By Dr. Mercola
Stopping the spread of microbes is important to reduce the spread of infection, colds and flu. Time and again research has demonstrated soap and water can kill germs causing acute gastroenteritis, pneumonia, hepatitis A and other contagious illnesses, including methicillin-resistant staphylococcus aureus (MRSA).1
In fact, handwashing may be the single most important strategy for reducing your exposure to potentially disease-causing germs and subsequent illness. While it is not the only factor, it drastically reduces the germs access to your body.
Inside a public bathroom many opt for toilet seat covers or piling on toilet paper. There is some intuitive appeal to covering a public toilet seat before sitting down. Some even choose to hover over the toilet in order to avoid touching the seat. However, unless the toilet seat is obviously dirty, piling toilet paper on the seat or using a seat cover may not give you the protection you think it does.
Your Skin Functions as a Barrier; Toilet Paper Does Not
As the outermost organ on the human body, your skin serves as a primary defense system, protecting your organs from the external environment. Your skin is also a sensory organ and regulates body temperature.2 With a total area of about 20 square feet, your skin has three distinctive layers. The epidermis is the outermost layer and provides a waterproof barrier.3
The permeability of your skin controls movement of water and other electrolytes, allowing for movement in both directions. However, bacteria and viruses cannot be absorbed through your skin, but only enter through a break in the barrier. Your skin is also naturally acidic.4 With a pH of nearly 5.5, it plays a role in inhibiting the growth of harmful bacteria. Using a combination of acid mantle and barrier function, your skin provides a strong first line of defense.
Dr. Peter Elias, a dermatologist from the University of California San Francisco, compares your skin to a brick wall.5 The bricks are the dried out, nonliving skin cells your body is ready to shed, while the mortar — the cement holding the bricks together — is the intercellular matrix composed of fats.
This is a highly impermeable barrier helping to prevent the uncontrolled loss of water and the entrance of harmful microorganisms. Your skin also functions as an endocrine organ, through the production of vitamin D with exposure to sunlight, and helps to regulate immune responses to pathogens coming into contact with the skin through the presence of Langerhans cells.6
According to Dr. William Schaffner, professor of preventive medicine at Vanderbilt University School of Medicine, there is no real evidence toilet seat covers can prevent illness or the transmission of infectious diseases.7 In fact, these paper products are porous and contain holes large enough for microscopic organisms to slip through. Microbiologist Philip Tierno, professor of microbiology and pathology at New York University School of Medicine, comments:8
“If you’re using several layers, that may provide a little more protection. But unless a toilet seat is overtly dirty, meaning there is liquid or particulate matter visible on the seat, it’s rare that you could catch something.”
Hovering Is Likely Not Your Best Answer
Let’s face it, there are times you’d probably rather hold it than sit on a public toilet seat. However, despite being a good workout for your quadriceps, doing a half squat over the toilet is not a healthy alternative for women. According to urologist Dr. Matthew Karlovsky, this semi squat position does not allow your pelvic floor muscles to completely relax.9 In order for your bladder to completely empty, these muscles must be relaxed. However, when hovering over the toilet the pelvic floor muscles may still be 30 to 40 percent engaged.10
As you rise to a standing position, you may therefore have a slight amount of urine left in your bladder. In a study published in the International Journal of Gynecology & Obstetrics,11 researchers found women who preferred to half squat over a public toilet seat had residual urine volume in their bladder, measured through urodynamic testing. This residual urine can irritate the lining of the bladder, making you feel like you have to go more frequently and even increasing your risk of urinary tract infection.12
Over time, residual urine can also lead to an irritated bladder and urinary incontinence. Depending upon the source,13,14 25 percent to 50 percent of men and women in the U.S. suffer from urinary incontinence. Nearly 33 million have an overactive bladder represented by symptoms of urgency and frequency. Increasing age increases the risk of this condition, but there are a range of factors triggering it in younger people.
Hovering in a half-squat is not to be confused with having a bowel movement in the squat position. Sitting on a toilet places your knees at 90 degree angle to your abdomen, which actually hinders bowel elimination by pinching off your anal canal.
In a squat position designed for bowel elimination, your knees are closer to your torso, which changes the position of your intestinal organs and musculature. This allows for relaxation and straightening of your rectum and maximizes the efficiency of elimination. You can read more in my previous article, “Want Better Bowel Movements? Squat, Don’t Sit!”
What Is Dirtier Than a Toilet Seat?
A number of research studies have identified everyday items carrying more bacteria than a toilet seat. For instance, many take their cellphone with them everywhere, including the dinner table, the doctor’s office and the bathroom. On average, Americans check their phones approximately 47 times per day,15 which increases opportunity for microbes to move from your fingers to your phone. In a study from scientists at the University of Arizona,16 data analysis determined cell phones carry 10 times more bacteria than most toilet seats.
While it’s important to remember human skin is naturally covered in microbes without commonly triggering negative health consequences, in some instances common everyday items you touch may carry staphylococcus.17 Cellphones may carry serious pathogens, including streptococcus, MRSA and even E. coli. While they don’t automatically make you sick, you don’t want to let them enter your system.
