Swedish Agency for Health Technology Assessment and Assessment of Social Services
Risk of infection for elderly using toilets with automated wash- and dry function
Toilets with a built-in, automated wash- and dry function (also called bidet toilets, shower toilets, spray toilets etc) make it easier for users who have difficulties twisting their bodies and using toilet paper. For elderly in care homes, wash and dry-toilets are used to maintain personal intergrity and reduce the need for assistance.
Question
What scientific studies and systematic reviews have been published regarding the risk of infection for elderly users of toilets with an automated wash- and dry function?
Method
A systematic literature search was performed using the following databases: MedLine, Scopus och Cinahl, as well as the International HTA Database provided by INAHTA.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.
Identified literature
No relevant systematic reviews were identified. However, one relevant primary study was identified [1]. Primary studies are not assessed for risk for bias.
| Included study | Population | Intervention | Outcome measures |
|---|---|---|---|
| Cohen-Mansfield et al., 2005 [1] | Female residents in a nursing home, identified by staff as having difficulty with toilet related cleanliness and care (n=22) Nursing assistants (n=27) |
Wash-and dry toilet seat, retrofitted to existing toilet. | Residents: Toileting experienceUrine cultures Nursing assistants: Residents’ toileting experienceAssessment of cleansing and drying function of wash and dry toilet |
References
[1] Cohen-Mansfield J, Biddison JR. The potential of wash-and-dry toilets to improve the toileting experience for nursing home residents. Gerontologist. 2005;45(5):694-9. Available from: https://doi.org/10.1093/geront/45.5.694.
Search strategies
| / = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
|---|---|---|
| Population | ||
| 1. | exp Aged/ | 3 482 003 |
| 2. | Homes for the Aged/ | 14 845 |
| 3. | Nursing Homes/ | 39 817 |
| 4. | (elderly or senior* or geriatric*).ab,bt,kw,ti. | 407 429 |
| 5. | ((old* or elder*) adj2 (age* or person* or people or frail or adult*)).ab,bt,kf,ti. | 368 085 |
| 6. | ((old* or elder* or aged) adj2 (care or home* or resident* or hous*)).ab,bt,kf,ti. | 37 302 |
| 7. | or /1-6 | 3 758 963 |
| Intervention | ||
| 8. | Bathroom Equipment/ | 230 |
| 9. | (hygien* or sanitary or wash*).ab,bt,kf,ti. | 249 306 |
| 10. | 8 or 9 | 249 549 |
| 11. | ((bidet or water spray or shower or wash* or intelligent or smart) adj1 toilet*).ab,bt,kf,ti. | 90 |
| Study types: systematic reviews and meta-analysis | ||
| 12. | ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) | |
| Combined sets: | ||
| 13. | 7 and 10 and 12 | 214 |
| 14. | 11 or 13 | 305 |
| Final result | ||
| 15. | 305 | |
| TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other.; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
|---|---|---|
| Population | ||
| 1. | TITLE-ABS-KEY ( elderly OR senior* OR geriatric* ) | 1 149 561 |
| 2. | TITLE-ABS-KEY ( ( old* OR elder* ) W/1 ( age* OR person* OR people OR frail OR adult* ) ) | 506 564 |
| 3. | TITLE-ABS-KEY ( ( old* OR elder* OR aged ) W/1 ( care OR home* OR resident* OR hous* ) ) | 100 165 |
| 4. | 1 OR 2 OR 3 | 1 445 042 |
| Intervention | ||
| 5. | TITLE-ABS-KEY ( hygien* OR sanitary OR wash* OR "bathroom equipment" ) | 602 018 |
| 6. | TITLE-ABS-KEY ( ( bidet OR "water spray" OR shower OR wash* OR intelligent OR smart ) W/1 ( toilet* ) ) | 559 |
| Study types: systematic reviews and meta-analysis | ||
| 7. | TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) | |
| Combined sets: | ||
| 8. | 4 AND 5 AND 7 | 286 |
| 9. | 6 OR 8 | 693 |
| Final result | ||
| 10. | 693 | |
| TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); MH = Exact subject heading, indexed keywords; TX = All text; PT = Publication type; Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
|---|---|---|
| Population | ||
| 1. | TI ( elderly OR senior* OR geriatric* OR ((old* OR elder*) N1 (age* OR person* OR people OR frail OR adult*)) OR ((old* OR elder* OR aged) N1 (care OR home* OR resident* OR hous*)) ) OR AB ( elderly OR senior* OR geriatric* OR ((old* OR elder*) N1 (age* OR person* OR people OR frail OR adult*)) OR ((old* OR elder* OR aged) N1 (care OR home* OR resident* OR hous*)) ) OR SU ( elderly OR senior* OR geriatric* OR ((old* OR elder*) N1 (age* OR person* OR people OR frail OR adult*)) OR ((old* OR elder* OR aged) N1 (care OR home* OR resident* OR hous*)) ) | 349 584 |
| Intervention | ||
| 2. | TI ( hygien* OR sanitary OR wash* OR "bathroom equipment") OR AB ( hygien* OR sanitary OR wash* OR "bathroom equipment") OR SU ( hygien* OR sanitary OR wash* OR "bathroom equipment”) | 80 075 |
| 3. | TI ( ((bidet OR "water spray" OR shower OR wash* OR intelligent OR smart) N1 (toilet*)) ) OR AB ( ((bidet OR "water spray" OR shower OR wash* OR intelligent OR smart) N1 (toilet*)) ) OR SU ( ((bidet OR "water spray" OR shower OR wash* OR intelligent OR smart) N1 (toilet*)) ) | 74 |
| Study types: systematic reviews and meta-analysis | ||
| 4. | ((TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter") | |
| Combined sets: | ||
| 5. | 1 AND 2 AND 4 | 111 |
| 6. | 3 OR 5 | 185 |
| Final result | ||
| 7. | 185 | |
| Search terms | Relevant items found | |
|---|---|---|
| Intervention | ||
| 1. | toilet | 0 |
| 2. | toilets | 0 |
| 3. | hygiene | 0 |
| 4. | hygienic | 0 |
| 5. | bathroom | 0 |
| 6. | bathrooms | 0 |
| Final result | ||
| 7. | 0 | |
Citation Search
| LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review; LIMIT-TO (PUBYEAR, X = Limit to publication year | ||
| Search terms | Items found | |
|---|---|---|
| Cited articles | ||
| 1. | TITLE ( "the potential of wash-and-dry toilets to improve the toileting experience for nursing home residents" OR "Can technology-assisted toilets improve hygiene and independence in geriatric rehabilitation") | 2 |
| Citing articles | ||
| 2. | #1 View cited by | 21 |
Articles used in forwards citation searching
Cohen-Mansfield J, Biddison JR. The potential of wash-and-dry toilets to improve the toileting experience for nursing home residents. Gerontologist. 2005;45(5):694-9.
Yachnin D, Finestone H, Chin A, Jutai J. Can technology-assisted toilets improve hygiene and independence in geriatric rehabilitation? A cohort study. Disabil. 2018;13(7):626-33. Available from: https://doi.org/10.1080/17483107.2017.1358303.