Sue Vernon BA, RGN, RSCN, is honorary senior research associate at the School of Medical Science (Department of Child Health) and School of Health and Population Studies (Department of Primary Care), University of Newcastle upon Tyne.
School toilet facilities are reported to be a problem for many school children as well as teachers, caretakers and school nurses (Croghan, 2002). In a recent survey, when children were asked to describe their school toilets, a clear picture emerged of poor standards of cleanliness, supervision and access (Vernon et al, 2002). Children frequently reported smelly, dirty and unpleasant toilets in their schools, inadequate supplies of toilet paper and soap, no hot water and no towels. They also commented on the lack of privacy and the problems associated with bullying (Vernon et al, 2002). Croghan (2002) also reported additional problems of overcrowding and potentially insanitary conditions.
Implications for children’s health
A survey in 2002 found that a significant number of children avoid using school toilets to defaecate, which can result in constipation (Vernon et al, 2002).
Constipation is an important contributory factor in recurrent urinary tract infections in children and is also associated with problems including encopresis and enuresis (Blethyn et al, 1995).
Dirty toilet seats encourage children to crouch rather than sit and studies have suggested that crouching may prevent complete bladder emptying (De Paepe et al,1998). In addition, the absence of adequate hand-washing facilities does not encourage good patterns of hygiene (Croghan, 2002) and may also lead to outbreaks of infectious diseases.
Effect on mental health
Many children report that they have been bullied in school toilets (Vernon et al, 2002) and this may have negative psychiatric consequences (Williams et al, 1996). Vernon et al (2002) found that children commented on the lack of privacy, resulting from inadequate or absent door locks, which was also associated with bullying.
Promoting good bowel and bladder habits
Childhood is an important time to promote a healthy lifestyle that includes regular bladder and bowel emptying and hand washing after using the toilet. While the current public health agenda emphasises the importance of health promotion, these habits are less likely to be reinforced at school if children either avoid using the school toilets because of unpleasant conditions or are discouraged from washing their hands because of inadequate facilities (Croghan, 2002; Vernon et al, 2002).
School nurses have an important and positive role to play in health education and ensuring that school toilets are kept clean (Croghan, 2002). However, the reduction in the number of school nurses is likely to have negative implications on improvements in school hygiene.
‘Water is Cool in School’ campaign
The ‘Water is Cool in School’ campaign organised by the Enuresis Resource and Information Centre (ERIC) to improve the availability of drinking water for children in school has been highly successful. But the positive effects of this campaign are likely to be partially mitigated, if children are avoiding using the toilet at school (Croghan, 2002).
Legislation on toilets
Present legislation on school toilets has a limited number of recommendations stipulating the number of toilets per pupil and facilities required for pupils with disabilities (The Education (School Premises) Regulations, 1996). This contrasts with The Workplace (Health, Safety and Welfare) Regulations for Workplaces, 1992, which has explicit guidelines regarding the number and standard of toilets in the workplace. The guidelines state that:
- Toilets and wash stations should be adequately ventilated and in rooms with lighting;
- Toilets and rooms should be kept in a clean and orderly condition;
- There should be separate toilets for men and women;
- Toilet paper must be provided;
- Clean hot and cold water should be provided (preferably running water) with soap and towels or other suitable means for hand drying;
- Privacy must be protected.
These recommendations do not extend to schools.
Some schools have responded positively to parents’ and children’s requests for reasonable toilet facilities. At one middle school in Northumberland the children have successfully negotiated with their head teacher for the provision of electric hand dryers. In another school, children, parents and teachers successfully planned a new school with two toilets adjacent to each classroom.
If schools were treated as workplaces for children and equivalent standards were applied, school toilets would be significantly improved.
It is hoped that the the Bog Standard campaign organised by ERIC, the Community Practitioners’ and Health Visitors’ Association, the Schools Council UK and the British Toilet Association will achieve its aim to improve the standard of provision and access to toilet facilities in schools (for more information, see p73).