Increased Infections: Poor Toilet Design and Disinfection - infections from sitting on toilet seats?

  • lindasemana
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Increased Infections: Poor Toilet Design and Disinfection

Sit on toilet seats are common in office settings and even urban schools. But instead of giving the required comfort they become a host for infections that affect women and girls in Uganda.

Three in 10 women using these toilets without proper disinfection is bound to have recurrent infections. As opposed to those who use squat hole toilets.

These infections according to the State Minister of Health Uganda, Hon. Sarah Opendi are a cause of infertility causing women 's Fallopian tubes to clog.
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  • bowenarrow
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Re: Increased Infections: Poor Toilet Design and Disinfection

In my 30 years of experience with toilet manufacture I have come to the conclusion that design does not cause these infective rates, but it comes down to culture and toilet use. It is no use introducing sit on pedestals if you cannot bring cultural change with such introduction. Squatting is not sitting, and sit on pedestals are bound to become useless if squatting practices are continued. There is no comparison between squat pans and sit on pedestals as far as cleaning is concerned. The throat and walls of a sit on pedestal are visible to guide cleaning practices but a squat pan conceals, and is therefore difficult to clean, leaving the maintenance crew only harsh chemicals to attempt effective sanitation.
Ross
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  • lindasemana
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Re: Increased Infections: Poor Toilet Design and Disinfection

Perhaps you should do a survey. I am talking from personal experience and from the views i have captured. In an organisation of 280 staff i learned that the majority of women had picked infections from the sit on pedestals ...me inclusive. Interesting in a workshop on sexual reproductive health i attended last month - i brought it up and not only was this further acknowledged but i also learned from the male participants they too found this technology risky because whenever they sat on the sit on toilets their male organs tended to make inappropriate contact with the toilet.

Did you know there is a number of people who stand (women) when using these toilets or even (worse case scenario) they stand on them?

Sit on toilets have one place their body parts directly on the sit. In a busy place where toilets are being shared this poses a risk.
And there is need to have disinfection measures put in place to prevent.
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  • bowenarrow
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Re: Increased Infections: Poor Toilet Design and Disinfection

To me the survey is done. Sit on toilets have been in use by millions of people throughout the world for over 100 years with no known side effects other than yours having been alluded too. How have these complainants proved that the infections they have sustained are caused by sit on toilets ? Where is that evidence ? Oral views ?
Ross
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  • lindasemana
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Re: Increased Infections: Poor Toilet Design and Disinfection

A practice being around for 100 years does not justify it as being okay. We have broken taboos on menstrual hygiene and this too will be eliminated.

We all know toilet seat bacteria can be transferred to the urethral or genital tract as well as the anal area. These are openings into our body that are sat on the affected toilet seat. So we are in a queue and two out of 10 have infections...guess what...we are all susceptible to being infected if there is no proper measure for disinfection.

You should read Flores GE, Bates ST, Knights D, Lauber CL, Stombaugh J, et al. (2011) Microbial Biogeography of Public Restroom Surfaces. PLoS ONE 6(11): e28132. doi:10.1371/journal.pone.0028132 Editor: Mark R. Liles, Auburn University, United States of America.
journals.plos.org/plosone/article?id=10....journal.pone.0028132

Besides my findings there is literature out there to support this.
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  • lindasemana
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Re: Increased Infections: Poor Toilet Design and Disinfection

Note by moderator:
The following abstract is from a paper on "Microbial Biogeography of Public Restroom Surfaces"
Citation: Flores GE, Bates ST, Knights D, Lauber CL, Stombaugh J, et al. (2011) Microbial Biogeography of Public Restroom Surfaces. PLoS ONE 6(11): e28132. doi:10.1371/journal.pone.0028132 Editor: Mark R. Liles, Auburn University, United States of America
journals.plos.org/plosone/article?id=10....journal.pone.0028132

