Abstract
BackgroundPublic toilets are a common transmission vector of infectious diseases due to environmental contamination. Research on Chinese people’s hygiene practices in public lavatories are lacking. This study examined Chinese people’s hygiene practices in public lavatories in Hong Kong.MethodsWe conducted qualitative interviews and a self-administered questionnaire survey with local residents from June 2016 to April 2018. Four focus group discussions and three individual interviews informed the design of the questionnaire. We recruited interviewees and survey respondents via social service centers. The interviews and questionnaire focused on the public’s daily practices and hygiene behaviors in public toilets. Content analysis of qualitative data was conducted. Multivariable logistic regressions were used to examine the association between age and toilet hygiene behaviors.ResultsOur qualitative component revealed a range of handwashing practices, from not washing at all, washing without soap, to washing for a longer time than instructions. Other toilet use practices were identified, such as not covering toilet lid before flushing and stepping on toilet seats due to dirtiness, and spitting into toilet bowls or hand basin.Totally, 300 respondents completed the questionnaire. Among them, 212 (70.9%) were female and 246 (86.1%) were aged 65 or below. More than two thirds always washed hands with soap (68.7%) and dried hands with paper towels (68.4%). Up to 16.2% reported stepping on toilet seats and 43.9% never covered the toilet lid before flushing. Over one fourth (26.4%) spit into squat toilets/ toilet bowl. Regression analyses showed that the elderly group were less likely to report stepping on toilet seats (adjusted odds ratio, AOR = 0.17, 95%CI 0.03–0.88), flushing with the toilet lid closed (AOR = 0.40, 0.16–0.96), but more likely to spit into squat toilets/ toilet bowl (AOR = 4.20, 1.50–11.74).ConclusionsHong Kong Chinese’s compliance to hygiene practices in public toilets is suboptimal. Stepping on toilet seat is a unique Chinese practice due to the dirtiness of toilet seats. Spitting practices may increase the risk of airborne infectious diseases and need improvement. Measures are needed to improve toilet hygiene behaviors, including public education campaigns and keeping toilet environment clean.
Highlights
Public toilets are a common transmission vector of infectious diseases due to environmental contamination
Probability of transmission is high for certain enteric pathogens such as norovirus and enterohemorrhagic E. coli (EHEC) in which < 100 cells are sufficient for infection [8]
Respondents in the elderly group were less likely to report stepping on toilet seats (AOR = 0.17, 0.03– 0.88), flushing with the toilet lid closed (AOR = 0.40, 0.16–0.96), but more likely to spit into squat toilets/ toilet bowl (AOR = 4.20, 1.50–11.74)
Summary
Public toilets are a common transmission vector of infectious diseases due to environmental contamination. Research on Chinese people’s hygiene practices in public lavatories are lacking. This study examined Chinese people’s hygiene practices in public lavatories in Hong Kong. Hygiene measures are most effective to control the outbreak of novel infectious diseases [1, 2], as well as to reduce the incidence of common respiratory, diarrheal and gastrointestinal illnesses [3]. Regarding use of public toilets, common hygiene measures include hand washing, drying hands, disinfecting or covering the toilet seat surface before use, and flushing the toilet with the lid closed [4,5,6]. Toilet plume is a contributor to the transmission of enteric diseases [5]. Spitting in the urinal is an interesting phenomenon and of special concern as it may increase risk of transferring respiratory diseases when the urine splashes back into the air [13]
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