The
question is: what is the real risk of public toilet seats?
If you spend
enough time outside your home, human physiology dictates that you will
eventually need to use a public restroom. And as with any shared space, chances
are that it will be filled with germs. But what risks, if any, do communal
lavatories pose to public health?
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“There are some
health risks associated with public bathrooms,” said Erica Donner, a professor
of environmental science at the
University of South Australia. The size of the
risk depends on many things, including how often the restroom is cleaned and
how well-ventilated it is, she said. But you can also take simple steps to
protect yourself, said Donner, a co-author of a recent review of studies on
infectious disease transmission in public restrooms.
Health officials
have traced the spread of certain disease-causing viruses and bacteria back to
public restrooms, including norovirus in workplace, airplane, and cruise ship
bathrooms; salmonella in dorm toilets; and hepatitis A in elementary school
restrooms. Plenty of research has also documented the presence of pathogenic
microbes on toilets and other surfaces in public restrooms, as Donner’s recent
article summarized.
Toilet seat covers also do not offer foolproof protection; they can be contaminated from previous toilet plumes or stall occupants.
Most of these
pathogens find their way onto bathroom surfaces via the toilet bowl, because
feces and even urine can contain many bacteria and viruses, said Charles Gerba,
a professor of microbiology at the
University of Arizona. Flushing the toilet
then disperses the tiny microbes in an aerosolized plume, which can reach 1.5m
into the air and remain suspended for an hour or more before settling on
surrounding surfaces, studies show. “All public toilets really get contaminated
to some degree just because of the flushing action of the toilet,” Gerba said.
But sitting on a
contaminated toilet seat and picking up a bit of virus or bacteria on the skin
of your backside will not necessarily make you sick; most of these pathogens
are not “butt-borne diseases,” as Gerba put it.
An exception may
be skin infections, particularly those caused by methicillin-resistant
Staphylococcus aureus, or MRSA, a type of bacteria that is resistant to several
antibiotics and hence is tricky to treat. MRSA has been detected on public
toilets and “can be transmitted from the skin to a surface to another person’s
skin,” Gerba said. It’s not well documented how often this happens, but
cleaning a public toilet seat with a disinfecting wipe before using it would
minimize your risk, he said. (Just make sure to dispose of the wipe into the trash,
not into the toilet bowl.)
He also agreed
with Dr Ina Park, an associate professor of family community medicine at the
University of California, San Francisco, who said the risk of MRSA may be “a
reason to use a toilet seat cover if it’s available, especially if you have any
broken skin that might come into contact with the toilet seat.” But, “in
general,” she added, “the risk is low.” And MRSA has been found on many other
public surfaces, including on ATM keypads, elevator buttons, locker handles, and
beach sand, as well as in buses and hotel rooms, so this risk is not unique to
toilets.
Toilet seat covers
also do not offer foolproof protection; they can be contaminated from previous
toilet plumes or stall occupants, Donner said, and sometimes they are not
available. In this case, is it better to hover over the toilet seat to avoid
direct contact? “If you have strong muscles, by all means hover, but only if
you have good aim,” she said. “You may accidentally create a mess and increase
the risk to others.”
More important
than whether you use a cover, sit, or hover, is how well you clean your hands
after using the bathroom, Donner said. Thanks to the toilet plume effect and
the use of hand air dryers, which she said can spread germs from wet hands or
nearby open trash cans as far as 3m, any surface in a public restroom — flush
handles, stall latches, sink taps and exit doors, for example — can be
contaminated. And the most common route of infection is “the charmingly termed
‘fecal-oral route,’ ” which occurs when pathogens from an infected person’s
feces get into your mouth after “touching contaminated surfaces and then
touching your face,” Donner said.
If you bring a bag or purse into a public restroom, avoid putting it on the floor, which
is one of the dirtiest surfaces in a bathroom.
For hand washing
to be effective, the
Centers for Disease Control and Prevention recommends
wetting your hands with clean water, scrubbing with soap for at least 20
seconds, rinsing and then drying them. But most people do not wash their hands
for long enough, and public restrooms are often out of soap and paper towels.
It is sometimes also difficult to wash well, like in airplane lavatories with
their tiny sinks and trickles of water, and hard to avoid touching a surface
afterward, Gerba said. After all public restroom visits, “the best option is to
wash your hands, and then use a hand sanitizer on the way out,” he said.
Other tips to keep
in mind: If you bring a bag or purse into a public restroom, avoid putting it
on the floor, which is one of the dirtiest surfaces in a bathroom, Gerba said.
Keep your phone stowed away to avoid contaminating it, and try to avoid
touching surfaces as much as you can, Donner recommended. Also consider closing
the toilet lid before you flush as a public health measure and a kindness to
others — this step reduces the toilet plume significantly.
One thing you do not need
to worry about is contracting a sexually transmitted infection in a restroom,
Park said. “I’m not going to say it’s absolutely impossible, but it’s so
unlikely,” she said. Pathogens like gonorrhea and chlamydia do not survive for
long on surfaces, and they need to get into the penis or vagina to cause
infection, she said. “Where we’re sitting on the toilet seat, it’s just not in
the right vicinity.”
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