++++++++++++

Abstract: We spend the majority of our lives indoors where we are constantly exposed to bacteria residing on surfaces. However, the diversity of these surface-associated communities is largely unknown. We explored the biogeographical patterns exhibited by bacteria across ten surfaces within each of twelve public restrooms. Using high-throughput barcoded pyrosequencing of the 16 S rRNA gene, we identified 19 bacterial phyla across all surfaces. Most sequences belonged to four phyla: Actinobacteria, Bacteriodetes, Firmicutes and Proteobacteria. The communities clustered into three general categories: those found on surfaces associated with toilets, those on the restroom floor, and those found on surfaces routinely touched with hands. On toilet surfaces, gut-associated taxa were more prevalent, suggesting fecal contamination of these surfaces. Floor surfaces were the most diverse of all communities and contained several taxa commonly found in soils. Skin-associated bacteria, especially the Propionibacteriaceae, dominated surfaces routinely touched with our hands. Certain taxa were more common in female than in male restrooms as vagina-associated Lactobacillaceae were widely distributed in female restrooms, likely from urine contamination. Use of the SourceTracker algorithm confirmed many of our taxonomic observations as human skin was the primary source of bacteria on restroom surfaces. Overall, these results demonstrate that restroom surfaces host relatively diverse microbial communities dominated by human-associated bacteria with clear linkages between communities on or in different body sites and those communities found on restroom surfaces. More generally, this work is relevant to the public health field as we show that human-associated microbes are commonly found on restroom surfaces suggesting that bacterial pathogens could readily be transmitted between individuals by the touching of surfaces. Furthermore, we demonstrate that we can use high-throughput analyses of bacterial communities to determine sources of bacteria on indoor surfaces, an approach which could be used to track pathogen transmission and test the efficacy of hygiene practices.

Citation: Flores GE, Bates ST, Knights D, Lauber CL, Stombaugh J, et al. (2011) Microbial Biogeography of Public Restroom Surfaces. PLoS ONE 6(11): e28132. doi:10.1371/journal.pone.0028132 Editor: Mark R. Liles, Auburn University, United States of America
journals.plos.org/plosone/article?id=10....journal.pone.0028132
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  • muench
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Re: Increased Infections: Poor Toilet Design and Disinfection

I agree with Ross that we need to carefully look at the scientific evidence.

The paper that you linked to, Linda, does not support your statements from your earlier posts. The paper merely confirms what we know already, i.e.:
"human-associated microbes are commonly found on restroom surfaces suggesting that bacterial pathogens could readily be transmitted between individuals by the touching of surfaces."

To jump from there to your opening statement of "These infections according to the State Minister of Health Uganda, Hon. Sarah Opendi are a cause of infertility causing women 's Fallopian tubes to clog." is a very far jump and completely unsupported of science.

Nevertheless, I have heard of many women (also in Germany) who do not like to sit on toilet seats in public toilets for fear of infections (mostly irrational fears in my opinion). They usually build a little "nest", i.e. put toilet paper onto the seat or they hover over the toilet seat in a skiers position. Therefore, their skin does not touch the seat. I guess if you have that kind of fear then it's a good solution.

So I don't really see a problem here?
Linda, are you trying to say that sitting toilets are no good and everyone should be forced to use squatting toilets (at least in public toilet settings)? You might also like to review this older thread that looked at the same issue as well:

forum.susana.org/forum/categories/141-ot...lets-in-your-country

Regards,
Elisabeth

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  • hester
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Re: Increased Infections: Poor Toilet Design and Disinfection

