Public Displays of Infection
Just how many people was their hands post-restroom?
---Originally published in the print edition of The Boise Weekly, March 15, 2007---

Dear Dr. Rabin:
My biggest pet peeve: public restrooms doors that make you PULL to get out. After washing my hands, the last thing I want to do is touch a nasty door handle full of germs from people who just pee and flee. And worse, when there are only hot air hand dryers and no paper towels, I can’t even protect my clean hands with a towel over the handle. Maybe I’m just germ-o-phobic, but when that happens I just stand and wait for someone to come in and open the door for me. 
-- Eric 

We could have been separated at birth; I do the exact same thing. I used to try to open the door with my foot until I lost my balance and ended up on the even dirtier floor. I’ve considered carrying an oven mitt, but that would be too hard to explain. So now, like you, I just simply wait. Of course, I’m branded a weirdo unless I casually re-tie my shoelaces or check my messages. With luck, I’m eventually released, proud of my still-sanitized state, only to be confronted by some sniffling acquaintance with an extended hand. Honestly, I can’t decide if I need Purell or therapy.

On the bright side, our bathroom lingering apparently encourages others to wash their hands. A study done more than 20 years ago showed that when there are observers in the restroom, the likelihood of post-elimination hand washing more than quadrupled. More recently, a project experimented with the use of signs reminding patrons to lather-up before leaving. This was quite effective…for women. Prior to the posted prompt, 61% of women washed their hands, a number that increased to 97% after the sign went up. Men, however, were not so compliant – less than half washed up before the sign and nothing changed afterward. Some might argue that this proves men cannot read. And, I suppose, their reasoning would be supported by the hand-scrawled “this gum tastes funny” on the condom machine.

The biggest study, by far, of bathroom hand washing is undertaken every four years by the American Society for Microbiology. In six large cities, observers are rotated through restrooms at major attractions (aquariums, museums, etc.) recording hygiene habits and, like me, attempting to look nonchalant. The 2005 results were somewhat encouraging as 90% of women and 75% of men washed their hands before exiting. But, is washing really necessary?

It is now common knowledge (at least to the Dwight Schrute in your office) that flushing a household toilet releases infectious droplets into the air. These airborne particles have been shown to land on faucets, toothbrushes and nearly every surface. One can easily imagine the pandemic possibilities of a half-dozen public stalls outfitted with toilets with roaring flush velocity capable of sucking down cell phones and paperbacks. In researching your question, I’ve found that men commonly justify their non-washing behavior by proudly declaring they touch nothing in the bathroom but themselves – and are quite capable of not urinating on their hands. If only they would. Urine is generally sterile, while their urine dispenser is not. In fact, that organ’s proximity to less – shall we say – attended-to body parts means a nearly certain contamination with coliform bacteria. Boys, really, wash your hands. 

I can, however, understand the reluctance when hot air dryers have replaced the paper towels. Without a doubt, this attempt to lower maintenance costs in public restrooms results in less post-lavatory hygiene. My own hanging around notwithstanding, who wants to spend extra time in the restroom waiting for their hands to dry? And, to short people, little kids, and those in wheelchairs, water rolling up to your elbows while reaching toward a barely warm air stream is not exactly appealing. Worse, new motion sensor models now force you to do the hand jive to keep them running more than a few seconds. The statement on the little metal plaque saying the hand dryer is “better, cleaner and more sanitary than paper towels”, may be the only hot air you get. 

As for why the management adds insult to injury by installing pull doors, I have no good answer. Obviously the same staff member who purchased the hand dryers made that decision. Fortunately, I recently came across some research showing the door handle is actually among the cleanest surfaces in most public bathrooms. Why? Eric, it’s because of people like us – inadvertently cleaning the handle with our protective paper towels. Reading that made me extremely happy; I don’t think I can take another Thanksgiving stuck in the bathroom at the public library.

"The Antidote" was a weekly column published from July 2005 to March 2008. Dr. Rabin tackled the hype surrounding alternative medicine, folk treatments, miracle supplements and cures-for-all-ills. His skeptical, evidence-based approach did not earn him many friends among local practitioners and multi-level marketers, but his monthly salary of two movie tickets made it all worth it.

Dr. Ed Rabin, Chiropractor

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Dr. Ed Rabin, Chiropractor  500 W. Idaho St., Suite 240, Boise, ID 83702  (208) 955-7277