Restrooms are a common feature in almost all public places. Be it malls or cinema theatres, restaurants, hotels, airports, railway stations and even in shopping centres. In fact there are even public utilities - Sulabh Shauchalayas - where you can ease yourself for a paltry payment. But the moment you enter some of these rest rooms, you wish you hadn’t. The odour and the not-so-hygienic condition of these public utilities make you realise that the name should be changed to pestrooms instead of restrooms. Even in places which appear clean there are, according to health experts, germs lurking everywhere - from flush handles to the taps - in fact every place that you touch. Ashok Malkani examines the sanitary conditions in the restrooms and discovers that drying the hands is as important as washing them.

Cleanliness is next to Godliness, it is said, but in India it looks like God is extra forgiving. For, Indians, by and large, are bereft of cleanliness habits. Spitting by the roadside, throwing trash all across the place is the birthright of us Indians. Even at the Commonwealth Games village when the media highlighted the filthy state of the rooms till a few days before the games, the officials treated the mess lightly. And why not? Because we are bindas and what’s a few scattered papers or paan stains or pee-in-the-pot paani puri between friends!

Truly, we can thank the Commonwealth Games organising committee general-secretary Lalit Bhanot for placing toilets firmly in the collective consciousness of this nation. “Their (Western) standard of hygiene and cleanliness could be different from ours so there is nothing to be ashamed about it”, Mr. Bhanot explained condescendingly to the protesting reporters at a press conference. Ever since those famous words, there is no escape from the toilet story.

The world at large has suddenly become aware that more people in India have access to mobile phones than to basic sanitation.

Is the toilet a template for the state of a nation or civilisation?

“The toilet is part of the history of human hygiene which is a critical chapter in the growth of civilisation”, says Dr. Bindeshwar Pathak, sociologist, toilet king - the man who started the low-cost Indian toilet system, the globally-acclaimed Sulabh Shauchalaya model.

The History
Indeed, tracing the history of this ‘human hygiene’ - called public washrooms - it is found that up to the nineteenth century, public washrooms were the norm and private-dwelling toilets were only built for the rich. The first evidence of actual physical facilities for public use was found in Knossos, dating back to approximately 1700 BC. In fact, most of the great cities of the ancient world provided startlingly sophisticated public facilities. The epitome of this approach was Rome, which provided public facilities on a wide scale in lieu of private facilities. Roman cities were famous for their advanced sewer systems and provide the first real example of a public urinal.

The decline of the Roman Empire brought with it a similar decline in public facilities and the disappearance of the sewage system in particular. In medieval Europe, the facilities ranged from none, to designated heaps, to privies, to carriage pots for the wealthy. Within private dwellings, it was customary to empty chamber pots out of upstairs windows by throwing their contents into the street, calling out: “gardez l’eau” (hence the word “loo”). Public toilets were located over rivers. Under medieval statutes, anyone, including women, had the right to squat in the gutter, for example within the boundary of the ancient City of London.

Industrialisation was accompanied by the expansion of towns and cities, and population growth put increased pressure for better sewer systems. It was not until the 1840s that the public street urinal made its reappearance, this time in Paris. By the 1860s Paris also boasted enclosed kiosks, and by the 1880s the washroom had become unisex and incorporated WCs as well. Still, most houses piled the sewage in the garden or waited for the nightsoil man to collect it. Nightsoil men were the central means for collection in Japan before World War II and in Australia around the same time. Cesspools were also common.

The third millennium B.C. was the “Age of Cleanliness”. Toilets and sewers were invented in several parts of the world, and Mohenjo- Daro circa 2800 B.C. had some of the most advanced public utilities, with lavatories built into the outer walls of houses. These were “Western-style” toilets made from bricks with wooden seats on top. They had vertical chutes, through which waste fell into street drains or cesspits. Sir Mortimer Wheeler, the director general of archaeology in India from 1944 to 1948, wrote, “The high quality of the sanitary arrangements could well be envied in many parts of the world today.”

The people of the Harappan civilization in Pakistan and north-western India had water flushing toilets in each house that were linked with drains covered with burnt clay bricks. Early water flushing toilets are also found at Skara Brae in Orkney, Scotland, which was occupied from about 3100 BC until 2500 BC. Some of the houses there have a drain running directly beneath them, and some of these had a cubicle over the drain.

The High Risk Zone
Public utilities are cause of several diseases. However, today we have flushing toilets but the flush rarely works, particularly in the public washrooms. People’s sanitary habits, today, leave a lot to be desired. And, according to CWG organising committee general-secretary Lalit Bhanot, paan stains and dirtying the place is the birthright of us Indians!

Well, when the general ambience is neglected what does one expect in the public washrooms? You don’t have to be a germophobe to fear restrooms in cinemas, or railway stations or other public places. And if you are planning to visit the Sulabh Shauchalaya, heaven help you!

A washroom or a public toilet (also called a bathroom, restroom, comfort room, powder room, toilet room, washroom, water closet, W.C., public lavatory) is often called public convenience, while it does nothing but cause inconvenience.

