The World Health Organization estimates that 3.1 million people die every year from preventable diseases related to contaminated water and poor sanitation. Recently, the United Nations issued a declaration that reads: “Water is fundamental to life and health. The human right to water is indispensable for leading a healthy life in human dignity. It is a prerequisite to the realization of other human rights.”

As far as we know, diseases are the result of various pathogenic bacteria and viruses transmitted from an infected person, animal or object to a healthy person, by direct contact or contaminated air, water or soil. A pathogen is a biological agent that causes disease or illness to its host.

This is not a new discovery. Louis Pasteur, a French doctor, and Robert Koch, at the end of 19th century, demonstrated that bacteria and viruses are the reasons for us being sick. Before that, the common belief was that diseases and illness were God’s punishment for our sins.

It is important to note that viruses are much smaller than bacteria and cannot be seen by a regular microscope. Although very small, with a simple structure, they are very powerful pathogens. With the discovery of new medications such as penicillin and similar antibiotics derivatives, we believed that we were safe from bacteria and viruses. But these small organisms surprised everyone when they evolved into different, more potent forms, and now are immune to the medications we prepared to get rid of them.

Plumbing Industry Praise

source: www.thegidcumbs.com

In the USA, the plumbing industry continues to work very hard to improve access to safe water and basic sanitation facilities for the entire population. A lot of effort has gone into educating people to observe simple and basic sanitation rules. Much was done, but much more is required to change the human behavior related to attitudes against pathogenic bacteria and viruses.

We should give full credit to our plumbing industry, as a whole, for the invention, fabrication and availability of wonderful “hands-free” electronic flushing devices for water closets, urinals, and lavatories; and electronic paper dispensers and warm air blowers for hand drying. These devices reduce the occurrence of touching fixtures in the public restrooms and, at the same time, conserve water. Both of these intentions are a step forward in our fight against transmitting diseases and wasting potable water.

All these improvements have appeared on the market in the last decade or so. Engineers and architects rushed to specify them, and, of course, the contractors installed them per specifications.

Let’s analyze a little more carefully how these new improvements are used and how they help us reduce hand contact with plumbing fixtures or other parts of the restrooms that may be contaminated with bacteria or viruses from previous visitors.

Entrance to the public restroom is generally through a door, which has a knob or handle that must be touched to open the door. Once in the restroom, you approach either the urinal or water closet to discharge urine or fecal matter. While performing these tasks, you occasionally come in direct contact with this matter, which may be contaminated with viruses. This may be acceptable, since it is your own matter and you plan to wash your hands before you leave the restroom.
But how many people really wash their hands before leaving public restrooms?

Enlarge this picture Figure 1. Paper towel dispensers (PDT) are located next to the lavatories, and waste baskets (WB) are located next to the exit doors.

From my personal observations (which are limited, I admit), I guesstimate that 20% to 30% of persons using public restrooms do not wash their hands at all. So for the purposes of this article, let’s assume that only 70% to 80% of persons will wash their hands to some degree.

Next, we must address a more technical question: What does it really mean to wash one’s hands? Manufacturers of antimicrobial liquid soap recommend people wash their hands for a minimum of 20 seconds with soap and, after that, rinse their hands thoroughly with warm water.

But be honest. How many times have you washed your hands with soap for 20 seconds in a public restroom? I estimate that at least 20% of people who say they wash their hands do not meet the recommended 20-second duration of washing and, thus, would not qualify as persons with clean hands.

[I admit that the percentages used in these examples are not substantiated by any documentation or scientific research. I make them just to prove a point: That a fair percentage of persons leave the restroom with contaminated hands, and, unfortunately, will touch and contaminate the door knob or handle.]

But assuming that you are one of the few who followed the proper washing procedures and have clean hands, you will still be contaminated when you touch the knob or handle to open the restroom door. At this point, all the money, time and effort spent to provide a hands-free restroom are canceled and lost.

