A mixed-methods study on toilet hygiene practices among Chinese in Hong Kong

Abstract

BackgroundPublic toilets are a common transmission vector of infectious diseases due to environmental contamination. Research on Chinese people’s hygiene practices in public lavatories are lacking. This study examined Chinese people’s hygiene practices in public lavatories in Hong Kong.MethodsWe conducted qualitative interviews and a self-administered questionnaire survey with local residents from June 2016 to April 2018. Four focus group discussions and three individual interviews informed the design of the questionnaire. We recruited interviewees and survey respondents via social service centers. The interviews and questionnaire focused on the public’s daily practices and hygiene behaviors in public toilets. Content analysis of qualitative data was conducted. Multivariable logistic regressions were used to examine the association between age and toilet hygiene behaviors.ResultsOur qualitative component revealed a range of handwashing practices, from not washing at all, washing without soap, to washing for a longer time than instructions. Other toilet use practices were identified, such as not covering toilet lid before flushing and stepping on toilet seats due to dirtiness, and spitting into toilet bowls or hand basin.Totally, 300 respondents completed the questionnaire. Among them, 212 (70.9%) were female and 246 (86.1%) were aged 65 or below. More than two thirds always washed hands with soap (68.7%) and dried hands with paper towels (68.4%). Up to 16.2% reported stepping on toilet seats and 43.9% never covered the toilet lid before flushing. Over one fourth (26.4%) spit into squat toilets/ toilet bowl. Regression analyses showed that the elderly group were less likely to report stepping on toilet seats (adjusted odds ratio, AOR = 0.17, 95%CI 0.03–0.88), flushing with the toilet lid closed (AOR = 0.40, 0.16–0.96), but more likely to spit into squat toilets/ toilet bowl (AOR = 4.20, 1.50–11.74).ConclusionsHong Kong Chinese’s compliance to hygiene practices in public toilets is suboptimal. Stepping on toilet seat is a unique Chinese practice due to the dirtiness of toilet seats. Spitting practices may increase the risk of airborne infectious diseases and need improvement. Measures are needed to improve toilet hygiene behaviors, including public education campaigns and keeping toilet environment clean.

What is the risk of acquiring SARS-CoV-2 from the use of public toilets?

“…2). Both surfaces and strainers in washbasins may be contaminated by nasal mucus, saliva and/or sputum due to hand and face washing, and spitting into the sink by users (D'Accolti et al, 2020;Gautret et al, 2020;Wu et al, 2019). When the next person uses the washbasin, the faucet water jet impinges on the bottom of the basin, which could aerosolise waste secretions.…”

“…The potential risk associated with toilet use should be promoted using social media, newspapers, television and radio; this would help to highlight potential risks from public toilet use and the need to maintain good personal hygiene (Okello et al, 2019;Wu et al, 2019). Many countries would benefit from educational campaigns given the studies showing poor compliance with hand hygiene and other practices in public toilets (Hateley and Jurnaa, 1999;Wu et al, 2019).…”

Improving Public Toilet Environment and Hygiene Practices in an Asian City: Voices From Hong Kong Residents

“…Details of the pilot testing were reported elsewhere. 13 A cross-sectional survey was conducted among the general public between July 2017 and April 2018. The target population were Chinese aged 18 or older, residing in Hong Kong.…”

“…The findings regarding behaviors in toilet use have been published elsewhere. 13 The objective of the present article is to explore public opinions on improving toilet environment and hygiene practices in Hong Kong with a focus on the barriers and enablers that influence their compliance. We used a mixed-methods approach, including qualitative interviews and a questionnaire survey.…”

Does spitting in public play a role in transmitting SARS-CoV-2?

“…Spitting is also common in public toilets in Asia. In a study conducted in Hong Kong in 2018 among 300 Chinese people, 36.4% reported spitting into urinals and 26.4% spat into squat toilets/toilet bowls [ 5 ].

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