of antibiotics that are effective. Further research is needed to explore how aerosols produced with or without faulty drainage systems can be disseminated by existing ventilation system and cause disease. In the case with the SARS outbreak, it was clearly shown that the spread of the virus containing aerosols created from the drains was facilitated by the ventilation system. It was further proven in a sham study that aerosols were created and spread by the airflow upon flushing a toilet [67] . Spread of pathogens from wastewater via the drainage systems and out where no physical barrier exist has also been proven in yet other sham studies [71] evoking further issues such as what are the consequences of letting out gases and aerosols through the roof, possibly next to a ventilation inlet, or if there is a leakage along the drainage systems within the building [71] ? Leakage or seepage shall be considered and its consequences analyzed. One possible effect could be that humidity is increased thus promoting microbial growth of for e.g. fungi risking mold in the building and allergies to the inhabitants. The impact of microscopic sized leakage is also of interest to study if these would allow microorganisms being microscopically small; virus being 0.1 μm, bacteria around 1 to 10 μm, and fungi around 10 μm big, to leak. Results may show that it is essential that drainage systems must be completely tight and intact where openings have physical barriers.