Restroom Use Research Articles

Status and content of outpatient preoperative education for rectal cancer patients undergoing stoma surgery provided by Japanese wound, ostomy, and continence nurses: a cross-sectional study

BackgroundPreoperative education can improve postoperative quality of life in patients undergoing stoma surgery. However, the prevalence and when, where, and how preoperative education is implemented are unclear. Therefore, this study aimed to assess the current status of outpatient preoperative education for patients undergoing stoma surgery for rectal cancer as perceived by nurses. Additionally, it sought to identify the information provided by Japanese healthcare providers as a part of preoperative education.MethodsThis cross-sectional study included 1,716 wound, ostomy, and continence nurses (WOCNs) in charge of stoma clinics at Japanese hospitals. Unsigned self-administered survey forms were mailed to the participants, and paper- or web-based responses were obtained. The main questions included: overview of the participants and their facilities, provision of outpatient preoperative education, status of implementation, and preoperative education components. To examine the factors associated with preoperative education, the independent variable was the presence or absence of preoperative education in the clinic, and the explanatory variables were the years of experience as a nurse, years of experience as a WOCN, type of hospital, number of beds, and number of intestinal stoma surgeries per year. Regression analysis was performed.ResultsWe received 773 valid responses (valid response rate: 45%). Duration of experience as a nurse and as a WOCN were 24.6 and 10.9 years, respectively. Outpatient preoperative education was provided by 24% of the participants. Most preoperative education sessions were conducted for patients or caregivers. Preoperative education took 31–60 min per patient, and one to five patients received preoperative education each month. Booklets, ostomy appliances, and stoma models/dolls were used as supplementary materials for preoperative education. The most frequently mentioned components of preoperative education were stoma care, daily life, social security, stoma clinic, traveling and going out, quality of life after stoma surgery, and precautions for medical treatment. In addition, education on the use of restrooms on the go, disaster preparedness, defecation disorders after restorative proctectomy, and complications after stoma closure were considered necessary.ConclusionsThe implementation rate of outpatient preoperative education was low (24%). Future challenges include the development of specific educational content and procedures suitable for the Japanese medical environment and the establishment of preoperative medical care teams for stoma surgery to promote the provision of outpatient preoperative education.

Transmission of Viruses from Restroom Use: A Quantitative Microbial Risk Assessment.

Restroom use has been implicated in a number of viral outbreaks. In this study, we apply quantitative microbial risk assessment to quantify the risk of viral transmission by contaminated restroom fomites. We estimate risk from high-touch fomite surfaces (entrance/exit door, toilet seat) for three viruses of interest (SARS-CoV-2, adenovirus, norovirus) through eight exposure scenarios involving differing user behaviors, and the use of hand sanitizer following each scenario. We assessed the impacts of several sequences of fomite contacts in the restroom, reflecting the variability of human behavior, on infection risks for these viruses. Touching of the toilet seat was assumed to model adjustment of the seat (open vs. closed), a common touch point in single-user restrooms (home, small business, hospital). A Monte Carlo simulation was conducted for each exposure scenario (10,000 simulations each). Norovirus resulted in the highest probability of infection for all exposure scenarios with fomite surfaces. Post-restroom automatic-dispensing hand sanitizer use reduced the probability of infection for each virus by up to 99.75%. Handwashing within the restroom, an important risk-reduction intervention, was not found to be as effective as use of a non-touch hand sanitizer dispenser for reducing risk to near or below 1/1,000,000, a commonly used risk threshold for comparison.

Assessing hand hygiene knowledge, attitudes, and behaviors among Guatemalan primary school students in the context of the COVID-19 pandemic

