CLEANLINESS

Cleanliness is both the abstract State of being clean and free from dirt, and the process of achieving and maintaining that State.

Cleanliness may be endowed with a moral quality, as indicated by the aphorism "cleanliness is next to godliness," and may be regarded as contributing to other ideals such as health and beauty.

In emphasizing an ongoing procedure or set of habits for the purpose of maintenance and prevention, the concept of cleanliness differs from purity, which is a physical, moral, or ritual State of freedom from pollutants. Whereas purity is usually a quality of an individual or substance, cleanliness has a social dimension, or implies a system of interactions. "Cleanliness," observed Jacob Burckhardt, "is indispensable to our modern notion of social perfection." A household or workplace may be said to exhibit cleanliness, but not ordinarily purity; cleanliness also would be a characteristic of the people who maintain cleanness or prevent dirtying.

On a practical level, cleanliness is thus related to hygiene and disease prevention. Washing is one way of achieving physical cleanliness, usually with water and often some kind of soap or detergent. Procedures of cleanliness are of utmost importance in many forms of manufacturing.

As an assertion of moral superiority or respectability, cleanliness has played a role in establishing cultural values in relation to social class, humanitarianism, and cultural imperialism.

In Islam

There are many verses in the Quran which discuss cleanliness. For example, “…Truly, Allah loves those who turn to Him constantly and He loves those who keep themselves pure and clean” (2:222). And, “…In mosque there are men who love to be clean and pure. Allah loves those who make themselves clean and pure” (9:108).

Hinduism

In Hinduism,cleanliness is an important virtue, and all Hindus must have taken a bath before entering temples in order to seek blessings.They also wash their feet before entering the temple as according to the Puranas,the demon kali is believed to reside on the hind of the feet.In some Orthodox hindu households,taking a bath after visiting a funeral is required as some hindus believe that it is an inauspicious thing to witness and the inauspiciousness would follow.This is also related to the pollution of the River Ganges.

Hindus also clean their homes particularly well in preparing to celebrate Diwali each year as they believe that it brings good luck .Most Hindus also believe that keeping your house clean and great devotion are gestures to welcome the Goddess Lakshmi to their abode to stay.Some orthodox hindus refrain from cleaning their houses on a Friday as it is a day dedicated to Goddess Lakshmi and cleaning homes on that day is considered inauspicious,so they are allowed to clean their homes on the rest of the days. Tamil people also keep their homes clean in preparation for pongal(see Bhogi Pandigai).

Hygiene

Since the germ theory of disease, cleanliness has come to mean an effort to remove germs and other hazardous materials. A reaction to an excessive desire for a germ-free environment began to occur around 1989, when David Strachan put forth the "hygiene hypothesis" in the British Medical Journal. In essence, this hypothesis holds that dirt plays a useful role in developing the immune system; the fewer germs people are exposed to in childhood, the more likely they are to get sick as adults. The valuation of cleanliness, therefore, has a social and cultural dimension beyond the requirements of hygiene for practical purposes.

Industry

In industry, certain processes such as those related to integrated circuit manufacturing, require conditions of exceptional cleanliness which are achieved by working in cleanrooms. Cleanliness is essential to successful electroplating, since molecular layers of oil can prevent adhesion of the coating. The industry has developed specialized techniques for parts cleaning, as well as tests for cleanliness. The most commonly used tests rely on the wetting behaviour of a clean hydrophillic metal surface. Cleanliness is also important to vacuum systems to reduce outgassing. Cleanliness is also crucial for semiconductor manufacturing.

What is Hygiene ?

Hygiene (which comes from the name of the Greek goddess of health, Hygieia), is a set of practices performed for the preservation of health. Whereas in popular culture and parlance it can often mean mere 'cleanliness', hygiene in its fullest and original meaning goes much beyond that to include all circumstances and practices, lifestyle issues, premises and commodities that engender a safe and healthy environment. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between different cultures, genders and etarian groups. Some regular hygienic practices may be considered good habits by a society while the neglect of hygiene can be considered disgusting, disrespectful or even threatening.

Sanitation in its current US popular meaning is often (incorrectly) taken to be merely the hygienic disposal and treatment by the civic authority of potentially unhealthy human waste, such as household garbage and sewage, and the maintenance of the sewerage and drainage infrastructure. In the UK the term 'sanitation' has unfortunately come closer to meaning water and waste plumbing and disposal, and it is not used to include garbage collection and disposal. The full and proper meaning of 'sanitation' is closer to the full meaning of 'hygiene' and includes the control of water and air quality; vectors; healthful housing; safe products; safe food and working conditions. The more recent broad term 'environmental health' equates to the original meaning of sanitation.

First attested in English in 1677s, the word hygiene comes from the French hygiene, the latinisation of the Greek ὑγιεινή (τέχνη) hugieinē technē, meaning "(art) of health", from ὑγιεινός hugieinos, "good for the health, healthy", in turn from ὑγιής (hugiēs), "healthful, sound, salutary, wholesome". In ancient Greek religion, Hygeia (Ὑγίεια) was the personification of health.

Concept of hygiene

Hygiene is an old concept related to medicine, as well as to personal and professional care practices related to most aspects of living. In medicine and in home (domestic) and everyday life settings, hygiene practices are employed as preventative measures to reduce the incidence and spreading of disease. In the manufacture of food, pharmaceutical, cosmetic and other products, good hygiene is a key part of quality assurance i.e. ensuring that the product complies with microbial specifications appropriate to its use. The terms cleanliness (or cleaning) and hygiene are often used interchangeably, which can cause confusion. In general, hygiene mostly means practices that prevent spread of disease-causing organisms. Since cleaning processes (e.g., hand washing) remove infectious microbes as well as dirt and soil, they are often the means to achieve hygiene. Other uses of the term appear in phrases including: body hygiene, personal hygiene, sleep hygiene, mental hygiene, dental hygiene, and occupational hygiene, used in connection with public health. Hygiene is also the name of a branch of science that deals with the promotion and preservation of health, also called hygienic. Hygiene practices vary widely, and what is considered acceptable in one culture might not be acceptable in another.