Dr. Dipak Chatterjee of Mumbai newspaper, Daily News and Analysis, claims that Indian public toilet facilities are so unhygienic that people, especially women, who are vulnerable to infections, should consider wearing adult diapers instead.

Public toilets without continuous supply of clean water, proper ventilation (at least one ventilator), and drainage can cause a lot of distress to the user. Bad smell, originating out of unclean loos, can cause nausea. Puddles of water can become breeding grounds for mosquitoes and lead to diseases such as malaria and dengue. The common cold, E. coli and hepatitis A all flourish in public toilets and sinks just waiting to pounce and infect.

From a common cold to stomach flu viruses, bad things lurk on sink surfaces, hand dryers and toilet seats. Without proper care, you’re at risk of being bedridden for weeks with a multitude of diseases like the nasty-sounding streptococcus (a form of strep throat and meningitis), E.coli, hepatitis A, and staphylococcus (the virus behind food poisoning and a form of pneumonia). It is highly possible that the strange cold you caught in the middle of the summer was transmitted to you through a public washroom.

Scrubbing the toilet bowl only once in seven days (as per the BMC guidelines) can make toilet-users, especially women, vulnerable to a host of infections. The chief and most common among them is urinary infection. Here, women need to be most careful. Those with severe bladder or liver-related problems should use adult diapers instead of using a public toilet frequently. This may be a costly way out, but it certainly is the safer way out.

As it is, the cities are burdened with more than they can bear. This is the reason why infections spread across the city so rapidly. Here are some severe infections that one can contract from using unclean public toilets: Syphilis, Gonorrhea, Pruritus and Urinary infection.

Hand Washing
Let’s face it. The majority of people who read this article do not wash their hands when they stop for a bathroom break at the office. We use the urinal and, with other things on our mind, we splash some water on our hands, wipe them on a towel, over the sink, which has been used by several other people and may contain all sorts of germs. In that two-minute trip to urinate, not only did we leave tons of germs on every surface we touched, a lot of germs attached themselves to us as well.

It is the simple truth that hand washing will drastically cut the chance for germ transference. A study done by Scott Papers, manufacturer of tissue napkins, found that more than nine out of ten respondents claimed to wash their hands when using public restrooms. However, only 67 per cent were actually observed doing so.

But, according to health experts, mere rinsing your hands with water is not enough. The ideal thing to do is: With hot water, lather up (with soap) for 20 to 30 seconds, not the one or two ticks you usually spend. Wash your palms and backs of your hands, in between your fingers and under your fingernails. The friction you generated has just killed off the deadliest of the bathroom bacteria.

Without getting too specific, there are many germs that can thrive in restrooms. Bacteria live off of moisture and organic food (or waste), which can be plentiful in public restrooms.

Fears of contacting STD’s (sexually transmitted diseases) from a public washroom have more to do with the fear of the disease than the likelihood of picking it up in a washroom. Many of these bacteria and viruses do not live long enough outside the body to be easily transmitted. Of greater concern are salmonella and shigella bacteria which can be transferred by contact with feces. The infected person can transmit the bacteria on their hands which can then be transferred to flushing handles, door handles and faucets.

In an in-depth study commissioned by hygiene products supplier Kimberly-Clark Professional, 87 per cent of respondents said public conveniences did not consistently provide adequate hand washing and drying facilities. Nearly a quarter (23 per cent) said facilities were either ‘never’ or ‘rarely’ of a good enough standard. And four fifths of respondents (79 per cent) said it was more difficult to maintain hand hygiene levels outside of the home than in it.

The survey shows that the issue is a worry for people, with 95 per cent of respondents believing that inadequate hand washing and drying facilities in public toilets impact on the public’s health and safety. A majority – 59 per cent – said they believed that a poor standard of washing and drying facilities impacts “a lot” on people’s welfare.

Importance of Hand Drying

Although hand hygiene campaigns frequently focus on the washing of hands, the Kimberly-Clark Professional survey also demonstrates that inadequate drying facilities, too, are a major health concern. The survey found that when faced with poor, or no, drying facilities people resort to other, significantly less hygienic, methods to dry their hands.

Nearly half of respondents, 48 percent, said they might allow their hands to dry naturally; one third said they might use toilet paper; and a quarter said they would dry their hands on clothing. Just as worryingly, 12 per cent of respondents said that inadequate hand drying facilities would deter them from washing their hands at all. Says Pete Oliver, category manager, Kimberly-Clark Professional: “People are right to be concerned about poor hand drying facilities in public conveniences. Wet surfaces transfer bacteria much more readily than dry ones, so a lack of acceptable drying facilities means we are not able to clean our hands properly and stop the spread of germs.”

