Jan van Zeijl is a clinical microbiologist at the IZORE Centre for infectious diseases in Friesland. For more than 10 years different toilet systems have been fine-tuned and tested there together with Villeroy & Boch to further improve hygiene standards for toilets. At IZORE, the CeramicPlus surface finish with the combined effect of the rimless DirectFlush WC and the AntiBac antibacterial glaze has been tested in a hospital laboratory environment for the first time. Interview about the role of toilet design from the perspective of a researcher and physician...
You are working and doing research at the microbiology IZORE Institute – the Centre for infectious diseases in Friesland. What are your interfaces to the construction industry?
My main areas of interest are hygiene, infection control and public health. My relation with the construction industry started after an epidemic with a highly resistant microorganism on the haematology-oncology ward of the Medical Centre Leeuwarden. We were able to prove the role of the toilets in this outbreak, and an enduring relationship started with Villeroy & Boch.
What role were the toilets playing?
When leukaemia patients are treated chemotherapeutically, they are admitted to isolation rooms with strict hygiene conditions. To avoid bacterial sepsis, these patients are treated with antibiotics and checked twice a week for colonization of the gut with potential pathogenic bacteria. In 2004 a highly resistant Escherichia coli bacterium had been detected in the intestine of a patient without knowing the cause of this colonization. In the next months three other patients acquired the same multi-resistant E. coli bacterium, one of which died. After all other causes had been excluded, it became clear that the infection must have been transmitted by the toilets, although these had been cleaned according to hygiene regulations. That was precisely what had happened, we discovered a biofilm in the concealed parts of the WC.
To find a solution for this problem, we talked to Villeroy & Boch and asked them if the company would be willing to develop a toilet free of plastic parts and we were in need for a toilet that would be completely – also including all the parts not visible – composed of an easy-to-clean ceramic glaze. The rimless DirectFlush models in combination with the CeramicPlus surface finish where no residues adhere to evolved from this. Today we are using these multiple-effect toilets in our hospital. Villeroy & Boch has thereby contributed to the solution of the problem.
Villeroy & Boch is also using an antibacterial glaze – AntiBac – on the basis of silver ions. Which advantages do you see in the use of antibacterial surfaces?
These surfaces tend to decrease the amount of organisms in the healthcare environment and add to create a safe surrounding. Yet these effects are difficult to detect under real conditions, there are too many other factors that are also relevant. However, that may be due to the large decrease of organisms by flushing and regularly cleaning. It is especially the design of the toilet that plays a crucial role. The way the water drains through the toilet, the way the flushing process is performed and the question if very fine spray droplets are formed, is also important. Glaze and surface condition are also essential. With the DirectFlush models with CeramicPlus surface we see a real effect. The finishing process ensures that the drops on the surface are immediately bundled to water droplets and drained off. In addition to the antibacterial coating the glaze and surface finish, the flush and drain characteristics, and of course the degree of how easy the toilet can be cleaned also play a role.
So what would you recommend architects and planners then when designing toilets with the highest hygiene standards? Are there any aspects that have necessarily to be taken into account?
Villeroy & Boch are entering the healthcare market at the moment. There is a great demand worldwide when it comes to more stringent hygienic requirements and infection control. Multi-resistant microorganisms are really a threat for healthcare in the world and what we need in hospitals as well as other healthcare institutions is a safe environment for the patients. That does not only apply to toilets, it applies to the rooms of the patients, to the bathrooms and e.g. to all surgery rooms. As soon as the effectiveness of silver ions – irrespective of their use as a toilet coating – has been tested in other isolated test procedures, complete bathrooms could be equipped with tiles with an antibacterial effect. There are for example glass panes with an antibacterial coating available. We are in need of a safe environment for the patient and that demands smooth and rimless areas that are easy to clean. Also the surfaces should be able to be cleaned with hydrogen peroxide, which nowadays is used as a disinfectant in hospitals. This all means that we have very high demands on hospital construction.
About the interviewee:
The IZORE Centre for infectious diseases in Friesland is a regional public health laboratory in charge of 5 hospitals and more than 450 general practitioners in the area. We cover an area with approx. 700,000 inhabitants. Apart from being one of the 8 medical microbiologists in the lab, Dr. Jan van Zeijl is a member of the medical staff of the Medical Centre Leeuwarden, a 600-bed teaching hospital in Leeuwarden. Leeuwarden is the capital of the province Friesland. At The IZORE Centre for infectious diseases in Friesland there are 130 people employed, most of them lab echnicians.