Medical hygiene

Medical hygiene pertains to the hygiene practices related to the administration of medicine, and medical care, that prevents or minimizes disease and the spreading of disease.

Medical hygiene practices include:

• Isolation or quarantine of infectious persons or materials to prevent spread of infection.
• Sterilization of instruments used in surgical procedures.
• Use of protective clothing and barriers, such as masks, gowns, caps, eyewear and gloves.
• Proper bandaging and dressing of injuries.
• Safe disposal of medical waste.
• Disinfection of reusables (i.e. linen, pads, uniforms)
• Scrubbing up, hand-washing, especially in an operating room, but in more general health-care settings as well, where diseases can be transmitted

Most of these practices were developed in the 19th century and were well established by the mid-20th century. Some procedures (such as disposal of medical waste) were refined in response to late-20th century disease outbreaks, notably AIDS and Ebola.

Home and everyday life hygiene

Home hygiene pertains to the hygiene practices that prevent or minimize disease and the spreading of disease in home (domestic) and in everyday life settings such as social settings, public transport, the work place, public places etc.

Hygiene in home and everyday life settings plays an important part in preventing spread of infectious diseases. It includes procedures used in a variety of domestic situations such as hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene (hygiene of environmental sites and surfaces), care of domestic animals, and home healthcare (the care of those who are at greater risk of infection).

At present, these components of hygiene tend to be regarded as separate issues, although all are based on the same underlying microbiological principles. Preventing the spread of infectious diseases means breaking the chain of infection transmission. The simple principle is that, if the chain of infection is broken, infection cannot spread. In response to the need for effective codes of hygiene in home and everyday life settings the International Scientific Forum on Home Hygiene has developed a risk-based approach (based on Hazard Analysis Critical Control Point (HACCP), which has come to be known as "targeted hygiene". Targeted hygiene is based on identifying the routes of spread of pathogens in the home, and applying hygiene procedures at critical points at appropriate times to break the chain of infection.

The main sources of infection in the home are people (who are carriers or are infected), foods (particularly raw foods) and water, and domestic animals (in western countries more than 50% of homes have one or more pets). Additionally, sites that accumulate stagnant water—such as sinks, toilets, waste pipes, cleaning tools, face cloths—readily support microbial growth, and can become secondary reservoirs of infection, though species are mostly those that threaten "at risk" groups. Germs (potentially infectious bacteria, viruses etc.) are constantly shed from these sources via mucous membranes, faeces, vomit, skin scales, etc. Thus, when circumstances combine, people become exposed, either directly or via food or water, and can develop an infection. The main "highways" for spread of germs in the home are the hands, hand and food contact surfaces, and cleaning cloths and utensils. Germs can also spread via clothing and household linens, such as towels. Utilities such as toilets and wash basins, for example, were invented for dealing safely with human waste, but still have risks associated with them, which may become critical at certain times, e.g., when someone has sickness or diarrhea. Safe disposal of human waste is a fundamental need; poor sanitation is a primary cause of diarrhea disease in low income communities. Respiratory viruses and fungal spores are also spread via the air.

Good home hygiene means targeting hygiene procedures at critical points, at appropriate times, to break the chain of infection i.e. to eliminate germs before they can spread further. Because the "infectious dose" for some pathogens can be very small (10-100 viable units, or even less for some viruses), and infection can result from direct transfer from surfaces via hands or food to the mouth, nasal mucosa or the eye, 'hygienic cleaning' procedures should be sufficient to eliminate pathogens from critical surfaces. Hygienic cleaning can be done by:

• Mechanical removal (i.e. cleaning) using a soap or detergent. To be effective as a hygiene measure, this process must be followed by thorough rinsing under running water to remove germs from the surface.

• Using a process or product that inactivates the pathogens in situ. Germ kill is achieved using a "micro-biocidal" product i.e. a disinfectant or antibacterial product or waterless hand sanitizer, or by application of heat.

Hand hygiene

Hand hygiene is defined as hand washing or washing hands and nails with soap and water or using a waterless hand sanitizer.

Hand hygiene is central to preventing spread of infectious diseases in home and everyday life settings.

In situations where hand washing with soap is not an option (e.g. when in a public place with no access to wash facilities), a waterless hand sanitizer such as an alcohol hand gel can be used. They can also be used in addition to hand washing, to minimize risks when caring for "at risk" groups. To be effective, alcohol hand gels should contain not less than 60%v/v alcohol. Hand sanitizers are not an option in most developing countries. In situations with limited water supply, there are water-conserving solutions, such as tippy-taps. (A tippy-tap is a simple technology using a jug suspended by a rope, and a foot-operated lever to pour a small amount of water over the hands and a bar of soap.) In low-income communities, mud or ash is sometimes used as an alternative to soap.

The World Health Organization recommends hand washing with ash if soap is not available in emergencies, schools without access to soap  and other difficult situations like post-emergencies where use of (clean) sand is recommended too. Use of ash is common and has in experiments been shown at least as effective as soap for removing bacteria.

Respiratory hygiene

Correct respiratory and hand hygiene when coughing and sneezing reduces the spread of germs particularly during the cold and flu season.

• Carry tissues and use them to catch coughs and sneezes
• Dispose of tissues as soon as possible
• Clean your hands by hand washing or using an alcohol hand sanitizer.

Food hygiene at home

Food hygiene is concerned with the hygiene practices that prevent food poisoning. The five key principles of food hygiene, according to WHO, are:

1.    Prevent contaminating food with mixing chemicals spreading from people, pets, and pests.

2.    Separate raw and cooked foods to prevent contaminating the cooked foods.

3.    Cook foods for the appropriate length of time and at the appropriate temperature to kill pathogens.

4.    Store food at the proper temperature.

5.    Use safe water and raw materials

Household water treatment and safe storage

Household water treatment and safe storage ensure drinking water is safe for consumption. Drinking water quality remains a significant problem, not only in developing countries but also in developed countries; even in the European region it is estimated that 120 million people do not have access to safe drinking water. Point-of-use water quality interventions can reduce diarrheal disease in communities where water quality is poor, or in emergency situations where there is a breakdown in water supply. Since water can become contaminated during storage at home (e.g. by contact with contaminated hands or using dirty storage vessels), safe storage of water in the home is also important.

