Room for improvement

It is not sufficient for washrooms just to provide the means to wash hands. We know from experience that many people fail to wash their hands after using a toilet. Displaying signs telling users to wash their hands helps, but education is also needed to ensure that toilet users understand why it is absolutely essential that hands are germ-free before they leave the toilet.

Toilet designers and toilet providers need to consider what the infection risks are in a toilet and how to avoid any opportunity for cross contamination, for example, 'hands free' lighting, toilet tissue dispensing, cistern flushing, wash basin water supply, soap dispensing and hand drying.

Hospitals can also consider supplying toilet seat covers that are replaced after each use, or sanitiser sprays to protect the otherwise 'must touch' toilet seat. Toilet seat covers act as a physical and protective barrier between the user and the toilet seat.

The door at the entrance to and exit from the toilet is normally a 'must touch' surface.

Coatings are now available that are invisible and can be applied to 'must touch' surfaces, including door handles. These coatings destroy both micro organisms, and foul odours, using nano-technology.

Organisms that can be harmful to health can survive on environmental surfaces. Viruses, in particular, can be excreted in large numbers in respiratory secretions and stools and can stay on surfaces for hours and even days. In addition to hand washing, hygienic toilet and hand washing facilities are vital to prevent the person-to-person spread of infections.

Quality controlled cleaning

The importance of high quality cleaning in all toilets cannot be overstated. Higher standards of cleaning are achieved by having clear cleaning specifications and properly trained staff.

Cleaning requirements must be set out in a cleaning specification - together with cleaning materials to be used and their frequency of use. The cleaning specification will detail the daily, weekly and monthly tasks that must be completed in each toilet.

Monitoring of cleaning activities through daily or weekly inspections is considered essential to maintain high standards. Toilets should be monitored regularly as part of a documented rota and policy. A cleaning audit checklist should be located in the toilets, dated and signed by the inspecting cleaning supervisor at regular intervals throughout the day. A faults and repair audit checklist should also be efficiently maintained.

Cleaning solutions are available for all surfaces that provide 99.9% effective sterility and germ kill. They are effective against MRSA, E Coli, and other forms of bacteria.

However, even the most careful cleaning can leave traces behind. Black light technology can be used to show residual splashes and stains. It reveals proteins that the eye can't see and not only uses a scientific process to establish the degree of cleanliness but also helps cleaning supervisors to understand what surfaces need more effective cleaning.

Sound preventative maintenance programmes and proper programme performance monitoring will ensure that operational problems are minimised along with reduced closure periods. Supplies of toilet paper, soap and paper towels must be re-stocked throughout the day. Emergency repairs must be completed promptly to minimise disruption to the service and planned maintenance should take place outside of normal toilet opening hours whenever possible.

There are an increasing number of toilet users, whose lives are affected by the state of Britain's toilets. These include people with physical disabilities or severe and multiple learning difficulties and their carers; the infirm or elderly; people with babies or young children and people of all ages who are coping with a range of medical conditions.

Loo of the Year Awards inspections focus attention on the need for high standards of public or 'away from home' toilets in all areas. For more information visit www.loo.co.uk