Public Restroom Zone Survival

Instead of focusing on what you still need to buy or that you’re running late for an appointment, you might want to focus on how you intend to use the restroom without becoming contaminated with pathogens.

Before you even open the door, consider some of these affirmations:

• “I’m in a hurry, so I’ll be careful about what I touch.”
• “I will wash my hands with soap for at least twenty seconds.”
• “If someone is coughing or sneezing, then I will immediately leave and find another public restroom.”
• “Remember, the closest toilet stall to the door is usually the cleanest.”
• “The first thing I’ll do is grab a paper towel and hang it from my pocket for later use.”

These positive affirmations are to help you focus on your mood, attitude, and awareness so that you can be ready for whatever you might find on the other side of the public restroom zone door. Regardless of whether there are dirty-looking wash basins, empty soap and paper towel dispensers, unflushed toilets, wet floors, and terrible smells, if you have to go, you have to go!

Stay focused and use the tricks and techniques in this book to increase your chances of avoiding pathogen infection.

Your friends and family will never know how much they should thank you for not contaminating them.

When I have the urge to use the restroom but do not go, it’s usually because I don’t want to stop what I’m doing. The longer I wait to take a restroom break, the more my muscles tense, and eventually my body rebels, and I have no choice but to use the public restroom.

I have not seen any studies about the intensity of the contracting muscles a person deploys to make it to the toilet or urinal in the nick of time, but my guess is:

• Accuracy would be the first significant problem and is one reason for wet floors.
• Difficulty adjusting the sanitary paper liner on a toilet seat when you can’t hold it in any longer. We don’t need to use our imagination to picture this because we’ve all been there, done that.
• Not carefully centering buttocks on the toilet seat with the anus directly above where the water is the deepest in the toilet bowl. If the aim is off, more fecal, urine, or blood residue will stick to the porcelain after flushing.

The more relaxed my body is, the easier it is for me to focus on everything that is around me. The sinks are dirty; there is urine on the toilet seat; two stalls from mine have wet floors; no sound from the ventilation fan; and dirty finger marks on the ragged, torn edge of the toilet paper hanging in my stall. These are the conditions I will notice when I am not in a hurry.

Dear reader, please leave the public restroom in the same condition you found it.

When walking to the restroom or standing at the sink, I will remember many things I have done with my hands since my last wash. People and objects my hands have been in contact with are still somewhat attached to me. I intend that washing my hands will help me let go of the past. I will be refreshed, and my hands will be ready to touch the future.

Sometimes after a bad experience at work, I will go to the public restroom to wash my hands. I visualize my anger or sadness floating away with the white, soapy foam. I then say goodbye to my worries, expectations, and disappointments while fresh, clean water rinses them all down the drain. Both my soul and my hands are now refreshed.

Opening the Public Restroom Door

If you have a jacket or a long-sleeved shirt on, you can pull a hand up inside the sleeve and grab the surface of the doorknob/handle with your shirt placed between your fingers and the door handle. If you are wearing a short-sleeved shirt and do not have a paper towel or sanitary wipe to open the restroom door, you could wait for the next person to come along to open the door while you follow them in.

If the restroom is for single use only, minimize your risk of contamination by using the following methods. Take your little finger, or your elbow, or the back of your hand, and push down on the handle to open the door. If it is a doorknob, grip it with your fingers, not your palm. Most importantly, do not allow the undersides of your fingernails to touch the surface of the doorknob.

What to Look for Once Inside the Public Restroom

Once inside the public restroom, decide whether to use it, go to another one, or wait until you get home. These are the rules to live by:

• If someone is coughing or sneezing, then leave immediately and find another public restroom.
• If the paper towel dispenser is empty or there is a roll of towels on the sink countertop, leave unless you brought towels.
• If the floor around the toilet or urinal is wet, leave.
• If the soap dispenser is empty or broken, leave unless you have soap with you.
• If there are no paper towels and only a hand dryer, either stay or leave. Complain to management.
• If there are flies, mosquitoes, or rodent droppings, leave.

If you decide to stay, then grab some paper towels and tuck a couple in your pocket and do the following before entering the toilet stall:

• Dispense soap on your hands and scrub them for 20 seconds without water.
• Use a paper towel to turn the water faucet handle.
• Thoroughly rinse hands to remove microorganisms that are still alive and suspended/trapped in the soap’s foamy solvents, especially under the fingertips.
• Turn off the water faucet handle with a paper towel, then use the toilet stall.