Methods for treatment of drinking water, include:

1.    Chemical disinfection using chlorine or iodine

2.    Boiling

3.    Filtration using ceramic filters

4.    Solar disinfection - Solar disinfection is an effective method, especially when no chemical disinfectants are available.

5.    UV irradiation - community or household UV systems may be batch or flow-though. The lamps can be suspended above the water channel or submerged in the water flow.

6.    Combined flocculation/disinfection systems – available as sachets of powder that act by coagulating and flocculating sediments in water followed by release of chlorine.

7.    Multibarrier methods – Some systems use two or more of the above treatments in combination or in succession to optimize efficacy.

Hygiene in the kitchen, bathroom and toilet

Routine cleaning of (hand, food and drinking water) sites and surfaces (such as toilet seats and flush handles, door and tap handles, work surfaces, bath and basin surfaces) in the kitchen, bathroom and toilet reduces the risk of spread of germs. The infection risk from the toilet itself is not high, provided it is properly maintained, although some splashing and aerosol formation can occur during flushing, particularly where someone in the family has diarrhea. Germs can survive in the scum or scale left behind on baths and wash basins after washing and bathing.

Water left stagnant in the pipes of showers can be contaminated with germs that become airborne when the shower is turned on. If a shower has not been used for some time, it should be left to run at a hot temperature for a few minutes before use.

Thorough cleaning is important in preventing the spread of fungal infections. Molds can live on wall and floor tiles and on shower curtains. Mold can be responsible for infections, cause allergic responses, deteriorate/damage surfaces and cause unpleasant odors. Primary sites of fungal growth are inanimate surfaces, including carpets and soft furnishings. Air-borne fungi are usually associated with damp conditions, poor ventilation or closed air systems.

Cleaning of toilets and hand wash facilities is important to prevent odors and make them socially acceptable. Social acceptance is an important part of encouraging people to use toilets and wash their hands.

Laundry hygiene

Laundry hygiene pertains to the practices that prevent or minimize disease and the spreading of disease via soiled clothing and household linens such as towels. Items most likely to be contaminated with pathogens are those that come into direct contact with the body, e.g., underwear, personal towels, facecloths, nappies. Cloths or other fabric items used during food preparation, or for cleaning the toilet or cleaning up material such as faeces or vomit are a particular risk.

Microbiological and epidemiological data indicates that clothing and household linens etc. are a risk factor for infection transmission in home and everyday life settings as well as institutional settings, although the lack of quantitative data directly linking contaminated clothing to infection in the domestic setting makes it difficult to assess the extent of the risk. Although microbiological data indicates that risks from clothing and household linens are somewhat less than those associated with hands, hand contact and food contact surfaces, and cleaning cloths, nevertheless these risks needs to be appropriately managed through effective laundering practices. In the home, this routine should be carried out as part of a multibarrier approach to hygiene which also includes hand, food, respiratory and other hygiene practices.

Infection risks from contaminated clothing etc. can increase significantly under certain conditions. e.g. in healthcare situations in hospitals, care homes and the domestic setting where someone has diarrhoea, vomiting, or a skin or wound infection. It also increases in circumstances where someone has reduced immunity to infection.

Hygiene measures, including laundry hygiene, are an important part of reducing spread of antibiotic resistant strains. In the community, otherwise healthy people can become persistent skin carriers of MRSA, or faecal carriers of enterobacteria strains which can carry multi-antibiotic resistance factors (e.g. NDM-1 or ESBL-producing strains). The risks are not apparent until, for example, they are admitted to hospital, when they can become “self infected” with their own resistant organisms following a surgical procedure. As persistent nasal, skin or bowel carriage in the healthy population spreads “silently” across the world, the risks from resistant strains in both hospitals and the community increases. In particular the data indicates that clothing and household linens are a risk factor for spread of S. aureus (including MRSA and PVL-producing MRSA strains), and that effectiveness of laundry processes may be an important factor in defining the rate of community spread of these strains. Experience in the USA suggests that these strains are transmissible within families, but also in community settings such as prisons, schools and sport teams. Skin-to-skin contact (including unabraded skin) and indirect contact with contaminated objects such as towels, sheets and sports equipment seem to represent the mode of transmission.

During laundering, temperature, together with the action of water and detergent work together to reduce microbial contamination levels on fabrics. During the wash cycle soil and microbes are detached from fabrics and suspended into the wash water. These are then “washed away” during the rinse and spin cycles. In addition to physical removal, micro-organisms can be killed by thermal inactivation which increases as the temperature is increased. Chemical inactivation of microbes by the surfactants and activated oxygen-based bleach used in detergents also contributes to the hygiene effectiveness of laundering. Adding hypochlorite bleach in the washing process also achieves inactivation of microbes. A number of other factors can also contribute including drying and ironing.

Laundry detergents contain a mix of ingredients including surfactants, builders, optical brighteners, etc. Cleaning action arises primarily from the action of the surfactants and other ingredients, which are designed to maximise release and suspension of dirt and microbes into the wash liquid, together with enzymes and/or an activated oxygen-based bleach which digest and remove stains. Although activated oxygen bleach is included in many powder detergents to digest and remove stains, it also produces some chemical inactivation of bacteria, fungi and viruses. As a rule of thumb, powders and tablets normally contain an activated oxygen bleach, but liquids, and all products (liquid or powder) used for “coloureds” do not. Surfactants also exert some chemical inactivation action against certain species although the extent of their action is not known.

