How to use a public bathroom in the time of COVID-19 - Cape Cod Healthcare

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Published on June 30, 2020

How to use a public bathroom in the time of COVID-19

Public Bathroom Safety

A quick pandemic quiz: What do all these things have in common?

  1. A leisurely lunch at a restaurant
  2. A day at the beach
  3. A four-hour drive to see your mom

Answer: Any one of those activities might require a stop in a public restroom. And right now, that’s likely to give most people pause.

But sometimes, you just have to go. And that’s OK, if you take precautions, said Patrick Cahill, MD, an infectious disease expert with Cape Cod Healthcare.

“I’ll go into a public bathroom if I need to,” he said. The trick, he added, is to follow the usual COVID-19 protocols, such as touching as few surfaces as possible, washing hands properly and closing the toilet lid before flushing -- assuming there is one.

A recent study published in the journal Physics of Fluids, found that the power of a flush can send up a plume of aerosols as high as 3.5 feet. The New York Times reported that while it’s still unclear if public or shared bathrooms are a source of COVID-19 spread, evidence of the virus has been found in the fecal matter of infected patients. Researchers recommend not only closing the lid also but wiping down the toilet surface before you sit to avoid spray droplets from the previous person.

Dr. Cahill said while, so far, there’s not much data that COVID-19 can be transmitted via fecal matter, taking precautions might keep you safe from other things, as well.

“Bathrooms are covered with bacteria,” he said. “Toilets have been well documented to transmit infectious diseases, although mostly gastrointestinal pathogens. Something like norovirus is extremely virulent. It only takes a handful of viral particles to infect another person. Lowering toilet lids is absolutely a good idea.”

What if, as in many public restrooms, there is no lid?

“Flush and step back,” he advised.

Here are Dr. Cahill’s other rules for using public restrooms:

Wash your hands carefully. No-touch faucets are best but otherwise turn on the water with your “dirty” hand. Soap up and wash your hands using the 20-second rule. Grab a paper towel, dry your hands and use it to turn the faucet off. Use a paper towel to touch the door handle on the way out. No paper towels? Shake off your hands or even dry them on your clothes.

“There’s a balance between wastefulness and hygiene,” he said. “The hand dryers can collect and distribute bacteria pretty efficiently, although they are more environmentally friendly.”

How about this worst-case scenario: There’s no soap.

“Scrub your hands with water, because the main way you get rid of bacteria and viruses from your hands is actually the physical shedding of it by the scrubbing motion. So, soap helps, but it’s not the only thing that’s working.”

Beware of urinals. “There’s less risk as far as transmitting diseases, but certainly they are a reservoir for bacteria,” Dr. Cahill said. As with everything else in the bathroom, minimize touching and watch for the “splash back” when urinating and when you flush. “I'm a fan of the ‘waterless’ or flush-free urinals from an environmental and infection control standpoint,” he said.

If you can’t wash your hands, use hand sanitizer. “Hand sanitizers are very good at killing most pathogens, including coronavirus. The things it doesn’t kill very well are C.difficile and norovirus -- both GI things that are very hardy.”

Dr. Cahill recommends about a dime-size squirt in your hand. Then, rub your hands together until they are dry, making sure that you’re getting as much as possible on the backs of your hands, the palms and around the fingernails.

Touch as little as possible. Open the restroom stall door with your foot or knee, without touching the hand plate. Stopping at a portable toilet? You don’t need to worry about the flush but try to minimize touching, and follow-up with hand sanitizer. “Sometimes I’ll go by the Cape Cod Canal and go running, and the porta-potties there have actually been very clean and have sanitizer in them,” Dr. Cahill said.

Be prepared. Don’t depend on the fact that public restrooms or portable toilets will be fully stocked with soap or sanitizer.

“I’ve been doing this for a long time before coronavirus, but I keep hand sanitizer in the car,” Dr. Cahill said. “If worse comes to worst, a bottle of rubbing alcohol 70 percent or greater is pretty much as effective as the hand sanitizers.”