Paper Towels vs. Hot-Air Dryer for Removing Germs?

In 2005, TUV Produkt und Umwelt conducted a study comparing different hand-drying methods. (25) They found:

The drying method using paper towels resulted in a decrease in bacterial count of 24%.

The drying method using a hot-air dryer resulted in an Increase in bacterial count of 12%.

What’s Behind Toilet Stall Door # 2?

Upon swinging open the toilet stall door, your eyes feast in horror upon an unflushed toilet.

Let’s not panic. Unfortunately, when one must use a toilet, you have only bad choices. Remember that an unflushed toilet might mean that it is: 1) broken or 2) someone can’t deal with their own $%&#, so they walked away without flushing.

Surveying the scene, you find four toilets: one broken, one in use, and two with unflushed excrement from the previous user who refused to touch the handle. Another stall has wet floors and an unflushed toilet, and another has no toilet paper and an unflushed toilet.

Two possible solutions are grabbing the toilet paper from the one stall with wet floors and using it for the stall with dry floors, but no toilet paper and the unflushed toilet looks better than the first one you picked. So there you are.

You decide to stay and use this toilet.

• Cover the automatic flushing sensor with a toilet seat sanitation cover.
• Use another toilet seat sanitation cover and unfold it, but do not separate the perforations.
• Place a seat cover flatly over unflushed materials inside the toilet bowl (to help shield you from back spray when flushing).
• If possible, have the door open before flushing the toilet.
• Remove the cover from the automatic flushing sensor, flush the toilet, exit the stall, and close the door.
• Wait at least ten seconds, open the door, and wait a few more seconds or until you feel comfortable reentering.
• If the toilet overflows, wash your hands and leave to find another restroom.

Wet Floor Cosmology

Avoid any wet areas of the floor, especially around the toilet or urinal. Public restroom floor areas, whether damp or dry, will harbor more bacteria and virus colonies than other surfaces.

Pathogen-infested water also contains dirt, hair, soap, urine, blood, and feces, which makes it sticky and stubbornly adheres to the bottom of your shoes as you walk back to your office or car. If this damp, sticky gunk is carried onto and deposited on your car's floorboards, these pathogens can be transmitted into your home. It is better to avoid wet areas altogether. Leave and use a different restroom.

If you’re not able to do that because you need to use the toilet or there is no other public restroom available, remember that your shoes are contaminated. If you are at work, return to your car and grab an extra pair of shoes, or find a carpeted area to wipe the bottoms of your shoes. Consider keeping an extra pair of shoes in your car’s trunk for emergencies; hopefully, you will never have to use them more than a few times a month.

Come to think of it, the Boy Scouts or Girl Scouts really should have a merit badge on infectious diseases for public restrooms.

Flip-flops are not a good idea to wear because when you flush the toilet or use a urinal, the aerosol mist can deliver tiny droplets containing captured germs onto your bare feet. If you have cuts, abrasions, or lesions on your feet or buttocks, do not use a public restroom. Go home.

Toilet Paper Colonization

During a toilet flush, the force of the swirling, draining water causes tiny aerosolized pathogenic droplets to fly out of the toilet bowl and land up to 6 feet away. All surfaces inside the toilet stall will become contaminated by this toilet-flushing overspray, but because these surfaces are smooth and hard, the pathogens will soon die.

Toilet paper is exceptionally absorbent, making it a perfect surface for absorbing the flushing toilet’s overspray. Toilet paper is a nurturing surface, so bacteria can live and grow on it until they catch a ride on the next person who touches it.

When you place toilet paper on a toilet seat before sitting on it, you are exposing yourself to more germs than if you just sat down on an unprotected toilet seat. The next best thing is to pull down the toilet paper foot, or at least four sheets, and to discard them. These tissues have been exposed to toilet flushing overspray. Just discard those tissues in the toilet bowl. Hopefully, you will now have fresh toilet tissue to use. Another solution to this problem is to have toilet paper with you.

Which method of holding toilet paper to wipe one’s buttocks is the most effective for removing the most excrement? You may choose from the following or experiment to determine which method works best for you.