In 2013 the International Scientific Forum on Home Hygiene (IFH) reviewed some 30 studies of the hygiene effectiveness of laundering at various temperatures ranging from room temperature to 70 °C, under varying conditions. A key finding was the lack of standardisation and control within studies, and the variability in test conditions between studies such as wash cycle time, number of rinses etc. The consequent variability in the data (i.e. the reduction in contamination on fabrics) obtained, in turn makes it extremely difficult to propose guidelines for laundering with any confidence, based on currently available data. As a result there is significant variability in the recommendations for hygienic laundering of clothing etc. given by different agencies.

Of concern is recent data suggesting that, in reality, modern domestic washing machines do not reach the temperature specified on the machine controls.

Medical hygiene at home

Medical hygiene pertains to the hygiene practices that prevents or minimizes disease and the spreading of disease in relation to administering medical care to those who are infected or who are more "at risk" of infection in the home. Across the world, governments are increasingly under pressure to fund the level of healthcare that people expect. Care of increasing numbers of patients in the community, including at home is one answer, but can be fatally undermined by inadequate infection control in the home. Increasingly, all of these "at-risk" groups are cared for at home by a carer who may be a household member who thus requires a good knowledge of hygiene. People with reduced immunity to infection, who are looked after at home, make up an increasing proportion of the population (currently up to 20%). The largest proportion are the elderly who have co-morbidities, which reduce their immunity to infection. It also includes the very young, patients discharged from hospital, taking immuno-suppressive drugs or using invasive systems, etc. For patients discharged from hospital, or being treated at home special "medical hygiene" (see above) procedures may need to be performed for them e.g. catheter or dressing replacement, which puts them at higher risk of infection.

Antiseptics may be applied to cuts, wounds abrasions of the skin to prevent the entry of harmful bacteria that can cause sepsis. Day-to-day hygiene practices, other than special medical hygiene procedures are no different for those at increased risk of infection than for other family members. The difference is that, if hygiene practices are not correctly carried out, the risk of infection is much greater.

Home hygiene in low-income communities

In the developing world, for decades, universal access to water and sanitation has been seen as the essential step in reducing the preventable ID burden, but it is now clear that this is best achieved by programs that integrate hygiene promotion with improvements in water quality and availability, and sanitation. About 2 million people die every year due to diarrheal diseases, most of them are children less than 5 years of age. The most affected are the populations in developing countries, living in extreme conditions of poverty, normally peri-urban dwellers or rural inhabitants. Providing access to sufficient quantities of safe water, the provision of facilities for a sanitary disposal of excreta, and introducing sound hygiene behaviors are of capital importance to reduce the burden of disease caused by these risk factors.

Research shows that, if widely practiced, hand washing with soap could reduce diarrhea by almost fifty percent and respiratory infections by nearly twenty-five percent Hand washing with soap also reduces the incidence of skin diseases, eye infections like trachoma and intestinal worms, especially ascariasis and trichuriasis.

Other hygiene practices, such as safe disposal of waste, surface hygiene, and care of domestic animals, are also important in low income communities to break the chain of infection transmission.

Disinfectants and antibacterials in home hygiene

Chemical disinfectants are products that kill germs (harmful bacteria, viruses and fungi). If the product is a disinfectant, the label on the product should say "disinfectant" and/or "kills" germs or bacteria etc. Some commercial products, e.g. bleaches, even though they are technically disinfectants, say that they "kill germs", but are not actually labelled as "disinfectants". Not all disinfectants kill all types of germs. All disinfectants kill bacteria (called bactericidal). Some also kill fungi (fungicidal), bacterial spores (sporicidal) and/or viruses (virucidal).

An antibacterial product is a product that acts against bacteria in some unspecified way. Some products labelled "antibacterial" kill bacteria while others may contain a concentration of active ingredient that only prevent them multiplying. It is, therefore, important to check whether the product label States that it "kills" bacteria." An antibacterial is not necessarily anti-fungal or anti-viral unless this is Stated on the label.

The term sanitizer has been used to define substances that both clean and disinfect. More recently this term has been applied to alcohol-based products that disinfect the hands (alcohol hand sanitizers). Alcohol hand sanitizers however are not considered to be effective on soiled hands.

The term biocide is a broad term for a substance that kills, inactivates or otherwise controls living organisms. It includes antiseptics and disinfectants, which combat micro-organisms, and also includes pesticides.

Personal hygiene

Personal hygiene involves those practices performed by an individual to care for one's bodily health and well being, through cleanliness. Motivations for personal hygiene practice include reduction of personal illness, healing from personal illness, optimal health and sense of well being, social acceptance and prevention of spread of illness to others. What is considered proper personal hygiene can be cultural-specific and may change over time. In some cultures removal of body hair is considered proper hygiene. Other practices that are generally considered proper hygiene include bathing regularly, washing hands regularly and especially before handling food, washing scalp hair, keeping hair short or removing hair, wearing clean clothing, brushing one's teeth, cutting finger nails, besides other practices. Some practices are gender-specific, such as by a woman during her menstrual cycle. People tend to develop a routine for attending to their personal hygiene needs. Other personal hygienic practices would include covering one's mouth when coughing, disposal of soiled tissues appropriately, making sure toilets are clean, and making sure food handling areas are clean, besides other practices. Some cultures do not kiss or shake hands to reduce transmission of bacteria by contact.

Personal grooming extends personal hygiene as it pertains to the maintenance of a good personal and public appearance, which need not necessarily be hygienic. It may involve, for example, using deodorants or perfume, shaving, or combing, besides other practices.

Excessive body hygiene

Excessive body hygiene and allergies

The hygiene hypothesis was first formulated in 1989 by Strachan who observed that there was an inverse relationship between family size and development of atopic allergic disorders – the more children in a family, the less likely they were to develop these allergies. From this, he hypothesised that lack of exposure to "infections" in early childhood transmitted by contact with older siblings could be a cause of the rapid rise in atopic disorders over the last thirty to forty years. Strachan further proposed that the reason why this exposure no longer occurs is, not only because of the trend towards smaller families, but also "improved household amenities and higher standards of personal cleanliness".

