4.2 Fomites

(1) Droplet: Transmitted through direct and indirect means. It can be inhaled directly by others when the infected patient cough or sneeze. In contrast, droplets may settle on table surface, and later on when another person touches the table before touching his own mucosal surfaces (including nose, mouth and eyes), the transmission of disease might then happen.

(2) Direct contact: Transmitted from the infected to the healthy through direct physical contacts.

(3) Indirect contact: Transmitted through fomites.

(4) Aerosols (possible): Aerosols are capable of traveling a longer distance and longer time in air, compared to typical droplets, before settling down owing to the small size and light weight. Aerosols can be generated during aerosol-generating procedures in hospital settings, such as resuscitation, endotracheal intubation, positive pressure ventilation, tracheostomy insertion, bronchosocopy, and airway suction, etc. Coughing, sneezing, toilet flushing, cigarette smoke and hot pot steam, etc. could also generate infective aerosols, further studies are needed to  test these hypothesis.

References
Barker J & Jones MV (2005): The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet. Journal of Applied Microbiology 99: 339-347.
Best EL, Sandoe JAT & Wilcox MH (2012): Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk. Journal of Hospital Infection 80: 1-5.
Tran K, Cimon K, Severn M, Pessoa-Silva CL & Conly J (2012): Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLOS ONE 7: e35797.