Men are aiding hospital "superbugs" by leaving toilets dirty

The researchers collected microbe samples from toilets in three general hospitals in Lanarkshire in the U.K., swabbing various surfaces in six types of toilets (male and female for both staff and patients, as well as disabled and unisex) around four hours after they had been cleaned. The surfaces included the flush, handrail, door handle, faucet, floor, shelves, tops of doors, and air vents.

They found that several surfaces were host to dangerous bacteria including E. coli and Staphylococcus aureus, as well as several species associated with bloodstream infections, chest infections and pneumonia, as well as urinary tract infections.

Many of these bacteria were also found to be drug-resistant superbugs, and these were discovered to be concentrated in the patient toilets. Superbugs are strains of bacteria, viruses, fungi, and parasites that have developed resistance to the medications commonly used to treat infections, such as antibiotics.

This resistance makes infections caused by superbugs difficult to treat and can result in longer illnesses and more hospitalizations. Examples of well-known superbugs include Methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Mycobacterium tuberculosis (MDR-TB).

"Every type of toilet in all three hospitals receives the same cleaning (type and frequency) every day but given our findings, we think that patient toilets should be cleaned more often," study researcher Stephanie Dancer, a consultant microbiologist at NHS Lanarkshire, said in a statement.

In terms of overall contamination, the unisex toilets had the highest levels of microbes on their surfaces. This may be due to them simply being used more, or due to them being used by more men, as the female-only toilets were consistently cleaner than the male-only toilets.

"The move to convert traditional male and female facilities to unisex facilities in some hospitals raises concern that people might be exposed to higher risks of contamination," Dancer said.

"For example, hand hygiene surveys show that women are more likely to clean their hands after bathroom use than men, so we decided to investigate which microbes were present on different surfaces in toilets and how many of them there were."

"Our results appear to confirm what is generally thought in society: women clean because their perception of dirt and disgust entices action whereas men either don't notice a dirty environment or don't care. It follows that women are more likely to leave a bathroom 'clean,' while men assume someone will clean up after them," she said.

"Single sex and disabled toilets should be retained; with additional facilities labeled unisex and available for anyone. But based on this study's findings, I don't believe we should be abandoning single sex toilets in favor of unisex toilets, since these toilets had the highest microbial burden overall."

The researchers also found that floors and surfaces like the tops of doors and the air vents had lighter levels of certain bacteria than surfaces that people would often touch with their hands.

"We think that the only logical explanation for this is that toilet flushing aerosolizes whatever is in the toilet bowl, whereupon tiny water particles carrying these organisms fly up to the ceiling and contaminate high sites," Dancer said.

This also was likely because hand-touch sites are more thoroughly cleaned than others, the researchers suggest.

"In contrast with hand-touch sites, floors are a major repository of dirt. Anything in the air eventually ends up on the floor, along with whatever is brought in on people's footwear or shed from skin and clothes when they use the toilet," Dancer said.

The female staff and patient toilets had lower levels of microbes than males, with male staff toilet door handles possessing eight times fewer microbes than those of female toilets. This could be down to more frequent hand-washing in female staff.

"There is no doubt everyone could do with more education on hand hygiene. The more we all understand about how to protect ourselves and others from germs, the better," said Dancer.

The researchers advise putting toilet lids down before flushing, washing hands well, and opening windows if possible,

"Put the lid down before you flush and then wash your hands well and dry them with a clean towel," Dancer said. "If you can, open a window in the bathroom, before using the toilet, and that's not just to get rid of the smell."

They hope to do further research into the bathrooms of other hospitals with differing cleaning schedules, as well as the effects of windows on the bathroom microbiota.

"None of the toilets sampled in the study had a window. I would be very interested to repeat the study in toilets with open windows providing an abundant supply of fresh air," Dancer said.

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