Your computer keyboard may also be a host of potentially harmful bacteria and a prime real estate for germs.18 In a study commissioned by a consumer advocacy group, researchers found at least one keyboard had five times the level of germs than those found on a toilet seat. In a study from the University of Arizona, researchers found the average desktop had 400 times more bacteria than the average toilet seat.19
Another study from Chicago’s Northwestern Memorial Hospital determined vancomycin-resistant enterococcus faecium and MRSA could survive up to 24 hours on a keyboard.20 In a comparison between kitchen handles and toilet handles done by the Hygiene Council, one-third of kitchen sink handles carried an unsatisfactory level of bacteria as compared to 15 percent of toilet handles.21
In a lecture by microbiologist Charles Gerba, to the U.S. Food and Drug Administration (FDA), Gerba explained a kitchen sponge and sink have 1,000 times more bacteria than a toilet seat.22 If you enjoy going out to eat, you may be surprised to learn the lemon slices floating in your water may be cut by chefs who have not washed their hands after handling meats.
Even menus typically carry more germs for the cold and flu virus than a toilet seat does.23 These findings are in line with research suggesting your daily routine puts you in contact with more potentially dangerous germs on common everyday items than does a public toilet seat.
Despite the Ick Factor, Hand Hygiene More Important Than Toilet Covers
In this short video you’ll discover only 5 percent of people actually wash their hands for more than 15 seconds with soap after using a public restroom24 and how important hand hygiene is to reducing the spread of infection and disease. Despite finding the idea of sitting on a public toilet less than desirable, not washing your hands holds a greater risk. As Tierno states, it is rare you can catch something from sitting on a toilet seat unless it is ripe with liquid or particulate matter.
However, just rinsing your hands under running water is not enough to clear bacteria and viruses from your hands and reduce your risk of acquiring an infection or passing one along. In a study performed by the U.S. Navy,25 recruits were ordered to wash their hands five times a day. Drill instructors received education monthly on the importance of handwashing and after two years recruits had 45 percent fewer cases of respiratory illnesses than recruits had in the year before the program began.
Washing your hands also helps to reduce a rising problem with antibiotic resistance as it may prevent respiratory infections when antibiotics may be unnecessarily prescribed.26 Correctly washing your hands helps to reduce bacteria being transferred from one person to another. To be truly effective for disease control, consider the following guidelines:
- Use warm, running water and a mild soap. You do not need antibacterial soap, and this has been scientifically verified. Even the FDA has stated,27 “There is currently no evidence that [antibacterial soaps] are any more effective at preventing illness than washing with plain soap and water.”
- Start with wet hands, add soap and work up a good lather, all the way up to your wrists, scrubbing for at least 15 or 20 seconds (most people only wash for about six seconds). A good way to time this is to sing the “Happy Birthday” song twice.
- Make sure you cover all surfaces, including the backs of your hands, wrists, between your fingers and around and below your fingernails.
- Rinse thoroughly under running water.
- Thoroughly dry your hands, ideally using a paper towel. In public places, also use a paper towel to open the door as a protection from germs handles may harbor.
Steer Clear of Antibacterial Soap
While clean hands are an important factor in reducing the spread of disease, what you wash your hands with is also a significant factor to your health and the health of the environment. In a study published in the Journal of Antimicrobial Chemotherapy,28 researchers looked at 20 bacterial strains, comparing the effectiveness of plain soap against one with 0.3 percent triclosan (the most widely used antiseptic agent in antibacterial soap).
The study evaluated the effectiveness of the soap in petri dishes, as well as on the hands of study volunteers who washed their hands for 30 seconds using either type of soap and warm water. The researchers found the antibacterial soap was not more effective than plain soap when used under real-life conditions. Only after the bacteria were soaked in antibacterial soap for nine hours did the triclosan-containing products kill more bacteria than plain soap, which is clearly a useless benefit for the average consumer.
In addition to being ineffective in killing additional bacteria while washing your hands, antibacterial soap is also harmful to your health and the health of the environment. Several studies have found triclosan induces changes in estrogenic activity29 and hormonal activity in animal studies,30 impairs muscle function in humans and animals31 and is linked to an increase in allergies among children.32
Triclosan can also be found in detergents, body washes, toothpaste and even cutting boards and lipstick. This additional exposure has added up to an opportunity to build antibiotic resistance in the environment. Triclosan persists in small quantities even after treatment at sewage plants. It affects algae’s ability to perform photosynthesis and may bioaccumulate to a certain degree as it travels up the food chain. As reported by Smithsonian magazine:33
“The chemical is also fat-soluble — meaning that it builds up in fatty tissues — so scientists are concerned that it can biomagnify, appearing at greater levels in the tissues of animals higher up the food chain, as the triclosan of all the plants and animals below them is concentrated. Evidence of this possibility was turned up in 2009, when surveys of bottlenose dolphins off the coast of South Carolina and Florida found concerning levels of the chemical in their blood.”
Watch Out for a Plume of Aerosolized Toilet Water
Once you’re done using the bathroom, you should put the toilet seat down before flushing. The reason is a phenomenon known as “toilet plume.” As you flush the toilet, your waste products are aerosolized by the swirling water. While low-flow toilets have a decreased risk, countless older toilets can send aerosolized droplets as much as 6 feet from the toilet. Tierno says plumes can reach as high as 15 feet.34
In a study published before the adoption of low-flow toilets,35 researchers found your toilet bowl can be seeded with infectious bacteria and viruses that disperse and settle on other bathroom surfaces, such as the floor, the sink and your toothbrush. In a similar study performed more recently,36 research finds this plume may play a contributory role in the transmission of infectious diseases.
Even flushing the toilet with the seat down, Tierno advises you store your mouth related items in a cabinet and exit public toilets at the time you flush.37 Yet, even as your toilet sprays urine and feces droplets up to 6 feet from the device, Tierno insists proper hand hygiene is more crucial than preventing toilet plume.