BackgroundHand hygiene (HH) is an important practice that prevents transmission of infectious diseases, such as COVID-19. However, in resource-limited areas, where water and soap are not always available, it can be difficult to practice HH correctly and at appropriate moments. The purpose of this study was to assess HH knowledge and behaviors among students from six elementary schools in Quetzaltenango, Guatemala to identify gaps that could later inform interventions to improve HH.MethodsWe conducted knowledge, attitude, and practices (KAP) surveys among primary school students during the COVID-19 pandemic in July 2022. We also observed students’ HH practices at three different moments during the day, making note of the use of the HH station and materials, duration of handwashing, presence of a HH assistant, and the students’ sex. We also used the Quantitative Personal Hygiene Assessment Tool (qPHAT), to measure hand dirtiness before eating, after restroom use, and upon arriving to school.ResultsWe surveyed 109 students across six schools. Mean scores were 4 out of 5 for knowledge, 8 out of 8 for attitudes, and 6 out of 7 for HH practices. Most students identified “before eating” as a critical moment for HH (68.8%), fewer identified “after restroom use” (31.2%), and no students mentioned HH being necessary “after coughing or sneezing”. We observed 326 HH opportunities of which 51.2% performed correct HH (used water and soap for at least 20 s or used alcohol-based hand rub, where materials were available). We collected 82 qPHAT hand swabs. A Kruskal Wallis test revealed a significant difference in hand dirtiness between entering the school and after restroom use (p = 0.017), but no significant difference before eating and after entering the school (p = 0.6988).ConclusionsThe results from the KAP survey show high scores, however correct identification of key moments for HH was relatively uncommon, especially after restroom use and after coughing or sneezing. Additionally, half of HH opportunities observed had correct HH practices and on average, hands were dirtiest when arriving at school. These findings will inform interventions to improve HH practices and behaviors, which will be evaluated with follow-up data collection.

Bacteriological quality of meat and hygiene practice among meat handlers in Kathmandu, Nepal

We investigated bacterial growth from raw meats and items used during meat handling, and hygiene practices followed by meat handlers at butcher shops in Kathmandu. A cross-sectional study was conducted; a total of 200 swab samples were collected from 121 butcher shops. A mean bacterial count was performed, and bacterial identification and antibiotic susceptibility test were performed. A face-to-face interview was conducted to evaluate the hygiene practices. Out of 200 samples, 90.5% showed bacterial growth. All Buffalo meat samples and more than 90.0% of Goat and Pork meat samples showed bacterial growth, and only 60.0% of knife swabs showed bacterial growth. Staphylococcus aureus was the predominant isolate followed by Escherichia coli, Salmonella spp., Citrobacter spp., Klebsiella spp., and Proteus spp. Mean bacterial count in Buffalo meat (6.43 log cfu/cm2 ) was the highest followed by Pork meat (5.26 log cfu/cm2 ) and Goat meat (5.04 log cfu/cm2 ). A total of 456 bacteria were isolated, of which 24.3% were multi-drug resistant. Out of 136 S. aureus isolated, 10.2% were Methicillin Resistant S. aureus. A statistically significant difference was noted in carcass handling during hand injury, before and after knives and chopping block cleaning, use of fly and rodent controllers, and clean water supply. Hygiene practices depicted a significant relation with the mean bacterial count, whilst no significant relation with hand hygiene practice after the use of restrooms and use of gloves. Bacterial growth in meat and butcher items is at an alarming rate in spite of having good hygiene practices and nearly a quarter of isolates are multi-drug resistant.

The public perceptions of urban sanitation infrastructure: a cross-sectional study in Kegalle township in Sri Lanka

Abstract Improving public restroom facilities in urban areas can contribute to ensuring the overall living standards of the urban populace. Access to improved sanitation and hygiene is also considered a fundamental human right. Therefore, the present study aims to understand public perceptions of urban public restroom use based on a case study conducted in the municipality of Kegalle township in Sri Lanka. This included a questionnaire survey (N = 115) and in-depth interviews (N = 5). The analysis indicates the urgent need for adequate, accessible, and good-quality sanitary services, particularly in densely populated urban areas of the country. More than 70% of people (from N = 115) indicate that public restrooms are not of good quality due to certain reasons such as poor maintenance and uncleanliness. Despite the insalubrity of public restrooms, many respondents have used them, indicating an urgent policy intervention in operating, and properly maintaining public restrooms in densely populated urban areas of the country. A significant number of respondents indicated that the quality of public restrooms is extremely poor (39%) or poor (31.1%). Around 86.9% of respondents are not satisfied with existing public restrooms, thus, 71.4% believe in reconstructing new public restrooms that pave the way for ensuring access, affordability, quality, and safety.

