WASHROOMS
The blind spot in clinical washroom hygiene
Estates teams need to acknowledge an operational reality: that a washroom can appear immaculate despite maintaining high bioaerosol loads. Here, Steve Levy, CEO and founder of Handy Dryers, explains why healthcare environments require hygiene standards that cover an entire room, and not just those surfaces that can be reached with a cloth.
A clinical washroom can pass every item on the cleaning schedule and still pose a hygiene risk. Sinks might have been wiped down, toilet bowls scrubbed, door handles disinfected, yet germs move through the air in the minutes before the next person enters – nothing in the cleaning audit accounts for it. This variable sits at the centre of an operational question estates teams are evaluating: does the current definition of ‘clean’ adequately cover what makes people sick? It is a necessary question to put to healthcare providers, public or private, because the answer is no. Washroom hygiene has been engineered around what can be seen and touched for so long that airborne risk has become invisible within standard compliance frameworks. This oversight grew from historical assumptions about where risk lives, assumptions that predate what is now understood about how pathogens travel.
Washroom hygiene focuses on what can be seen and touched.
What the standards cover The National Standards of Healthcare Cleanliness 2025 is explicit about what cleaning entails. It involves fluid and friction, removing organic matter such as dirt and bodily fluids, from surfaces and equipment. Disinfection applies to objects and surfaces. Read it closely and you will notice that air is not cited as a factor in washroom cleaning. That oversight reflects how the standard was created, at a time when hospital infection control was thought of in terms of what hands and cloths could reach. The regulatory backbone behind it inherits the same blind spot: the CQC judges providers against the Health and
Social Care Act 2008: code of practice on the prevention and control of infections and related guidance, issued under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The standard washrooms are cleaned against simply has no line item for airborne pathogens.
What happens when a toilet flushes Flush a toilet and you get a burst of bacteria-laden aerosol thrown into the room – rising as high as five feet and travelling up to six feet within seconds, before it settles onto whatever surfaces the next person is going to touch. Anyone who enters that cubicle afterwards is, in effect, sharing air with a stranger’s last visit. An undesirable reality. That aerosol creates risk along two distinct routes, and
the distinction matters for what can actually intervene. The first is direct. Standing in a cubicle within minutes of a previous, unwell user means inhaling whatever they exhaled or flushed into the air moments earlier. The second is indirect. That same aerosol settles onto taps, door handles, and surfaces, where it is picked up by touch rather than breath. Once contamination has made that transition from air to surface, it becomes a surface cleaning problem, not an air one; the moment for treating the air itself has passed. The value of active air treatment lies specifically in that first window, intercepting the aerosol before it is inhaled directly or settles and starts the surface contamination chain in the first place. Health Technical Memorandum 03-01 (HTM 03-01)
was written to manage this problem. HTM 03-01 requires washrooms and toilets to be maintained under negative pressure relative to adjacent corridors and patient rooms. This pressure differential ensures that opening a door draws air inward rather than allowing contaminated air to exfiltrate into main circulation spaces. The extracted air must vent directly outside, with recirculation prohibited. Extraction systems are designed to deliver a meaningful air change rate to dilute and clear bioaerosols – microscopic particles of living or once-living material, suspended in the air – generated by flushing or hand washing. Analysing what this means in practice reveals an
operational vulnerability. A meaningful air change rate provides continuous exchange, but clearance is not instantaneous. A distinct time window exists between initial contamination and complete air clearance. During an active norovirus outbreak, or when a patient carrying a respiratory infection uses a shared facility, this clearance window carries risk – a window that surface cleaning checklists cannot monitor or close.
90 Health Estate Journal October 2026
AdobeStock / Diego Cervo
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