• Toilet paper wrapped around four fingers protects fingers and nails from contamination.
• Paper crumpled in a ball with multiple edges to wipe skin more effectively in removing residual excrement.
• A twelve-inch length of toilet paper folded in half and then again to provide eight tissue layers to protect hand.s
• Sanitary wipes used from your DIY restroom zone kit

Squat, Crouch, Hoover, Sit, or Levitate?

Squatting at a 35-degree angle is how most people around the world have positioned themselves for bowel movements for thousands of years. Today’s modern toilet design forces people to sit at a 90-degree angle. This toilet position pinches the intestines so that the complete evacuation of excrement is sealed off, which can cause constipation, hemorrhoids, and irritable bowels. The correct way to sit on the toilet —you’ve been doing it wrong your entire life. (26)

The problem today is that some countries only have 90-degree sitting-throne toilets, and people use a squatting posture on the toilet seat. If people want to leave the restroom in the same condition or better than they found it, then they must not squat over the toilet bowl by placing shoes on the toilet seat or bowl rim and balancing themselves while aiming at the center of the toilet bowl. The people who use this squatting style are trashing the restroom and making it more infectious for the next innocent user.

• The gunk on the bottom of your shoes will grind into the toilet seat surface, marring the antimicrobial finish and making it more infectious and harder to clean.
• People from higher elevations above the toilet bowl will leave more urine, pubic hairs, feces, and blood on the seat and floor.
• The next person who uses the toilet sees a vista that says, “I didn’t care. Why should you?”

If you do not want to sit down on the toilet seat, it is much better to hover or crouch over the toilet without sitting on the throne. This allows you to sit on the toilet without overspraying the seat and floor. This method of crouching over the toilet will not mar the toilet seat’s antimicrobial finish, but it still causes more urine, feces, and blood to be sprayed onto the seat and the floor than just sitting on the toilet seat.

• Women spend twice as much time using a toilet as do men.
• Eighty-five percent of women crouch over the toilet.

Hovering can be effective if the person has strong leg muscles and can stay on target while doing the do. Remember, the more elevated your buttocks above the toilet bowl seat, the more forceful the backsplash will be upward toward your genital areas, which is a major problem with hovering.

I guess that people who hover above the toilet will have two answers as to why they use this method:

• My mom told me to “never sit on the toilet seat.”
• I would never touch a toilet. The toilet is gross! (self-fulfilling prophecy)

If only plumbing fixture manufacturers designed a female toilet bowl shaped like a dolphin’s head for hovering. Unfortunately, this hovering toilet dolphin bowl design still couldn’t prevent urine overspray from a person who is losing balance, off-center, or adjusting aim while reaching for the toilet paper. I guess that this design might reduce overspray by 15 percent when hovering compared to a typical toilet bowl.

"Twinkle, twinkle, little drop,
How I wonder where you’ll plop!
Down beneath the world unseen,
Like a Virus in the bloodstream."

Sitting down on the toilet seat contaminates the toilet stall and the floor area less than crouching or levitating. Sitting down and relaxing to do the do is the best defense against the spread of epidemics and pandemics in the community. This is social justice.

Every time a toilet flushes, the aerosolized spray of toilet water contaminates all surfaces. These include the toilet paper dispenser, toilet flush handle, and door latch.

However, the walls are the most contaminated of all the surfaces inside the stall. The top of the toilet seat is usually the least contaminated surface.

Sitting down on the toilet seat is the best practice for keeping public restrooms clean and safe and this minimizes the spread of a pandemic. The top of a toilet seat averages around 700-1000 pathogens per square inch.

The underside of a toilet seat has 20,000-35,000. The office desktop has around 25,000, but the top of the toilet seat has 750 to 1,000 pathogens per square inch. You do the math.

“It’s better to eat your sandwich on a toilet seat than on your office desktop.” 
Dr. Charles P. Gerba, also known as Dr. Germ, is a University of Arizona Professor of Microbiology. (27)

The human skin on our backside is impermeable, so bacteria need cuts and abrasions to penetrate the skin and cause an infection. It is safe to sit down on a toilet seat with a naked butt if you wipe the toilet seat first. Parents should not tell their children to never sit on a toilet seat. That’s fear without knowledge, indoctrinating future generations with social injustice. So many Moms teach their daughters "never sit down on the toilet seat," thus enabling them to spread disease to their fellow sisters who have to use the stall next. Is this Social Justice?