He Who Has Hope, Has Everything.

He Who Has Hope, Has Everything.

Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China

ObjectiveTo describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC...

Public Restrooms in Neighborhoods and Public Spaces: a Qualitative Study of Transgender and Nonbinary Adults in New York City

The purpose of this study is to qualitatively explore transgender and nonbinary (TGNB) individuals’ experiences with bathroom use in neighborhoods and public spaces in the context of navigating experiences of harassment, lack of safety, and discrimination in New York City. Forty diverse TGNB individuals were recruited in the summer of 2017 in New York City for semi-structured qualitative interviews on health and neighborhoods. Inductive thematic analysis coding process was used to determine themes. Themes related to public bathroom use were compiled and analyzed. A total of 31 participant interviews identified bathroom use as an experience that shapes their health and wellbeing. Major themes included avoiding restroom use or planning travel around perceived bathroom access; planning bathroom use compromised mental health and self-image; delaying bathroom use to avoid harassment that leads to negative physical health effects; perceived gender presentation limited bathroom use; and bathrooms advertised as gender-neutral promoted safety and comfort. In a diverse, urban sample of TGNB individuals, bathroom use was identified as relevant to physical and mental health. Despite progressive bathroom laws in the state and city in which the study was conducted, respondents described how bathroom use influences how they move throughout their day. We demonstrate the continued importance of nondiscriminatory access to public spaces such as restrooms to the health of TGNB populations and the need for further prospective research elucidating the impact of nondiscrimination legislation.

Real-time daily assessment of work interference on healthcare professionals' restroom use: A pilot study.

Certain occupations may predispose individuals to develop lower urinary tract symptoms presumably through the adoption of unhealthy toileting behaviors. This study aimed to pilot the feasibility of recording healthcare workers' perceptions of daily, work-related interference with toilet use using a cellular, text-based survey tool. A cohort study of adult healthcare professionals completed a baseline questionnaire, a daily survey for fourteen consecutive days regarding their restroom use for the current workday, and a posttest survey providing feedback on study design and participation. Contributors to daily toilet use were analyzed in a linear mixed effects model that allowed for modeling effects within a given day. A backward stepwise regression was performed to assess for the presence of the effect of toilet use among control variables. Increased work burden (i.e., increased inconvenience for using the restroom at work) was provisionally found to be associated with fewer voids per day. The number of voids at work was also associated with the number of breaks, urinary urgency, and limiting fluids. Subjects reported that participation in the study was easy, did not interfere with work, and that they would be willing to participate again in a similar study. The utilization of a daily text message survey is a feasible way to study healthcare workers and their toileting behaviors at work. A larger similarly designed study could potentially confirm that limitations to restroom use may result in toileting behaviors that could predispose healthcare workers to develop bothersome urinary symptoms. Further investigation is warranted.

Women's Perceptions of Public Restrooms and the Relationships with Toileting Behaviors and Bladder Symptoms: A Cross-Sectional Study.

Because current knowledge about public restroom use and bladder health is limited, we sought to identify why women avoid public restrooms and the associations of lower urinary tract symptoms and toileting behaviors. Between October and December 2017 we recruited a convenience sample of U.S. women to complete a cross-sectional, anonymous questionnaire about public restroom use, lower urinary tract symptoms (International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms [ICIQ-FLUTS]) and toileting behavior (Web-Based Toileting Behavior [TB-WEB]). We compared women who reported limiting public restroom use all or most of the time to those who did not limit or did so occasionally or sometimes. Of the 6,004 women in the study 26% limited public restroom use most or all of the time and were more concerned with cleanliness than those who did not limit public restroom use. They also reported more often using nonsitting positions when away from home and holding urine to avoid public restrooms, higher ICIQ-FLUTS scores, more frequent overactive bladder and fewer than 7 voids a day. A large number of women reported avoiding public restrooms, often over concerns of cleanliness, availability of amenities and privacy. Women who habitually limit public restroom use more frequently reported unhealthy toilet behaviors and lower urinary tract conditions. These findings will help guide future research and inform public policy and bladder health awareness.

A survey of public restrooms microbial contamination in Tehran city, capital of Iran, during 2019.

