Many people are squeamish about using public washrooms for fear of picking up an illness. And it is easy to understand this fear. Public toilets are often small, crowded, windowless facilities where large numbers of people share the same space, breathing in the same air and touching the same amenities such as toilet rolls, sinks, soap bars, towels and taps.
The potential to pick up a bug in a public washroom seems huge – particularly at this time of year when illnesses are rife. But how much of a threat do toilets actually pose? Colds and flu can be passed on via coughs and sneezes from an infected person – something that is hard to avoid in a crowded washroom. Germs can also be transmitted by touching a surface that an infected person has previously touched.
Cases of colds and flu peak at the height of winter, with the first signs usually emerging around now, in October and November. While most colds tend to go away by themselves, flu can be much more serious and is thought to kill up to 500,000 people worldwide every year.
Flu vaccines are routinely offered to the vulnerable, but the virus is mutating all the time which means that no inoculation is failsafe. And there is no vaccine for colds, with most adults averaging between two and four colds per year.
Studies have shown that cold and flu viruses can linger on surfaces for 24 hours or more. So a washroom visitor who coughs on to his or her own hand before using a tap, dispenser or air dryer will potentially contaminate that surface and risk passing on the virus to the next washroom user.
Washroom surfaces can also become contaminated by other means. For example, studies have shown that flushing a toilet may propel germs into the air, and these then go on to contaminate the washroom environment. According to an article published in the Journal of Hospital Infection in 2011, the number of viable C. difficile bacteria on the surrounding surfaces following a toilet flush was 12 times higher when the toilet lid was open compared to when it had been closed.
The study concluded that closing the toilet lid before flushing was a sensible precaution in order to avoid the risk of contamination.
More recently a study carried out at the University of Leeds this autumn found evidence of germ activity in the washrooms of hospitals in the UK, France and Italy linked with the use of air dryers. The bugs in question included E. coli, which causes gastroenteritis and pneumonia; Staphylococcus aureus, responsible for wound infections and blood poisoning, and enterococci, which cause difficult-to-treat infections.
The bacteria were mostly to be found on the floor but were also present in the air, dust and surfaces. And five times more bacteria were found in washrooms that had been equipped with air dryers compared with toilets where paper towels had been supplied. This suggested that germs were being blown around the washroom by the dryers, with the authors concluding that air dryers should not be used in vulnerable environments such as healthcare settings.
Many people also worry about the possibility of picking up a sexually transmitted disease from a toilet seat. However, the risks of doing so are practically nil according to experts, since the germs that cause STDs cannot live outside the body for long – particularly not on a cold, hard toilet seat.
So, how risky are public washrooms in terms of contracting an illness? It is difficult to avoid picking up a bug from an infected person who is sneezing or coughing nearby. And we can only avoid touching those potentially contaminated surfaces up to a point.
Some washroom providers equip their facilities with automatic lights and outer partitions in place of doors in order to avoid the need for the visitor to have to touch the door handle or light switch. Touch-free taps, flushes and dispensers will also reduce the number of surfaces with which the visitor needs to come into contact.
But some washroom fixtures are impossible to avoid. A medical-based television programme in the US recently analysed a public washroom’s surfaces and found that the toilet paper dispenser was the most germ-laden surface of all, harbouring 150 per cent more bacteria than the toilet seat.
The researchers behind the programme reasoned that while most people avoid touching the toilet seat, they still need to use their hands to access the toilet paper – and some dispensers require the user to reach up inside the unit and fumble around for the end of the paper roll. Bacteria found on toilet tissue dispensers included acinetobacter and enterobacter, which can cause urinary tract infections, pneumonia and womb infections.
The washroom sink is another potential breeding ground for bacteria. A study carried out at the University of Arizona some years ago revealed that the sinks of 10 per cent of public toilets tested showed traces of fecal bacteria, salmonella and typhoid fever. However, the study authors concluded that the risk to visitors was slight provided they avoided touching the inside of the sink when washing their hands.
While all these reports appear somewhat alarming, scientists are relatively relaxed about the risks of picking up a serious illness in a washroom. According to the University of Utah’s Professor of Pathology, Judy Daly: “Even if you do come into contact with a particular virus or bacteria, you’d have to contract them in amounts large enough to make you sick. Your own immune system is your first line of defence against contracting diseases in public restrooms – but hand washing is a very important adjunct.”
This is the crux of the issue. Thoroughly washing one’s hands before leaving a washroom will remove any germs you may have picked up from other people.
Washroom providers can help to make their facilities as safe as possible by installing automatic systems to limit the number of surfaces that need to be touched. Enclosed toilet paper dispensers will also avoid the need for any fumbling around inside the unit in search of paper. And, of course, hand hygiene facilities should be made freely available with plentiful supplies of soap and paper towels provided to facilitate hand washing and drying.
It is now generally accepted by health bodies everywhere that hand washing is the first line of defence against many illnesses, including colds and flu. By minimising the opportunities for contamination in the washroom – and by encouraging good hand hygiene – washroom providers can help to keep us all safe this winter.