Dear all, it seems like this conversation is turning into a 'sitting toilets yes' versus 'sitting toilets no' discussion and on whom can bring along the best scientific proof to strengthen his or her statement. I agree with Linda that especially in the case of crowded places like public toilets and school toilets (in Africa and Asia for example), squatting latrines are a better option to prevent infections. Think especially of children in schools, the chance of getting in contact with bacteria by sitting on a toilet seat is quite high, and think about cases of diarrhea - how nice would it be if after each toilet visit, someone would disinfect the latrine. How many schools do we know where this hygiene measure is practiced? In my country, the Netherlands, none - there are a lot of complaints about the cleanliness of school toilets in my country.. No, I do not bring along scientific proof along with my preference for squatting as a hygienic option as opposed to sitting on toilets - I just bring some experiences from working especially with schools in Africa. I remember a very nice dry sitting toilet introduced in Mozambique which was rejected by users with the argument of increased danger of infection. Maybe this rejection was just based on cultural preferences - what do you think. Elizabeth? Of course in all cases, frequent cleaning would help to prevent the danger of infections. In a practical sense, squatting toilets in crowded places are easier to clean and with less water - which in this 'water scarce era' is an important issue. Bring in chemicals then in schools in remote rural areas? Who would pay for that, and what would side effects be?
For some reason, the good old French have squatted for ages and still do, to a large extend - and they won the World Soccer games. Could we ask a French woman about the experiences in her country, and the reason why many French prefer squatting over sitting on toilets?

And for my understanding: if Linda says she has evidence from infections caused by unclean sitting toilets, why would we not believe her?
Cheers, Hester Foppen, Aqua for All, Netherlands.
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  • bowenarrow
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Re: Increased Infections: Poor Toilet Design and Disinfection

I have no doubts about the dangers of infections and the paper put forward illustrates that, but to put the blame on sitting toilets when with squatting the risk factors are the same leaves me with no alternative than to think this is just bias.

Where does the contamination come from with a sitting toilet ? From the user I imagine, and the same thing applies to a squatting toilet particularly with children. A squat plate can harbour just about the same level of contamination or ever more as the area is larger. You don't sit on a squat plate but you do squat adjacent to the throat so contamination risks are higher through misdirection as you are above the plate.
Where then does the contamination actually come from when sitting ? The Pedestal walls and throat can be spoiled but this is equal to the risks when considering a squat plate. So to me if a sitting pedestal seat is carrying contamination it can only come from someone squatting when they should be sitting. In those circumstances how is the Pedestal at fault ?
Ross
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  • hester
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Re: Increased Infections: Poor Toilet Design and Disinfection

Sure, I am biased, I do admit. I myself, if I were in charge of investment decisions (like the Ugandan ministry which was mentioned earlier), in situations where there is a challenge in guarantying cleanliness. I would opt for a dual model: a row of squatting toilets and one or two sitting toilets for elderly people / people who do not like squatting, for whatever reason. A challenge in guarantying cleanliness can be caused by:
-frequency of use of the toilets (public toilets in (informal) urban areas, where many houses lack toilet facilities and people are queuing for the public toilet building at peak hours);
-scarcity of water (which is the case in many African and Asian cities, large part of the year);
-scarcity of budget allocated to cleaning of toilets - which is the case in many countries;
-cultural preferences for squatting - which is the case in many countries.

So this is my bias. I would wish a world in which every household would possess a bathroom with running water 24 hours a day, during the whole year, and then, they could as well invest in a sitting toilet. Sitting toilets are aspirational, for many people. But in this imperfect world, this aspiration is more a dream than a realistic goal. I remember a 'model school' in Ghana, adopted by the First Lady, with a beautiful row of small toilet pots for the smallest children. But: not in use, because the school could not pay the water bill. This is a reality in our far from perfect world, which makes me have a preference for squatting toilets in the cases I mentioned.
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  • hester
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Re: Increased Infections: Poor Toilet Design and Disinfection

Talking about how to prevent infections from toilet use, either by toilet seats or latrines: could urinals for women help to prevent the splashing while using public latrines, which is reported (I heard it recently from Tanzania where squatting is the common practice) as a cause of infections? Any experiences with this technology? I know it is applied at some schools.
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  • lindasemana
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Re: Increased Infections: Poor Toilet Design and Disinfection

Disinfection is core to urinals, squats or sit on toilets. And its the factor that determines an increase in infections if missing. Currently it is not quite focused on.
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