Introduction:Daily use of public restrooms may have a significant impact on spreading infectious diseases. Human society could be affected by spreading of transitional infectious diseases through feces, urinary tract infection and poor personal hygiene. According to the World Health Organization reports, plenty of people's developed diseases caused by contaminated public restrooms that may result in severe health problems.Methods:This descriptive cross-sectional study was conducted on 7,482 samples that were collected randomly in 6 months (spring and summer 2019) in different regions of Tehran. The Data were obtained by analyzing 804 restroom's indoor and outdoor handles, 1062 toilet faucet, 826 washbasin taps, 1,062 toilet hoses, 804 flush tank levers, 643 soap dispenser bottoms, 643 liquid soaps, 99 bar soaps, 169 toilet papers and paper towels, and 50 hand dryer machines. Samples which were tested, based on bacteriology standard methods.Result:7,482 samples were gathered of which 6,678 contaminated cases (89.25%) were observed and 804 cases (10.75%) were found non-contaminated. Escherichia coli with 28.48% and Pseudomonas with 0.39% were the most and the least common bacteria, respectively, in this study.Conclusion:The required tests to identify the bacteria that cause contamination through the use of public restrooms have been done. It is essential to inform the public of the mentioned items and teach how to prevent infectious diseases.

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Nov 2019Editorial CommentThis article comments on the following:Toileting Behaviors and Bladder Symptoms in Women Who Limit Restroom Use at Work: A Cross-Sectional Study Alayne D. Markland Alayne D. MarklandAlayne D. Markland Geriatric Research Education and Clinical Center, Birmingham Veterans Affairs Medical Center Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000579624.34013.a9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 202(5), p. 1014 Reference 1. : Infrequent voiders syndrome (nurses bladder). Prevalence among nurses and assistant nurses in a surgical ward. Scand J Urol Nephrol 1991; 25: 201. Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyOct 9, 2019, 5:43:23 AMToileting Behaviors and Bladder Symptoms in Women Who Limit Restroom Use at Work: A Cross-Sectional Study Volume 202Issue 5November 2019Page: 1014-1014 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alayne D. Markland Geriatric Research Education and Clinical Center, Birmingham Veterans Affairs Medical Center Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama More articles by this author Expand All Advertisement Loading ...

Toileting Behaviors and Bladder Symptoms in Women Who Limit Restroom Use at Work: A Cross-Sectional Study.

While lower urinary tract symptoms and bladder behaviors are known to be associated with certain occupations, little is known about restroom access or environmental factors which may contribute to this relationship. We aimed to characterize reasons that women limit restroom use at work. We also sought to determine whether women who limit use at work report more unhealthy bladder habits and lower urinary tract symptoms. We performed a cross-sectional study of full-time working women in the United States. Women completed validated questionnaires recording toileting behaviors, lower urinary tract symptoms and perceptions of the occupational toilet environment. We compared women who limited restroom use at work most or all of the time to those who did not limit or did so occasionally or sometimes. Of the 3,062 women in the final analytical sample 11% reported limiting restroom use at work most or all of the time. This group reported lower satisfaction with restroom cleanliness and privacy in particular. They more frequently identified toilet factors of poor quality, limited accessibility and restricted use by employer. The prevalence of unhealthy bladder habits was significantly higher among women who limited restroom use, as was the prevalence of urgency, monthly urinary incontinence and infrequent voiding. In this cross-sectional study of women working full time those who limited restroom use at work reported a higher prevalence of unhealthy bladder habits and certain urinary disorders. Future studies should determine whether limited restroom use at work is a modifiable risk factor for unhealthy bladder habits and bladder health outcomes.

Sleep Validity of a Non-Contact Bedside Movement and Respiration-Sensing Device.

