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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Thursday, June 15, 2006

Dirty Places, Part 1: Public Toilets

If you’re just now joining us, you’ll want to read Airplanes (part 2) and hospitals and doctors’ offices (part 3).

Someone posted on the WebMD General Health Board recently, horrified that her four-year old sat on a public restroom toilet seat without a protective cover or a lining of toilet paper. The mother was worried about all of the diseases her child may now be incubating.

Is this four-year old likely to get a Rotavirus infection (a common cause of diarrhea)? How about Herpes? I have seen some disgusting public restrooms in my life, so I can understand this mother’s concern; however, exposure to an infectious organism does not necessarily mean a person will develop a disease.

The human body is well-adapted to fighting off these ongoing exposures. Germs do not typically enter intact buttocks skin from a toilet seat, but no one wants to sit on them anyway. Using seat covers and paper is fine, but it really doesn’t protect you from microorganisms.

Children have a bad habit of holding on to the toilet seat, with their little fingers clutching underneath the rim. Granted, they don’t want to fall in, but those little fingertips will pick up under-seat germs like Velcro.

Germs do enter the body through the nose, eyes, and mouth, usually transmitted from our own, contaminated hands and fingers. If you watch a child wash their hands, you will see that they tend to miss the fingertips — perhaps the most contaminated part of the hands. And, those dirty fingertips will most likely be probing a nose or rubbing an eye within a few minutes.

I have to admit that I avoid public restrooms; however, the call of nature is not always convenient. Men do have a distinct advantage of being able to stand at a urinal — a very hygienic method to urinate. Women “hover” (so I am told). Perhaps this is why women develop very strong thigh and leg muscles. I have never been in a women’s restroom, but I suspect they are cleaner than a men’s room.

Little boys have a difficult time reaching adult urinals so they use the stall, peeing on both the seat and floor. Children also have not developed the fine art of flushing the toilet with their feet. After thoroughly washing my hands at a public restroom, I patiently wait until someone else comes in so that I can shoot out without touching the door. If no one comes in, I must resort to using a paper towel, assuming that the door has a handle to grab.

Men will also pee just about anywhere there is a tree, and we freely teach this skill to our male children. Working outside with my three-year old grandson, he announced that he needed to go potty. Not wanting to walk to the house, I told him he could just pee behind a tree. He was absolutely thrilled about this new technique.

Several weeks later, he asked his Dad if he could potty outside, like at Grandpa’s house. His Dad said okay, so Dylan promptly pulled down his pants and pooped in the front yard along a busy street.

I diagnose several urinary tract infections per week in my pediatric clinic. As part of the medical history, I always inquire about the restrooms at the schools. Many school toilets are worse than some backwoods gas stations. Some do not have locks that work or even doors for privacy. When restrooms are dirty, or not private, children won’t use them.

When children (usually little girls) hold their urine, they are more likely to get urinary tract infections. Kids also do not want to waste their precious recess time peeing or standing in line at the bathroom, so they just hold it. Although I know it can be disruptive, but elementary teachers who dish out severe penalties for children who ask to go to the toilet during class time should be forced to use the kid’s bathroom themselves.

Custodians usually clean restrooms at the end of the day, but it is rare that the toilets and other fixtures are disinfected.

Rotavirus infections can cause profound diarrhea and vomiting. This organism is easily spread in public restrooms and schools. As gross as this statement sounds, diarrhea tends to splash, spreading highly contaminated feces on surfaces and other fixtures. And, the dominant hand that wipes is the hand that contaminates door handles and faucets; and the hand that shakes your hand during greetings.

Perhaps this is why the Japanese bow, instead of shaking hands. While traveling in Japan many years ago, I experienced the Japanese style toilet — a long, narrow trough at floor level requiring the user to squat. Odd, yes, but quite sanitary. Now, speaking of men peeing anywhere they want — Japanese men in three-piece suits will pee into street in full view of the passing public. Many restrooms are unisex, so women have to file past the line of men peeing at urinals.

“We are trained not to look,” our Japanese friend told us. Of course, my wife was not Japanese. She routinely looked.

In some places in Great Britain and Europe, there are high-tech pay toilets that are completely disinfected between each use. Personally, I would happily pay for cleaner toilets.

When Nature calls, we must answer. Public restrooms are a very necessary convenience, but they are not without inherent risks. Take aim and/or hover. Use your seat liners and stacks of toilet paper. And, for Goodness sake, wash your hands (and fingertips!); methodically and thoroughly; with lots of soap and running water.

Related Topics: Drug May Shorten Kids’ Severe Diarrhea, What To Do About Diarrhea

Technorati Tags: rotavirus, diarrhea, hand-washing

Posted by: Rod Moser, PA, PhD at 12:30 am

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