Although there is substantial evidence that some microbial exposures in early childhood can in some way protect against allergies, there is no evidence that we need exposure to harmful microbes (infection) or that we need to suffer a clinical infection. Nor is there evidence that hygiene measures such as hand washing, food hygiene etc. are linked to increased susceptibility to atopic disease. If this is the case, there is no conflict between the goals of preventing infection and minimising allergies. A consensus is now developing among experts that the answer lies in more fundamental changes in lifestyle etc. that have led to decreased exposure to certain microbial or other species, such as helminths, that are important for development of immuno-regulatory mechanisms. There is still much uncertainty as to which lifestyle factors are involved.

Although media coverage of the hygiene hypothesis has declined, a strong ‘collective mindset’ has become established that dirt is ‘healthy’ and hygiene somehow ‘unnatural’. This has caused concern among health professionals that everyday life hygiene behaviours, which are the foundation of public health, are being undermined. In response to the need for effective hygiene in home and everyday life settings, the International Scientific Forum on Home Hygiene has developed a "risk-based" or targeted approach to home hygiene that seeks to ensure that hygiene measures are focussed on the places, and at the times most critical for infection transmission. Whilst targeted hygiene was originally developed as an effective approach to hygiene practice, it also seeks, as far as possible, to sustain "normal" levels of exposure to the microbial flora of our environment to the extent that is important to build a balanced immune system.

Excessive body hygiene of internal ear canals

Excessive body hygiene of the ear canals can result in infection or irritation. The ear canals require less body hygiene care than other parts of the body, because they are sensitive, and the body system adequately cares for these parts. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of the skin lining the ear canal from the eardrum to the outer opening of the ear. Old earwax is constantly being transported from the deeper areas of the ear canal out to the opening where it usually dries, flakes, and falls out. Attempts to clean the ear canals through the removal of earwax can actually reduce ear canal cleanliness by pushing debris and foreign material into the ear that the natural movement of ear wax out of the ear would have removed.

Excessive body hygiene of skin

Excessive body hygiene of the skin can result in skin irritation. The skin has a natural layer of oil, which promotes elasticity, and protects the skin from drying. When washing, unless using aqueous creams with compensatory mechanisms, this layer is removed leaving the skin unprotected.

Excessive application of soaps, creams, and ointments can also adversely affect certain of the natural processes of the skin. For examples, soaps and ointments can deplete the skin of natural protective oils and fat-soluble content such as cholecalciferol (vitamin D3), and external substances can be absorbed, to disturb natural hormonal balances.

Culinary and food hygiene

Culinary hygiene pertains to the practices related to food management and cooking to prevent food contamination, prevent food poisoning and minimize the transmission of disease to other foods, humans or animals. Culinary hygiene practices specify safe ways to handle, store, prepare, serve and eat food.

Culinary practices include:

• Cleaning and disinfection of food-preparation areas and equipment (for example using designated cutting boards for preparing raw meats and vegetables). Cleaning may involve use of chlorine bleach, ethanol, ultraviolet light, etc. for disinfection.
• Careful avoidance of meats contaminated by trichina worms, salmonella, and other pathogens; or thorough cooking of questionable meats.
• Extreme care in preparing raw foods, such as sushi and sashimi.
• Institutional dish sanitizing by washing with soap and clean water.
• Washing of hands thoroughly before touching any food.
• Washing of hands after touching uncooked food when preparing meals.
• Not using the same utensils to prepare different foods.
• Not sharing cutlery when eating.
• Not licking fingers or hands while or after eating.
• Not reusing serving utensils that have been licked.
• Proper storage of food so as to prevent contamination by vermin.
• Refrigeration of foods (and avoidance of specific foods in environments where refrigeration is or was not feasible).
• Labeling food to indicate when it was produced (or, as food manufacturers prefer, to indicate its "best before" date).
• Proper disposal of uneaten food and packaging.

Personal service hygiene

Personal service hygiene pertains to the practices related to the care and use of instruments used in the administration of personal care services to people:

Personal hygiene practices include:

• Sterilization of instruments used by service providers including hairdressers, aestheticians, and other service providers.
• Sterilization by autoclave of instruments used in body piercing and tattoo marking.
• Cleaning hands.

History of hygienic practices

The earliest written account of Elaborate codes of hygiene can be found in several Hindu texts, such as the Manusmriti and the Vishnu Purana. Bathing is one of the five Nitya karmas (daily duties) in Hinduism, and not performing it leads to sin, according to some scriptures.

Regular bathing was a hallmark of Roman civilization. Elaborate baths were constructed in urban areas to serve the public, who typically demanded the infrastructure to maintain personal cleanliness. The complexes usually consisted of large, swimming pool-like baths, smaller cold and hot pools, saunas, and spa-like facilities where individuals could be depilated, oiled, and massaged. Water was constantly changed by an aqueduct-fed flow. Bathing outside of urban centers involved smaller, less elaborate bathing facilities, or simply the use of clean bodies of water. Roman cities also had large sewers, such as Rome's Cloaca Maxima, into which public and private latrines drained. Romans didn't have demand-flush toilets but did have some toilets with a continuous flow of water under them. (Similar toilets are seen in Acre Prison in the film Exodus.)

Until the late 19th Century, only the elite in Western cities typically possessed indoor facilities for relieving bodily functions. The poorer majority used communal facilities built above cesspools in backyards and courtyards. This changed after Dr. John Snow discovered that cholera was transmitted by the fecal contamination of water. Though it took decades for his findings to gain wide acceptance, governments and sanitary reformers were eventually convinced of the health benefits of using sewers to keep human waste from contaminating water. This encouraged the widespread adoption of both the flush toilet and the moral imperative that bathrooms should be indoors and as private as possible.

Islamic hygienical jurisprudence

Since the 7^th century, Islam has always placed a strong emphasis on hygiene. Other than the need to be ritually clean in time for the daily prayer (Arabic: Salat) through Wudu and Ghusl, there are a large number of other hygiene-related rules governing the lives of Muslims. Other issues include the Islamic dietary laws. In general, the Qur'an advises Muslims to uphold high standards of physical hygiene and to be ritually clean whenever possible.