The World Health Organisation recommends in its ‘Hand Hygiene: When and How’ guide that single-use hand towels are used as part of a hygienic hand washing routine. Says Oliver: “While hygiene campaigns rightly focus on the importance of washing your hands, it is essential we don’t forget the role hand drying also plays in preventing the spread of germs. However, our survey shows that managers of public conveniences are often failing to meet people’s expectations in terms of the hand drying facilities they are providing. In turn, this is fuelling concerns about public health, and suggests that certain measures – such as installing paper towel dispensers in public washrooms – could help allay people’s concerns.”

Tips for Facility Managers

A satisfactory level of restroom cleanliness can be difficult for facility managers to achieve on a regular basis. The more traffic a facility receives, the more expensive it is to maintain and the more difficult it can be to provide service throughout the day. Eventually, this can lead to depletion of supplies. Facility managers, particularly in hotels and A grade restaurants are keen to allay public fears about public restrooms.

One way facility managers can help to reduce the spread of germs is through the installation of touch less products and systems in the restroom. By minimizing the user’s need for direct skin to surface contact, touch free dispensers can help reduce the transmission of illnesses and germs. In restrooms with these systems, users do not have to touch handles, levers, or buttons in order to flush toilets, turn on water, or dispense washroom products.

Some no touch systems are relatively simple to use. There is a toilet paper system, for example, that holds individual, inter-leaved sheets of paper. With this system, users can easily reach inside for the sheets they need without being forced to search around a potentially dirty dispenser. This may provide a cleaner and more hygienic delivery system than conventional toilet paper dispensers.

Other no touch systems employ more high-tech methods like sensor activated devices that control water faucets and lights. No touch technology can also be helpful when incorporated into hand towel dispensers, since hand towels are typically used once hands are already cleaned.

Touchless systems don’t have to be electronic. Simple, no touch hand towel dispensing systems are also available. For instance, a low cost hygienic option dispenses the towels one-at-a-time, and users only have to touch the towel they need.

Another way to minimize the items touched in the restroom is to install automatic toilet flushing mechanisms. There are two primary types of systems: one flushes the unit after each use, and another operates at regular intervals to keep fresh water in the bowl at all times. In either case, the addition of automatic dispensing of a disinfectant with each flush can help minimize bacteria formation in the bowl and reduce odors.

With these devices, hand contact and germ transmission is reduced, and maintenance teams have an easier time cleaning flush valves and handles. Both users and facility managers can benefit from this approach.

Sanitary Restroom Environment

Maintaining an adequate supply of personal care products in the restroom is another important aspect of creating and maintaining a sanitary restroom environment. Nothing says “unhygienic” more than the absence of toilet paper, hand soap, or hand towels in a restroom. One way to help ensure an adequate supply of product in the restroom is to select high capacity systems. High capacity systems reduce product depletion by lasting longer and offering less frequent product change outs.

When selecting toilet paper, one high capacity option is a coreless jumbo roll tissue system. Because this system contains no hole in the center and no cardboard core, it provides the equivalent in length of nearly six standard rolls of bath tissue.

To make sure soap is there when people need it, facility managers can consider a wall mounted replaceable system that provides a new, clean dispenser with each refill. Counter mounted systems with disposable cartridges are also desirable. Both will last longer and help eliminate drips, leaks, and clogs.

The Initiative

The knowledge that proper washing and drying can protect you from even unsavory public restrooms is comforting. The fact that public washrooms still need to provide the basics for good hygiene, as well as good maintenance is something that needs work. Several social groups have realised the importance of maintaining hygiene in public washrooms. Mata Amritanandamayi has said that the Mata Amritanandamayi Math, Kochi, was ready to take up the responsibility of cleaning schools and public places if it gets the support and cooperation of state governments and other organisations. “It is said that India is growing and developing. However, in matters of environmental cleanliness and hygiene, we are lagging behind by centuries. The lack of cleanliness on our roads, public bathrooms and toilets is proof of this,” the Amma is reported to have said at Amritapuri. Amma has said that the Math was ready to construct public toilets in schools and public places if state government, school management committees and the local people collaborate. The project will be implemented through proper blueprints, planning and the cooperation of students and the general public. The project will be initiated in Kerala. Thereafter, it will be implemented gradually in other states.

Proper maintenance of public toilets is a need for concern because according to a study conducted by the World Bank, Indian economy loses nearly $54 billion (around Rs. 24,000 crore) annually due to lack of toilets and poor hygiene. In a study ‘Economic Impact of Inadequate Sanitation in India’, conducted by its South Asia water and Sanitation unit, the multilateral body said revenue from tourism was one of the main factors behind the significant economic loss. “For decades, we have been aware of the significant impacts of inadequate sanitation in India,” Christopher Juan Costain, the World Bank’s head for South Asia’s water and sanitation programme, told. The cost of treatment for diseases due to poor hygiene was estimated at $38.5 billion (over Rs. 17,000 crore). Costain said the Indian economy loses $260 million (over Rs. 1,000 crore) in tourism revenues due to poor sanitation as tourists are reluctant to come to India due to lack of sanitation facilities. “We all hear about people worrying over Delhi Belly, but tourists are reluctant to come here due to health concerns like this and this is losing India money,” Constain said.