Public Restroom Social Justice

Unfortunately, people generally do not have a “veil of ignorance” persona (“Theory of Justice” by John Rawls), so that there can be “social justice” while using a public restroom. (28)

People damn public restrooms by their own intentional or ignorant behaviors.

• Scared of the toilet stall, people trash the toilet area by squatting with their feet on the toilet seat.
• They do not flush the toilet when done.
• After people use the toilet, some decide that the handwashing basins are too dirty to use and leave the restroom.
• To protect their investment in beautiful, ornate, manicured fingernails, they wash their hands with water alone, without soap.
• Their mantra is, “The faster I leave the restroom, the safer I’ll be.”
• The janitor can clean up my mess.
• Men who refuse to use a urinal and then do not lift the toilet seat to pee.
• Some people use the restroom only in emergencies.
• The manboy always heard mom say, "It's not his fault, it's God's design."

The practice of using the foot to flush the toilet is how toilets get broken. This flushing handle was not designed to withstand such heavy force. If it’s not broken, there is still the next person who must touch the handle to consider. Use the knee instead to reduce the risk of breaking it.

Bacterial “Resistome” is a term used to describe different types of Bacteria that can exchange DNA codes with each other to produce a SuperBug.

The floors of public restrooms are experimental labs concocting new varieties of drug-resistant microscopic life forms that can mutate into superbugs and exchange DNA codes with other microbes, thus adapting each other’s infectious abilities. This is the scariest reality living within the public restroom zone.

A shout-out to the researchers, Mkrtchyan HV, Russell CA, Wang N, Cutler RR (2013), who conducted this study, and to those who funded it. (29)

Public Restrooms Could Be an Environment for Bacterial Resistomes

“Bacterial ‘resistomes’ are communities of bacteria often localized in specific areas and within these environments, drug resistance determinants may be freely transferred.”

“Antibiotic resistance in bacteria remains a major problem, and environments that help maintain such resistance represent a significant problem for infection control in the community.”

“Restrooms have always been regarded as potential sources of infectious diseases, and we suggest they have the potential to sustain bacterial ‘resistomes. ”

“Our study shows that non-healthcare restrooms are a source of antibiotic-resistant bacteria where a collection of antibiotic resistance genes in pathogenic and nonpathogenic bacteria could form a resistome containing a ‘nexus of genetic diversity.”

Code Brown

I’m not surprised that hospitals don’t have a Code Brown for public restrooms. Seriously, public restrooms in Hospitals, medical office buildings, and healthcare centers are the cleanest and safest places to use the restroom in the world.

The “terminal cleaning” methods used by Environmental Restroom Technicians help maintain healthy, safe public restroom environments. All government and commercial building owners should use these hospital environmental cleaning procedures. Building managers and janitorial cleaning businesses could include language in rental/service agreements specifying the use of healthcare environmental “terminalcleaning” methods for non-healthcare public restroom floors. Today’s janitors and custodians will need to be trained and certified as Environmental Restroom Technicians.

I predict that someday, the United States Congress, with Bipartisan support, will pass the American Public Restroom Act (APRA) into law, implementing IDC (Infectious Disease Control) guidelines for every non-healthcare public restroom.

• High-volume exhaust HEPA-filter ventilation systems.
• Only Certified Janitorial staff trained using hospital-designed “terminal-cleaning” floor maintenance programs. This would protect the public from spreading disease thought-out the public building and down the street.
• Paper Towel shielded dispensers.
• Toilet Paper shielded dispensers.
• No electric hand-drying air-blowers allowed.
• The toilet automatically flushes when you

open the door to leave the confined-space toilet stall.

Join me, let us imagine a future world with safe, non-healthcare public restrooms; gas stations, restaurants, public and private schools, universities, sporting events, shopping centers, and Porta Potties at construction sites, parks, and special events. All of these restrooms will have one thing in common: they share the same display sign —the Nurses Seal of Approval. This seal is only displayed if the restroom is maintained and cleaned by certified restroom technicians.

The bottom line, where you sign with your behind, is to leave the public restroom in the same or in better condition than when you first entered.