To increase the likelihood of proper hand washing, I recommend posting a small plaque (3" x 2") at all lavatories to remind or inform the users of the importance of properly washing the hands. The plaque inscription should say:

Wash your hands thoroughly with soap for 20 seconds and rinse your hands with warm water after using the restroom or before handling food.

Need For Better Planning

Enlarge this picture Figure 2. Paper towel dispensers (PDT) and waste baskets (WB) are located next to the exit doors.

I believe that with better planning of public restrooms and more education of the public, we can substantially reduce the risk of contamination from other persons.

Some architects and designers are designing bathrooms with paper towels and the wastebasket, or only the wastebasket, near the exit door (see Figure 1). In these instances, the person will dry his hands, and with the paper towel protecting his hand, touch the door knob or handle — thereby avoiding direct contact of his clean hand with the contaminated door knob or handle.

However, most of the public restrooms have the paper towels and wastebasket located near the lavatories and far away from the exit door (see Figure 2). What a waste! This is a typical example of a designer’s total lack of understanding of the concept of hands-free planning.

Some owners of fast food restaurants or other similar places, in order to satisfy their paramount goal to save paper (and money), decided to completely eliminate paper towels. These establishments offer only hot air blowers in the public restrooms. Obviously, in these cases, there is no paper to assist at the door opening, so we must touch the doorknob or the handle to exit the restroom.

Another alternative is to provide the self-closing restroom exit without a doorknob or handle and open the door in the direction of egress. This allows the person with clean hands to open the door without using his hands by pushing the door with his body.

There are several public restrooms designed without entrance doors (see Figure 3). This requires a little planning, more space for a vestibule before entering the restroom, and, therefore, may not be applicable in all locations.                                                                                               

Hospitals, in particular, are a place where contamination is frequent. It is estimated that two million patients are infected each year in hospitals. More than 90,000 of these patients die. In fact, “nosocomia” is a special name for hospital-acquired diseases.

Recent investigations regarding antimicrobial properties of copper, copper alloys, aluminum, stainless steel, plastics and other building materials concluded that copper and copper alloys will inhibit the growth of some pathogenic bacteria.

Frequent decontamination of knobs, plates, faucets, etc., colonized with bacteria, has been shown to reduce transmission of bacteria to other persons. I believe that architects and designers responsible for restroom design should pay more attention to the access, flow and exit of persons in the public restroom.

Another feature that concerns me is the floor in a public restroom. Many times the floor is made up of small tiles (2" x 2" or 4" x 4") so that it looks good, especially if the tiles are of different colors and installed in a specific pattern. On the other hand, using these relatively small tiles requires a substantial increase in grout footage. As we know, grout is porous and cracks easily, which makes a perfect space for bacteria to grow.

Why not use large tiles, which require less grout? Or better yet, make the restroom floor poured in place, and completely eliminate the grout.

When designing public restrooms, we also have to take into consideration how the maintenance personnel will be able to keep the floor clean and disinfected. One way is to use less grout.

Another way to avoid contamination is to use automatic-flushing water closets.

Conservation Concerns

Enlarge this picture Figure 3. Entrances to the restrooms have no doors. Privacy is provided by creating vestibules for both men’s and women’s restrooms.

I also have great concerns about the impact of bathroom design on saving water. Consider water closet stalls that are very small. After using a water closet, the person will stand up and start to pull up or down his/her clothes. Upon doing this, the closet automatically flushes, discharging a predetermined quantity of water. I believe that if the person stays in close proximity of the water closet (to dress up), the automatic flushing device will be activated again. Then when the person actually leaves the stall, another flushing will occur.

Depending upon the type of automatic flushing device installed, this unnecessary flushing can be eliminated quite easily by a simple adjustment. Another alternative is to increase the stall size to allow more space for the user. Something must be done to stop wasting precious potable water by extra flushing.

Maybe a joint committee can be formed to address these issues further — one that is made up of representatives from ASPE, AIA, manufacturers and contractors.

Together we can revisit the design of modern public restrooms and come up with practical recommendations to reduce the chances of contamination and save more water.