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In conversation with Dr Lisa Ackerley, The Hygiene Doctor

    Hygiene has come under new levels of scrutiny in recent times, with campaigns promoting new levels of hand washing protocol just one aspect of the war against disease. Margaret Talbot, VitrA’s UK Marketing Manager, talked to Chartered Environmental Health Practitioner Dr Lisa Ackerley, about the public health impacts of coronavirus and the part that design can play in promoting hygienic and healthy environments.

    Watch the interview here

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    Margaret TalbotI'm really interested in understanding what you think are the key hygiene factors for people to bear in mind in our domestic environments, now that so many of us are working from home?

    Dr Lisa Ackerley Well, I think what's important is how many people there are in the home. In a really busy household the issue of spreading germs is obviously heightened. If you live on your own you can stop the journey of the germ at the front door by washing or sanitising your hands before you come in. When lots of occupants are sharing the same bathroom, or if you've got lots of visitors, then it becomes really important to consider how easy it is to keep your bathroom clean, and also to think about how you're going to disinfect surfaces, because touch points are very key.

    I've just had a bathroom refurbishment done at home, so I’ve been thinking about hygiene and how easy things are to keep clean. One of the bugbears in my household is that the men don't put the toilet seat down – I think a lot of women would say the same thing. So I've had it designed so that the toilet seat has to go down before you can flush. I thought that was a neat way of getting round it, because we know that plumes from toilet flushing can spread around the bathroom.

    MT Yes, there’s been quite a bit in the press recently about plumes of bacteria when you flush the toilet. Is it now thought important with coronavirus to put the lid down to prevent that?

    Dr A It's interesting that more and more advice is coming out in the wake of coronavirus, and that's not necessarily because anyone has proved that coronavirus can be spread by the fecal-oral route but because they’re now finding the virus in faeces and sewage systems. At the moment that is being used as an indicator of whether the virus is in the community. Of course plumes are a possible means of transmission but because the virus is new, we don't know enough about the roots and rate of transmission to say for sure.

    MTWhat about hand dryers versus towels in relation to public toilets?

    Dr A At the moment hand dryers seem to be a potential risk because they stir up aerosols and even droplets that would otherwise fall to the floor. The other issue with air dryers is that, if they're not really rapid, people don't actually dry their hands properly. Paper towels on the other hand help to get off that last layer of dirt that may have been removed by hand washing alone.

    MTIt’s interesting talking about public toilets because Government ministers recently contacted local councils about reopening access to public washing facilities and toilets. Are you pleased to see the Government taking this seriously and asking councils to open up?

    Dr A Absolutely. In fact I've had a bit of a mini campaign and was quoted in a number of newspapers saying I think public toilets need to be open (though some councils did actually leave their toilets open the whole time). The trouble was that the messaging in the UK was people could travel as far as they wanted but nobody thought this through in terms of people needing to go to the toilet.

    Public toilets are a facility we need. It's not just about visitors to an area – if you think about all the extra delivery vehicles on the road at the moment – parcels and food deliveries and so on – and those workers don't have anywhere to go to the loo. The health effects of that are concerning: The Royal Society for Public Health recently published an report called Taking the Pee, which was about how bad it is for people's health not to have access to toilets because they dehydrate deliberately.

    MTDo you think new public attitudes towards hygiene, for instance hand hygiene, will stay even when Covid-19 eases and there’s less press focus? Do you think the new behaviours are here to stay, or will people just revert to how they were before?

    Dr A I think the repercussions will go on for a long time. I’m hopeful that the hygiene messages will be embedded but I think as a society, sadly, we're probably going to suffer collectively from some form of post-traumatic stress syndrome from this experience.

    MTThere's been quite a bit of comment about the half-life of coronavirus in relation to different materials such as plastics, paper and copper. What's your view on that, and do you think we need to be integrating that knowledge into design?

    Dr A It is a factor. The shorter life seems to be on products such as cardboard and newspaper, which wouldn't really make any difference in bathroom design. Plastics do seem to be the surfaces where the organism survives longest. And there have certainly been some papers on various metals affecting the half-life. Specifics of environments, the temperature, the surfaces – all seem to have an effect on how long the virus remains viable. Generally speaking, if you don't want to confuse people, you could say that after 72 hours that on any surface the virus has effectively disappeared. But for some surfaces, such as cardboard and paper, the survival time does seem to be much shorter. So, yes there is potentially work to be done around materials and how they’re used in design.

    MTLet's talk about the bathroom space for a little bit. What’s your view on the flash points for transmission in the bathroom?

    Dr A A key thing is to make sure that door handles are easy to clean, because obviously you're going to be touching those on a regular basis. If you can have an automatic flush – fantastic, because it removes a touch points and that reduces cleaning work. An automatic soap dispenser, even in the home, removes another touch point. Taps that switch on and off easily make a lot of sense to me. I'm a real fan of the mixer tap, and mine are ones I can switch off with my elbow so I don't have to retouch the surface I’ve just contacted with dirty hands.

    MTIs there anything you think architects and designers should be thinking about in terms of the bathroom, such as being able to wash hands hygienically?

    Dr A I think much more could be done to improve washroom hygiene in office spaces and public spaces generally. As I’ve said, reducing the number of doors that people have to touch is very important. We need to think about the journey of the people using the buildings. I'm dealing with risk assessments for the reopening of buildings in the Covid–19 context, and I'm saying to people: think about the uses of the building, map out what people do in it, and work out how you can make it safer. If we think about toilet spaces for example – somebody comes in and generally has to open a door and then, to go to the loo, they will have to open another door. And then they have to shut it. I keep going through all the different steps wondering what design could do to help. What if we don't have so many doors just to get to the toilet cubicle? Or maybe the cubicle door opens outwards, so that when you come out you don't have to touch the door handle. Maybe doors could be automatic. Maybe the flush and the seat could also be automatic. All of these measures would stop people having to touch anything.

    It may be that you could have washbasins outside the toilet area. In the case of public toilets that would mean people on the street could use them too. With social distancing we're trying to reduce the number of people using a toilet or any enclosed space at any one time. It may be that this is the time to remove mirrors from toilet spaces because they slow down the use of the toilets. In schools I’d like to see washbasins at the side of classrooms, and outside of the building at the entrance. Interestingly, in some places I’ve visited in Africa that has actually been the case, with hand washing stations located outside buildings. I think with design we need to get back to some of the fundamental hygiene principles.

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