Hygiene in medieval Europe

Contrary to popular belief and although the Early Christian leaders, such as Boniface I, condemned bathing as unspiritual, bathing and sanitation were not lost in Europe with the collapse of the Roman Empire. Soap making first became an established trade during the so-called "Dark Ages". The Romans used scented oils (mostly from Egypt), among other alternatives.

Northern Europeans were not in the habit of bathing: in the ninth century Notker the Stammerer, a Frankish monk of St Gall, related a disapproving anecdote that attributed ill results of personal hygiene to an Italian fashion:

There was a certain deacon who followed the habits of the Italians in that he was perpetually trying to resist nature. He used to take baths, he had his head very closely shaved, he polished his skin, he cleaned his nail, he had his hair cut as short as if it were turned on a lathe, and he wore linen underclothes and a snow-white shirt.

Secular medieval texts constantly refer to the washing of hands before and after meals, but Sone de Nansay, hero of a 13th-century romance, discovers to his chagrin that the Norwegians do not wash up after eating. In the 11th and 12th centuries, bathing was essential to the Western European upper class: the Cluniac monasteries to which they resorted or retired were always provided with bathhouses, and even the monks were required to take full immersion baths twice a year, at the two Christian festivals of renewal, though exhorted not to uncover themselves from under their bathing sheets. In 14th century Tuscany, the newlywed couple's bath together was such a firm convention one such couple, in a large coopered tub, is illustrated in fresco in the town hall of San Gimignano.

Bathing had fallen out of fashion in Northern Europe long before the Renaissance, when the communal public baths of German cities were in their turn a wonder to Italian visitors. Bathing was replaced by the heavy use of sweat-bathing and perfume, as it was thought in Europe that water could carry disease into the body through the skin. Bathing encouraged an erotic atmosphere that was played upon by the writers of romances intended for the upper class; in the tale of Melusine the bath was a crucial element of the plot. "Bathing and grooming were regarded with suspicion by moralists, however, because they unveiled the attractiveness of the body. Bathing was said to be a prelude to sin, and in the penitential of Burchard of Worms we find a full catalogue of the sins that ensued when men and women bathed together." Medieval church authorities believed that public bathing created an environment open to immorality and disease; the 26 public baths of Paris in the late 13th century were strictly overseen by the civil authorities. At a later date Roman Catholic Church officials even banned public bathing in an unsuccessful effort to halt syphilis epidemics from sweeping Europe.

Modern sanitation was not widely adopted until the 19th and 20th centuries. According to medieval historian Lynn Thorndike, people in Medieval Europe probably bathed more than people did in the 19th century. Sometime after Louis Pasteur's experiments proved the germ theory of disease and Joseph Lister and others put them into practice in sanitation, hygienic practices came to be regarded as synonymous with health, as they are in modern times.

Industrial society

A social hygiene movement in the late 19th and early 20th centuries, sometimes including mental hygiene (now mental health), sexual hygiene and racial hygiene movements, was an attempt by Progressive-era reformers to prevent and control disease by changing the public's habits through the use of scientific research methods and modern media techniques. It was also based in part on eugenics, and by the 1930s thousands of forced sterilizations of people deemed undesirable took place in America each year. After 1945 when the Nazis had taken it even further, the movement was largely discredited. The drive for cleanliness persisted, however, particularly cleanliness in children. This showed many benefits such as reduced child mortality rates. It also became increasingly commercialized, however, and may have contributed to environmental pollution, resistance to antibiotics, and even restricting the development of the immune system leading to increased incidence of diseases such as asthma or allergies.

Information society

In connection with the development of the information society, appeared information pollution, evolving information ecology - associated with informational hygiene.

what is Sanitation ?

Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes as well as the treatment and proper disposal of sewage or wastewater. Hazards can be either physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems include human and animal excreta, solid wastes, domestic wastewater (sewage, sullage, greywater), industrial wastes and agricultural wastes. Hygienic means of prevention can be by using engineering solutions (e.g., sewerage, wastewater treatment, stormwater drainage, solid waste management, excreta management), simple technologies (e.g., pit latrines, dry toilets, UDDTs, septic tanks), or even simply by personal hygiene practices (e.g., hand washing with soap, behavior change).

 The World Health Organization States that:

"Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces. Inadequate sanitation is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities. The word 'sanitation' also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal.

Sanitation includes all four of these engineering infrastructure items (even though often only the first one is strongly associated with the term "sanitation"):

• Excreta management systems
• Wastewater management systems
• Solid waste management systems
• Drainage systems for rainwater, also called stormwater drainage

Despite the fact that sanitation includes wastewater treatment, the two terms are often use side by side: people tend to speak of sanitation and wastewater management which is why the differeantiation is also made in the sub-headings in this article. The term sanitation has been connected to several descriptors so that the terms sustainable sanitation, improved sanitation, unimproved sanitation, environmental sanitation, on-site sanitation, ecological sanitation, dry sanitation are all in use today. Sanitation should be regarded with a systems approach in mind which includes collection/containment, conveyance/transport, treatment and disposal or reuse.

Wastewater management

Collection

The standard sanitation technology in urban areas is the collection of wastewater in sewers, its treatment in wastewater treatment plants for reuse or disposal in rivers, lakes or the sea. Sewers are either combined with storm drains or separated from them as sanitary sewers. Combined sewers are usually found in the central, older parts or urban areas. Heavy rainfall and inadequate maintenance can lead to combined sewer overflows or sanitary sewer overflows, i.e., more or less diluted raw sewage being discharged into the environment. Industries often discharge wastewater into municipal sewers, which can complicate wastewater treatment unless industries pre-treat their discharges.

The high investment cost of conventional wastewater collection systems are difficult to afford for many developing countries. Some countries have therefore promoted alternative wastewater collection systems such as condominial sewerage, which uses pipes with smaller diameters at lower depth with different network layouts from conventional sewerage.

Treatment

For more details on this topic, see Sewage treatment.

