Why you should close hospital toilet before you flush

Could the next potential ‘superbug’ that overruns hospitals come from their bathrooms? Researchers from the National Health Service in Scotland believe so.  

A new study has revealed that hospital toilets are the real hotbeds of bacteria and fungi, including dangerous drug-resistant superbugs—with men’s toilets being the worst culprits. 

Stephanie Dancer, a professor and a consultant microbiologist at the institution, led a team that swabbed various surfaces in hospital bathrooms, from the obvious culprits like toilet flushes and door handles to the seemingly innocent ceilings and air vents. The results, presented at the European Society of Clinical Microbiology and Infectious Diseases Global Congress in Spain, paint a rather unsettling picture of what’s lurking in these busy spaces. 

Let’s start with the gender divide. Women’s bathrooms, it turns out, harboured fewer microbes than men’s. Female staff toilets were the cleanest of the lot. Why the difference? 

“Our results appear to confirm what is generally thought in society: women clean because their perception of dirt and disgust entices action, whereas men either don’t notice a dirty environment or don’t care,” says Dancer in a media release. “Women are more likely to leave a bathroom ‘clean’, while men assume someone will clean up after them.” 

But it’s not just a matter of cleanliness. Researchers found that multi-drug resistant bacteria, the so-called superbugs that are becoming an increasing threat globally, were concentrated in patient toilets. These pathogens, which include infamous names like Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, can cause severe infections in wounds, blood, and lungs, particularly in patients with weakened immune systems. 

The discovery of these bugs on high surfaces like ceilings and air vents was shocking. 

Previous studies using high-speed specialist camera technology have captured images of droplets and aerosol particles as they leave a toilet, demonstrating how germs can spread in the bathroom.  

“We think that the only logical explanation for this is that toilet flushing aerosolizes whatever is in the toilet bowl, and then tiny water particles carrying these organisms fly up to the ceiling and contaminate high sites,” explains Dancer. 

The rise of gender-neutral toilets, including disabled toilets, is also a concern. These were found to have the highest microbial burden overall, possibly due to heavier use and differing attitudes towards cleanliness between men and women. The solution to the problem is simple: close the toilet lid before you flush. 

“Airborne microorganisms and contaminated surfaces  carry a potential risk for infection. Hospital toilets should have lids, which should be closed before you flush, and patient toilets should be cleaned more frequently than other toilets,” notes Dancer. 

Dancer also advocates for keeping single-sex toilets rather than converting all facilities to unisex. 

However, it’s not just down to the hospitals. We can all play a part in reducing the spread of germs. 

“There is no doubt everyone could benefit from more education on hand hygiene,” says Dancer. The more we all understand how to protect ourselves and others from germs, the better.” 

What about at home? The team says the same principles apply. 

“Put the lid down before you flush, and then wash your hands well and dry them with a clean towel,” concludes Dancer. “If you can, open a bathroom window before using the toilet, and that’s not just to eliminate the smell.”