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Are we doomed to pick up a few million invisible, health-destroying bacteria every time nature calls while we're out and about and we have no choice but to use a public bathroom? Or can we make it out germ-free? The power is in your hands — so wash them.

Nobody likes public bathrooms. But when nature calls at the mall, in the library, or at the dreaded highway stop, we don't have much choice. Are we doomed to pick up a few million invisible, health-destroying microterrors, or can we make it out sans pathogens? The power is, as they say, in your hands.

Public restrooms are always crawling with microorganisms, but they can also be a source of pathogens – the disease-causing microbes we really want to avoid. 

Many bacteria, and even viruses, can survive in the humid environment of restrooms long enough for other people to pick them up and spread them around. Shigella spp., Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and norovirus have all earned themselves spots on the unwanted-guest list.  

The most frightening bacteria lurking in some low-hygiene restrooms is the methicillin-resistant Staphylococcus aureus (MRSA) that renders most antibiotics powerless. 

Given the constant traffic in these “necessary evil” spots, hygiene standards in public bathrooms have an important impact on public health. Those in charge of maintaining these restrooms play a key role in deciding how germy public spaces are, but users, too, can take steps to prevent the spread of pathogens. 

Public bathrooms: Where do the germs hide out? 

Toilet seats and other surfaces that constantly see direct contact with users’ private parts represent, it will come as no surprise, the biggest microbial “congestion zone”. They shouldn’t be your primary concern, mind you, as most infections actually arise from improper hand hygiene after using the toilet. 

When it comes to hand hygiene, some public restrooms are better equipped than others. Automatic faucets — which allow you to wash your hands without ever touching potentially germ-ridden taps to turn them off — are real winners.

Drying your hands is as important as washing them, because wet hands are more likely to transmit residual microbes. 

While scientists are still engaged in heated debates about the benefits of paper towel dispensers vs electric hand dryers, most experts see disposable paper towels as more hygienic. Electric dryers disperse water from the hands, after all, putting other users at risk of inhaling evaporated germ-ridden particles. 

Others, however, think electric dryers do a better job. Paper towels are less efficient and subsequently end up in bins, which can also be a source of contamination.

Whatever method is available in any particular restroom — drying your hands is far superior to keeping them wet. 

So, you’re done with your business, and have washed and dried your hands like the health-conscious citizen you are — but you’re not danger-free quite yet. If you have to touch a door to get out, know that microbiologists have isolated more bacterial strains from classic door handles than from doorknobs. This means that doorknobs are more sanitary than internal door handles in public bathrooms.

The good news? Every time you wash your hands properly, you're also reminding others who haven't quite received the message yet to do the same! Good habits are contagious, and you can absolutely do your part in passing your meticulous hand hygiene skills onto others:

Effective handwashing is a practical skill that you can easily learn, teach to others, & use every day to #PrepYourHealth for an #emergency. Here are 3 reasons why you should always care about handwashing: #KeepHandsClean #Thanksgiving #ThursdayThoughts

— CDC Emergency (@CDCemergency) November 28, 2019

If you're visiting public restrooms with your family in tow, that includes your children! Don't forget to get your kids to wash their hands, too. 

Should you use hand sanitizer after using a public restroom?

Alcohol-based hand sanitizers are quite an efficient way to protect yourself against bathroom-based viruses and bacteria — even, according to many studies, performing better than regular soaps. They don’t do much for public health, on the other hand, if you skip the soap and water and go on to touch doorknobs and other surfaces with dirty hands before you break out the hand sanitizer. If you really want to use hand sanitizer, consider making it an addition instead of a replacement. 

Men vs women: Whose bathrooms are more disgusting?

Most studies on the topic reveal that female public bathrooms are generally cleaner than male bathrooms. Researchers have isolated tons more microbes from doorknobs and other elements in male bathrooms. 

This is consistent with the finding that women are simply better about using soap after going to the toilet, while men often just stick to water. Some men who participated in one study confessed that they’d sometimes skip handwashing altogether if they “only” urinated and were in a hurry. 

Women might have better hand hygiene habits, but it’s important to point out that they have space for improvement all the same — they, too, rarely follow CDC guidelines to scrub their hands with soap for 20 seconds, and then rinse with water.

What can you do to encourage people to wash their hands?

If your workplace — perhaps a school, large office, or mall — has a public bathroom, some simple steps could make a huge difference in encouraging folks to de-germ their hands. 

You’d think posters and signs reminding you to wash and dry your hands could only have positive results — but it turns out that that’s not necessarily true. If these signs invoke fear, warning you about the flu or other illnesses, they actually simply make users want to get out of the bathroom immediately, instead of encouraging them to wash their hands. If you’re going to put up reminders, keep them positive! 

Many people are also more inclined to skip the quick, simple, and potentially life-saving step of washing their hands if they don’t have anywhere to stash their personal belongings until they’re done. Studies show that only 15 percent of US public restrooms have this feature. Thinking about ways to keep your bathroom visitors’ stuff safe while they wash their hands could lead to a drastic cut in the number of pathogens on surfaces all over your workplace!

Do all public bathrooms carry the same risks?

Of course not. Think of shared bathrooms in hostels, public bathrooms in shopping malls, airports, kindergartens, and hospitals. Very different types and numbers of users see the inside of such bathrooms every day. That is why they have different cleaning policies.

Restrooms in hospitals are a special case, because of the risk of intrahospital infections. In a hospital environment, hygiene is maintained using very aggressive sanitizers and disinfectants. Many patients will be using antibiotics at any given time, and their presence in this environment poses a risk for very resistant bacterial strains that cause nearly untreatable intrahospital infections.

Intrahospital infections have become one of the most challenging problems even in the world’s top hospitals — but the global trend of overprescribing antibiotics means that you can now get the MRSA that was once confined to clinics and emergency rooms basically anywhere, with community-acquired cases of antibiotic-resistant super bacteria rising rapidly. Because of this, washing your hands properly is becoming more important than ever before.