The workplace or customer washroom is one of the most problematic areas for businesses that are re-opening during the coronavirus crisis. There are many hygiene issues in the washroom because of the number of users, the number of common surfaces that people have to touch and the confined space making social distancing problematic. There’s also the issue of human waste containing a wide range of bacteria and viruses, so its disposal can result in pathogens entering the business environment.
1. Air hygiene
Toilet sneeze is the main source of airborne infection risk in the washroom. The ‘sneeze effect’, caused by the rapid movement of water when the toilet is flushing, creates a plume of droplets of varying sizes that are launched into the air.
These droplets can carry viruses and bacteria from urine and faeces. The larger droplets immediately fall onto surfaces in the cubicle, but the smaller droplets and aerosols can spread around the average washroom in air currents, contaminating other surfaces and the air.
The aerosols can remain in the washroom air for hours and are spread to other parts of the building by opening and closing the washroom door. Poor ventilation increases the accumulation of microbes in the air and leaves bad odours in the washroom.
Closing the toilet lid before flushing was found to reduce concentrations of C. difficile in the air above by 12 times, showing it’s effective at preventing a large proportion of sneeze escaping. Closing the lid should, therefore, be promoted as a means of reducing the spread of infections.
Bad odours in washrooms are caused not only by the users, but also poor maintenance of the toilets, urinals, drainpipes and water supply. Bacteria, uric acid and calcification can build up, generating lingering bad odours and becoming sources of infection. Damp areas caused by faulty plumbing and ventilation can attract mould growth and increase production of mould spores.
A study of COVID-19 patients in China found 55% carried the coronavirus in their faeces and it was present for several weeks after respiratory samples had tested negative. During the SARS outbreak in Hong Kong in 2003, the faulty wastewater plumbing system and bathroom extract ventilation were found to have spread the virus by airborne transmission. The result was 342 cases of infection and 42 deaths in one housing block. That’s unlikely to happen again, but the case shows that air hygiene is an important factor for reducing the risk of COVID-19 infection.
For the removal of bacterial and viral aerosols in the air, businesses should include odour remediation and air hygiene measures that effectively remove these pathogens from an enclosed environment.
2. Surface hygiene
There are many places in the washroom that people touch and can pick up infectious microorganisms or transfer them to surfaces from a contaminated hand. Bacteria and viruses can survive for days on surfaces where they can accumulate, creating reservoirs for spreading infections.
Surfaces inside the cubicles receive the majority of the toilet sneeze. Microbe-containing droplets from toilet sneezes can land on any surface, such as the washroom and cubicle door handles, toilet flush handles, floor, feminine hygiene units (FHUs), wash basins, taps, soap dispensers, unprotected toilet paper and paper towels and any personal items taken into the cubicle.
The simplest and most effective measure is to encourage users to close the lid before flushing and not to take in personal items. Using anti-microbial units and no-touch dispensers, systems that release a consistent dose of cleaning agent with every flush, and cleaning surfaces regularly will also greatly reduce contamination.
Urinals also create a spray of droplets when they are used and during flushing. Urinal sanitisers can help reduce the build-up of limescale and growth of bacteria here.
Moving from the cubicle to the basins, washroom users can cross-contaminate surfaces with their hands as they go through the actions of washing and drying hands. A study of 4800 surfaces in office buildings found the highest microbe readings on the washroom taps, with 75% being classed as “dirty”. Businesses can install no-touch taps and dispensers or, where this isn’t immediately possible, encourage visitors to use paper towels to close taps after cleaning their hands.
People themselves are also sources of contamination. Droplets of mucus and saliva from coughing, sneezing and talking behave in the same way as toilet sneeze and can carry microorganisms from the respiratory system onto all the washroom surfaces mentioned above. Cleaning regimes will need to include wipe-downs of such surfaces with antibacterial surface sprays and solutions.
Clothes, shoes and personal items can carry dust and soil containing bacteria, viruses, fungal spores and pollen from outside into the washroom and other areas of the building. These can be tackled at entry points with floor mats that can remove a high proportion of pathogens.
Personal items such as handbags can be sources of cross-contamination when moving from the cubicle floor or door hook to the sink counter, to the owner’s work space and even to their home — possibly onto a kitchen surface where food is prepared. Businesses should encourage such items either to be left outside washrooms or wiped regularly to avoid cross-contamination.
3. Hand hygiene
Hand hygiene is widely recognised as one of the most important factors in preventing the spread of infectious diseases. It’s closely tied to surface hygiene in the washroom because hands need to touch so many surfaces to make use of the facility.
Maintaining hand hygiene requires good personal hygiene habits from the users, good maintenance of the washroom to keep high hygiene levels, and adequate facilities for users to wash and dry their hands hygienically.
Washroom users bring their personal selection of resident and transient skin microbes into the washroom and can transfer them to any of the surfaces and gain high levels of microbes after using a cubicle.
Encouraging users to wash with soap and rinsing for 20 seconds is the best way to remove bacteria and viruses. The physical effect of rinsing is the most critical for removing viruses as they are harder to remove than bacteria, parasite cysts and eggs.
Businesses might want to consider giving users the option of sanitising hands after washing and drying. Studies in the US have shown that regular use of hand sanitiser led to a 30–40% reduction in respiratory and gastrointestinal illnesses in university dormitories, a US army base and an office building.
Several factors in washroom design can help to improve hand hygiene for washroom users.
- Use no-touch technology wherever possible, such as taps, soap dispensers, paper dispensers, sanitiser dispenser, doors, FHUs
- Protect toilet paper and paper towels from airborne and hand contamination by using antibacterial dispensers
- Provide antibacterial soap, hand lotion to help skin health and hand sanitiser for extra protection
- Install door handle covers or pedal solutions, which can prevent re-contamination from elsewhere in the washroom as users exit
Hand hygiene can also require psychological input to change poor behaviour when compliance rates are low. This may require education outside the washroom, but a simple addition to the washroom, a pleasant smell, was found to increase handwashing compliance.
For FMs and business owners, smart hygiene systems for washrooms use data and analysis to optimise cleaning frequencies as the devices indicate when consumables are running low and show which cubicles have been used most often. Cleaning staff can accurately predict when re-filling and cleaning needs to take place based on actual use and predicted busy times rather than at fixed intervals. This helps to reduce cleaning frequency, saves time and cuts costs.
Holistic hygiene approach
Prevention of infection in the washroom is dependent on an integrated approach to hygiene, using a combination of air, surface and hand hygiene measures to break the chain of infection. A wide range of solutions is available to protect each risk area and help stop the spread of pathogens.
- disinfecting and sanitising solutions and wipes to protect surfaces
- handwashing, drying, sanitising and moisturising solutions to protect hands and prevent hand-borne transmission of diseases
- no-touch dispensers and antibacterial door handle covers to prevent cross-contamination to other surfaces and people
- air purification and remediation solutions to protect and enhance the air and create a pleasant experience for washroom users