World Toilet Day and infection control

Jan. 1, 2011
I was standing in line at the grocery checkout holding a single thing in my hand – a package of toilet paper.

by Noel Kelsch, RDHAP
[email protected]

I was standing in line at the grocery checkout holding a single thing in my hand – a package of toilet paper. Not the simple, little, single pack or half a dozen rolls; no, I think big. I had 30 rolls of toilet paper in hand because it was my turn to buy it (my husband and I take turns supposedly, but it always seems to be my turn). I was not going to come back for more in a short time, or find myself trapped in the restroom with only tissues to turn to.

The man standing behind me said, "So, are you getting ready to celebrate? You know, November 19 is World Toilet Day."

"Really?" I said. "Another reason to plan a party and get my hats out!"

Wow. I went home and discovered that he was not joking. November 19 is a very important day on the calendar. There are many things in infection control that I take for granted. After reading about World Toilet Day, I soon discovered that toilets are one of them.1

The World Toilet Organization (WTO) is getting the message across to everyone. You see, most people do not want to even talk about toilets. The WTO is trying to change that. As WTO states, "When we do not discuss things, we cannot change things."

Did you know that globally diarrhea is the leading cause of illness and death? Poor sanitation is the main cause of this statistic. UNICEF has reported that 2.5 billion people worldwide are without access to proper sanitation, which places risks on their health, strips their dignity, and kills 1.8 million people – mostly children – each year.

Diarrheal diseases kill five times as many children in the developing world as HIV/AIDS. Not only that, but the diseases kill more children than either malaria or AIDS, stunts growth, and forces millions – adults and children alike – to spend weeks at a time off work or school, which affects both the country's economy and chances of a better future for its citizens. The majority of illness in the world is caused by fecal matter, and lack of sanitation is the world's biggest cause of infection. One gram of feces can contain 10 million viruses, one million bacteria, 1,000 parasite cysts, and 100 parasite eggs. Safe disposal of children's feces leads to nearly a 40% reduction in childhood diarrhea.2

According to WTO, 60% of all rural diseases are caused by poor hygiene and sanitation conditions. Half the people sitting in hospital beds are there because of waterborne diseases that are a result of untreated sewage. Understanding preventive medicine for the world starts with understanding proper sanitation.3

It is staggering to think that 2.6 million people do not even have access to a toilet or sanitation. WTO is trying to change that through campaigns such as "Pee or Poo, Break the Taboo" and "PeePoople." Using humor and facts, the organization is spreading a message that has otherwise been avoided. The WTO has developed standards and new technologies, and are bringing forward the message of sanitation to all through creative means.

What can you do?

WTO shares some things you can do right here at home and across the world:

  • We need women's rights. Studies show that women take longer to use restrooms than men. Archaic building codes don't consider women's physiological needs. Make your public planning departments aware of this fact when they are planning new buildings and renovations. Spread the message.
  • We need public restrooms. Public restrooms aren't just a matter of convenience; they're a matter of public health, safety, and a way to make our cities more livable. Our cities need to invest far more in these facilities.
  • We need clean bathrooms. While you may not want to think about it, it's important that our bathrooms are cleaned frequently – especially public restrooms. Encourage your community, dental office, and home to keep restrooms clean. Make people aware when sanitation is poor in a restroom.
  • We need to TWIN our toilet. It stinks that many do not have a porcelain throne to call their own; 2.6 billion people don't have somewhere safe, clean, and hygienic to answer nature's call. By donating at, you can twin your toilet with a latrine in the African countryside, and do your bit to flush away poverty.

When you flush the toilet, aerosols are formed. These small atomized particles can be suspended in air and travel quite long distances. Dr. Charles Gerba of the University of Arizona studied the distance this invisible cloud could travel and discovered it can go six to eight feet out and up, so the areas of the bathroom not directly adjacent the toilet can be contaminated along with the toilet and toilet paper.

Encourage your public agencies to cover toilet paper with a metal or plastic covering to prevent the spread of disease from toilet paper exposed to aerosols. Close the lid of the toilet when flushing, if the toilet has a lid. Keep toothbrushes and other personal hygiene products farther than six feet away from the toilet, or have them covered.

Do not store reading material near the toilet. It can become contaminated by unsanitary hands and aerosols from flushing. Leave immediately after flushing so as not to have the microscopic, airborne mist land on you. Wait several seconds before entering a toilet stall after another person has used the toilet.

After being enlightened by a man in the grocery store checkout line, I realize just what my toilet means to me. It is a blessing and gift that makes a difference in my health, hygiene, and life each day. I will never look at toilets the same.


1. Accessed 10/15/10.

2. Accessed 10/15/10.

3. Accessed 10/15/10.

4. %20Toilets%20E-book%20by%20BTA.pdf.

Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She is a member of the Organization for Safety, Asepsis and Prevention, and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamine and drug use. She is immediate past president of the California Dental Hygienists' Association, and is on the board of directors for the Simi Valley Free Clinic.

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