To assess the sleep detection and staging validity of a non-contact, commercially available bedside bio-motion sensing device (S+, ResMed) and evaluate the impact of algorithm updates. Polysomnography data from 27 healthy adult participants was compared epoch-by-epoch to synchronized data that were recorded and staged by actigraphy and S+. An update to the S+ algorithm (common in the rapidly evolving commercial sleep tracker industry) permitted comparison of the original (S+V1) and updated (S+V2) versions. Sleep detection accuracy by S+V1 (93.3%), S+V2 (93.8%), and actigraphy (96.0%) was high; wake detection accuracy by each (69.6%, 73.1%, and 47.9%, respectively) was low. Higher overall S+ specificity, compared to actigraphy, was driven by higher accuracy in detecting wake before sleep onset (WBSO), which differed between S+V2 (90.4%) and actigraphy (46.5%). Stage detection accuracy by the S+ did not exceed 67.6% (for stage N2 sleep, by S+V2) for any stage. Performance is compared to previously established variance in polysomnography scored by humans: a performance standard which commercial devices should ideally strive to reach. Similar limitations in detecting wake after sleep onset (WASO) were found for the S+ as have been previously reported for actigraphy and other commercial sleep tracking devices. S+ WBSO detection was higher than actigraphy, and S+V2 algorithm further improved WASO accuracy. Researchers and clinicians should remain aware of the potential for algorithm updates to impact validity. A commentary on this article appears in this issue on page 935.

Impact of Triggering Events on Outcomes of Acute Heart Failure

BackgroundThe onset of acute heart failure is known to be associated with increased physical activity and other specific behaviors that can trigger hemodynamic deterioration. This analysis aimed to describe the distribution of triggers in patients hospitalized for acute heart failure, and investigate their effects on in-hospital outcomes. MethodsConsecutive patients hospitalized for acute heart failure between 2010 and 2014 were registered in a multicenter data registration system (72 institutions within Tokyo, Japan). Baseline demographics and in-hospital mortality were extracted from 17,473 patients. Patients with a trigger were grouped based on their triggering event: those with onset during (a) physical activity; (b) sleeping; (c) eating or watching television; (d) bathing or excretion (use of restrooms); and (e) engaging in other activities. These patients were compared with patients without identifiable triggers. Multiple imputation was used for missing data. ResultsPatients were predominantly men (57.1%), with a mean age of 76.0 ± 13.0 years; a triggering event was present in 49.1%. No significant difference in baseline characteristics was noted between groups except for younger age, higher blood pressure, and prevalence of signs of congestion in the trigger-positive group. In-hospital mortality rate was 7.9%. Presence of triggers was positively associated with a reduced risk of in-hospital mortality (adjusted odds ratio 0.79; 95% confidence interval, 0.70-0.90; P = .0003). In a delta-adjusted pattern mixture model, the effect of a triggering event on in-hospital mortality remained consistently significant. ConclusionTriggering events for acute heart failure can provide additional information for risk prediction. Efforts to identify the triggers should be made to classify patients according to risk group.

P-039 Concerns of Store Managers About Employee Restroom Use Are addressed by Restroom Access Legislation

P-039 Concerns of Store Managers About Employee Restroom Use Are addressed by Restroom Access Legislation

P-035 Reasons that Retail Store Managers Deny Employee Restroom Access to Individuals with Inflammatory Bowel Disease that Have Urgent Medical Concerns

Restroom Access legislation provides individuals with inflammatory bowel disease and other medical needs access to employee bathrooms in retail stores. This law has been passed by 14 state legislatures and rejected by one. Washington, DC does not have restroom access legislation. However, this jurisdiction neighbors a state that has passed restroom access legislation and a state that has rejected the legislation. The reasons for lack of passage are uncertain. This study surveyed retail store managers in Washington, DC about employee bathroom access for individuals with medical needs. Managers of Washington, DC retail stores with dedicated employee bathrooms were surveyed. Stores within one mile of a university medical center were included in the survey. All stores open during the surveying period were included. There were no exclusion factors. The store type, manager gender and age, bathroom access for individuals with medical needs and reasons for denial of bathroom access were obtained. A database, maintaining retail store and manager confidentiality, was created. Qualitative evaluation and quantitative analysis using Fisher Exact test with significance set at P < 0.05 were performed. The study was approved by the university Institutional Review Board. Thirty-one managers (16 male, 15 female; most frequent age 20-30) of stores with employee bathrooms were surveyed. There were 13 clothing stores, 5 food specialty stores, 5 shoe stores, 3 health and beauty stores, 3 convenience stores and 2 antique/art stores. Twenty-four of 31 managers (77.4%; 13 male, 11 female) indicated that they could not allow an individual with medical needs access to an employee bathroom. Twenty-two of 24 (92%) managers indicated that corporate or store policy restricted restroom use. Additionally, 13 managers (54%) expressed concerns about safety, 10 (42%) about property loss, 1 (4%) about the potential for abuse, and 1 (4%) about the potential of affecting their “high end clientele”. The managers' gender and age did not influence the rate that policy (P = 1.000), safety (P = 0.1228 and P = 0.1942) or property loss (P = 1.000) was stated to be the reason for denial of restroom access. There was no difference in the rate at which managers of clothing stores compared to other stores stated that policy (P = 1.000), safety (P = 0.4622) or property loss (P = 0.4521) was the reason for denial of restroom access. Restroom Access Laws provide individuals with inflammatory bowel disease and other medical conditions emergency access to employee bathrooms in retail stores. However, there is not universal acceptance of this legislation. This survey revealed that store policy was the primary reason given for denial of restroom access. Further questioning discovered that concerns about safety and property loss most often influenced store policy. The managers' gender, age and the type of store did not influence emergency restroom access. This study is important because it offers insight into factors that can affect restroom access for individuals with medical needs. Understanding the reasons for denial of access to restrooms has the potential to assist in developing legislation that will address retail store concerns.