Centralised treatment

In developed countries treatment of municipal wastewater is now widespread, but not yet universal (for an overview of technologies see wastewater treatment). In developing countries most wastewater is still discharged untreated into the environment. For example, in Latin America only about 15% of collected sewerage is being treated (see water and sanitation in Latin America)

On-site treatment, decentralised treatment

In many suburban and rural areas households are not connected to sewers. They discharge their wastewater into septic tanks or other types of on-site sanitation. On-site systems include drain fields, which require significant area of land. This makes septic systems unsuitable for most cities.

Constructed wetlands are another example for a possible decentralised treatment option.

Disposal or reuse of treated wastewater

The reuse of untreated or partially treated wastewater in irrigated agriculture is common in developing countries. The reuse of treated wastewater in landscaping, especially on golf courses, irrigated agriculture and for industrial use is becoming increasingly widespread.

Types of sanitation

The term sanitation is connected with various descriptors to signify certain types of sanitation systems. Here they are shown in alphabetical order:

Dry sanitation

The term "dry sanitation" is somewhat misleading as sanitation as includes handwashing and can never be "dry". A more precise term would be "dry excreta management". When people speak of "dry sanitation" they usually mean sanitation systems with dry toilets with urine diversion, in particular the urine-diverting dry toilet (UDDT).

Ecological sanitation

Ecological sanitation, which is commonly abbreviated to ecosan, is an approach, rather than a technology or a device which is characterized by a desire to "close the loop" (mainly for the nutrients and organic matter) between sanitation and agriculture in a safe manner. Put in other words: "Ecosan systems safely recycle excreta resources (plant nutrients and organic matter) to crop production in such a way that the use of non-renewable resources is minimised". When properly designed and operated, ecosan systems provide a hygienically safe, economical, and closed-loop system to convert human excreta into nutrients to be returned to the soil, and water to be returned to the land. Ecosan is also called resource-oriented sanitation.

Environmental sanitation

Environmental sanitation is the control of environmental factors that form links in disease transmission. Subsets of this category are solid waste management, water and wastewater treatment, industrial waste treatment and noise and pollution control.

Improved and unimproved sanitation

Improved sanitation and unimproved sanitation refers to the management of human feces at the household level. This terminology is the indicator used to describe the target of the Millennium Development Goal on sanitation, by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation.

Lack of sanitation

Lack of sanitation refers to the absence of sanitation. In practical terms it usually means lack of toilets or lack of hygienic toilets that anybody would want to use voluntarily. The result of lack of sanitation is usually open defecation (and open urination but this is of less concern) with the associated serious public health issues.

On-site sanitation

Onsite sanitation is the collection and treatment of waste is done where it is deposited. Examples are the use of pit latrines, septic tanks, and Imhoff tanks

Sustainable sanitation

Sustainable sanitation is a term that has been defined with five sustainability criteria by the Sustainable Sanitation Alliance. In order to be sustainable, a sanitation system has to be not only (i) economically viable, (ii) socially acceptable, and (iii) technically and (iv) institutionally appropriate, it should also (v) protect the environment and the natural resources. The main objective of a sanitation system is to protect and promote human health by providing a clean environment and breaking the cycle of disease.

clean Toilets

A toilet is a sanitation fixture used primarily for the disposal of human urine and feces. They are often found in a small room referred to as a toilet, bathroom or lavatory. A toilet can be designed for people who prefer to sit (on a toilet pedestal) or for people who prefer to squat (over a squatting toilet). Flush toilets, which are common in many parts of the world (particularly in more affluent countries or regions), may be connected to a nearby septic tank or more commonly in urban areas via "large" (3–6 in or 7.6–15.2 cm) sewer pipe connected to a sewerage pipe system. The water and waste from many different sources is piped in large pipes to a more distant sewage treatment plant or wastewater treatment plant. Dry toilets, including pit latrines and composting toilets require no or little water with excreta being removed manually or composted in situ. Chemical toilets or mobile dry toilets can be used in mobile and many temporary situations where there is no access to sewerage. Some types of toilets are more commonly referred to as latrines, for example the "pit latrine", and for most people the term "toilet" has a cleaner more upmarket connotation than the word "latrine".

Ancient civilizations used toilets attached to simple flowing water sewage systems included those of the Indus Valley Civilization, e.g., Harappa and Mohenjo-daro which are located in present day India and Pakistan and also the Romans and Egyptians. Although a precursor to the flush toilet system which is widely used nowadays was designed in 1596 by John Harington, such systems did not come into widespread use until the late nineteenth century. Thomas Crapper was one of the early makers of flush toilets in England.

Diseases, including cholera, which still affects some 3 million people each year, can be largely prevented when effective sanitation and water treatment prevents fecal matter from contaminating drinking water supplies.

History

Ancient civilizations

According to Teresi et al. (2002)

The third millennium BC was the "Age of Cleanliness." Toilets and sewers were invented in several parts of the world, and Mohenjo-Daro circa 2800 BC had some of the most advanced, with lavatories built into the outer walls of houses. These were primitive "Western-style" toilets made from bricks with wooden seats on top. They had vertical chutes, through which waste fell into street drains or cesspits. Sir Mortimer Wheeler, the director general of archaeology in India from 1944 to 1948, wrote, "The high quality of the sanitary arrangements could well be envied in many parts of the world today."

The toilets at Mohenjo-Daro, built about 2600 BC and described above, were only used by the affluent classes. Most people would have squatted over old pots set into the ground or used open pits. The people of the Harappan civilization in Pakistan and northwestern India had primitive water-cleaning toilets that used flowing water in each house that were linked with drains covered with burnt clay bricks. The flowing water removed the human wastes.

Early toilets that used flowing water to remove the waste are also found at Skara Brae in Orkney, Scotland, which was occupied from about 3100 BC until 2500 BC. Some of the houses there have a drain running directly beneath them, and some of these had a cubicle over the drain. Around the 18th century BC, toilets started to appear in Minoan Crete, Egypt in the time of the Pharaohs and ancient Persia. In Roman civilization, toilets using flowing water were sometimes part of public bath houses.

