@misc{ding_qian_xu_huang_miao_yen_xiao_cui_wu_shao_et al._2020, 
  title={Toilets dominate environmental detection of SARS-CoV-2 virus in a hospital}, 
  DOI={10.1101/2020.04.03.20052175}, 
  abstractNote={<jats:p>Background: Respiratory and faecal aerosols play a suspected role in transmitting the SARS-CoV-2 virus. We performed extensive environmental sampling in a dedicated hospital building for Covid-19 patients in both toilet and non-toilet environments, and analysed the associated environmental factors. 

Methods: We collected data of the Covid-19 patients. 107 surface samples, 46 air samples, two exhaled condensate samples, and two expired air samples were collected were collected within and beyond the four three-bed isolation rooms. We reviewed the environmental design of the building and the cleaning routines. We conducted field measurement of airflow and CO2 concentrations.  

Findings: The 107 surface samples comprised 37 from toilets, 34 from other surfaces in isolation rooms (ventilated at 30-60 L/s), and 36 from other surfaces outside isolation rooms in the hospital. Four of these samples were positive, namely two ward door-handles, one bathroom toilet-seat cover and one bathroom door-handle; and three were weakly positive, namely one bathroom toilet seat, one bathroom washbasin tap lever and one bathroom ceiling-exhaust louvre. One of the 46 air samples was weakly positive, and this was a corridor air sample. The two exhaled condensate samples and the two expired air samples were negative. 

Interpretation: The faecal-derived aerosols in patients' toilets contained most of the detected SARS-CoV-2 virus in the hospital, highlighting the importance of surface and hand hygiene for intervention.</jats:p>}, 
  publisher={Cold Spring Harbor Laboratory}, 
  author={Ding, Zhen and Qian, Hua and Xu, Bin and Huang, Ying and Miao, Te and Yen, Hui-Ling and Xiao, Shenglan and Cui, Lunbiao and Wu, Xiaosong and Shao, Wei and et al.}, 
  year={2020}, 
  month={Apr}
  }