Evaluating Traveler Preferences, Values, and Behaviors Associated with Public Rest Areas

How travelers select and value public rest areas was investigated. A comprehensive survey was conducted at 15 public rest areas throughout Michigan; a similar survey was performed at two large commercial travel centers for comparison purposes. The primary objectives of this survey were to (a) identify the reasons motorists stop at public rest areas versus commercial service facilities, (b) estimate the value of services provided by public rest areas, and (c) determine the probable action taken by motorists in the event that a public rest area was unavailable. Results of the survey indicated that patrons at both public rest areas and commercial service facilities generally preferred rest areas for basic services (e.g., restroom use, short break) primarily because of the convenient freeway access. The median patron-reported value of services at standard public rest areas was $1.68 per stop compared with $2.21 per stop at rest areas that included a traveler information center. Even though drivers of commercial vehicles were the most frequent users of public rest areas, they tended to be less satisfied and gave a lower value to services provided. Had a particular public rest area not been available, approximately two-thirds of travelers in private vehicles would have diverted off the freeway to a commercial service facility, whereas one-quarter would have continued to the next rest area along the route. Commercial truck drivers were equally likely to continue to the next rest area as to divert off the freeway.

Developing and Testing a Touch-Path Model for Hand Hygiene and Pathogen Risk

Researchers explored 48 fast-food restaurant and coffee shop restrooms for factors that influence hand hygiene and the spread of disease. Using a naturalistic-observation approach, a catalogue of restroom design features requiring a hand touch were tabulated. Restroom data provided the basis for a conceptual framework for modeling pathogen risk, as defined by the number of hand touches to operate a restroom facility. The touch-path model tested whether men’s and women’s “perceptions of risk” and “intent to hand wash” were influenced by restroom use of commodes, urinals, design innovations, and other design configurations. Results showed that men’s and women’s perceptions of risk and intent to hand wash decreased as a function of design innovations. Women, as compared with men, reported greater perceptions of risk and intent to hand wash. In addition to the social-norm and self-awareness theory, this research supported the approach of understanding design-behavior interactions with respect to hand hygiene.

Access and exclusion

The purpose of this analysis is to discern how the binary gender segregation of public toilet facilities in North America affects demographics of gender and sexual marginalisation. Though often taken for granted, public toilets present examples of institutionalised services that both reflect and manifest social inequality. In particular, gender and sexual minorities risk facing methods of social discipline, ranging from discomfort to expulsion and hostility; the binary method of toilet segregation is a visual erasure of identity and recreates restrictive norms. Concurrently, failure to address specific needs results in inadequate design for female users, trans people, individuals with disabilities, and heterogeneous families. There are numerous strategies for improvement that include grassroots activism, legal routes, and appeals to business owners and building designers. In light of the complexity of problematic aspects regarding restroom use and design, there exists a need for a multifaceted and integrated approach, to create coalitions, and ensure greater accessibility to this basic human right.