In 2012, archaeologists founded what is believed to be Southeast Asia's earliest latrine during the excavation of a neolithic village in the Rạch Núi archaeological site, southern Viet Nam. The toilet, dating back 1500 BC, yielded important clues about early Southeast Asian society. More than 30 preserved feces from humans and dogs containing fish and shattered animal bones from the site provided a wealth of information on the diet of humans and dogs at Rạch Núi and on the types of parasites each had to contend with.

Roman toilets, like the ones pictured here, are commonly thought to have been used in the sitting position. But sitting toilets only came into general use in the mid-19th century in the Western world. The Roman toilets were probably elevated to raise them above open sewers which were periodically "flushed" with flowing water, rather than elevated for sitting.

The Romans weren't the first civilisation to adopt a sewer system: The Indus Valley civilisation had a rudimentary network of sewers built under grid pattern streets, and it was the most advanced seen so far.

Squat toilets (also known as an Arabic, French, Chinese, Japanese, Korean, Iranian, Indian, Turkish or Natural-Position toilet) are used by squatting rather than sitting and are still used by the majority of the world's population.

There are several types of squat toilets, but they all consist essentially of a hole in the ground or floor with provisions for human waste.

Early modern Europe

Chamber pots were in common use in Europe from ancient times, even being taken to the Middle East by Christian pilgrims during the Middle Ages. By the Early Modern era, chamber pots were frequently made of china or copper and could include elaborate decoration. They were emptied into the gutter of the street nearest to the home.

During the Victorian era, British housemaids emptied household chamber pots into a "slop sink" that was inside a housemaid's cupboard on the upper floor of the house. The housemaids' cupboard also contained a separate sink, made of wood with a lead lining to prevent chipping china chamber pots, for washing the "bedroom ware". Once indoor running water was built into British houses, servants were sometimes given their own lavatory downstairs, separate from the family lavatory.

By the 16th century, cesspits and cesspools were increasingly dug into the ground near houses in Europe as a means of collecting waste, as urban populations grew and street gutters became blocked with the larger volume of human waste. Rain was no longer sufficient to wash away waste from the gutters.

A pipe connected the latrine to the cesspool, and sometimes a small amount of water washed waste through the pipe into the cesspool. Cesspools would be cleaned out by tradesmen, who pumped out liquid waste, then shovelled out the solid waste and collected it in horse-drawn carts during the night. This solid waste would be used as fertilizer.

The perception that human waste had value as fertilizer, and in ammonia production, delayed the construction of a modern sewer system as a replacement for the city's cesspool system. In the early 19th century, public officials and public hygiene experts studied and debated the matter at length, for several decades.

The construction of an underground network of pipes to carry away solid and liquid waste was only begun in the mid 19th-century, gradually replacing the cesspool system, although cesspools were still in use in some parts of Paris into the 20th century. The growth of indoor plumbing, toilets and bathtubs with running water came at the same time.

Development of the flush toilet

In 1596, Sir John Harington (1561–1612) published A New Discourse of a Stale Subject, Called the Metamorphosis of Ajax, describing a forerunner to the modern flush toilet installed at his house at Kelston. The design had a flush valve to let water out of the tank, and a wash-down design to empty the bowl. He installed one for his godmother Queen Elizabeth I at Richmond Palace, although she refused to use it because it made too much noise. The Ajax was not taken up on a wide scale in England, but was adopted in France under the name Angrez.

With the onset of the Industrial Revolution and related advances in technology, the flush toilet began to emerge into its modern form. A crucial advance in plumbing, was the S-trap, invented by Alexander Cummings in 1775, and still in use today. This device uses the standing water to seal the outlet of the bowl, preventing the escape of foul air from the sewer. His design had a sliding valve in the bowl outlet above the trap. Two years later, Samuel Prosser applied for a British patent for a "plunger closet".

Prolific inventor Joseph Bramah began his professional career installing water closets (toilets) that were based on Alexander Cumming's patented design of 1775. He found that the current model being installed in London houses had a tendency to freeze in cold weather. In collaboration with a Mr. Allen, he improved the design by replacing the usual slide valve with a hinged flap that sealed the bottom of the bowl.

He also developed a float valve system for the flush tank. Obtaining the patent for it in 1778, he began making toilets at a workshop in Denmark Street, St Giles. The design was arguably the first practical flush toilet, and production continued well into the 19th century, used mainly on boats.

Dry earth closet alternative

Before the flush toilet became universally accepted, there were inventors, scientists, and public health officials who supported the use of dry earth closets. These were invented by the English clergyman Henry Moule, who dedicated his life to improving public sanitation after witnessing the horrors of the cholera epidemics of 1849 and 1854. Impressed by the insalubrity of the houses, especially in the summer of 1858 (the Great Stink) he invented what is called the dry earth system.

In partnership with James Bannehr, he took out a patent for the process (No. 1316, dated 28 May 1860). Among his works bearing on the subject were: ‘The Advantages of the Dry Earth System,’ 1868; ‘The Impossibility overcome: or the Inoffensive, Safe, and Economical Disposal of the Refuse of Towns and Villages,’ 1870; ‘The Dry Earth System,’ 1871; ‘Town Refuse, the Remedy for Local Taxation,’ 1872, and ‘National Health and Wealth promoted by the general adoption of the Dry Earth System,’ 1873.

His system was adopted in private houses, in rural districts, in military camps, in many hospitals, and extensively in the British Raj.

Ultimately, however, it failed to gain the same public support and attention as the water closet, although the design remains today in some parts of the world.

Industrial production

It was only in the mid-19th century, with growing levels of urbanisation and industrial prosperity, that the flush toilet became a widely used and marketed invention. This period coincided with the dramatic growth in the sewage system, especially in London, which made the flush toilet particularly attractive for health and sanitation reasons.

George Jennings established a business manufacturing water closets, salt-glaze drainage, sanitary pipes and sanitaryware at Parkstone Pottery in the 1840s, where he popularized the flush toilet to middle class. At The Great Exhibition at Hyde Park held from 1 May to 15 October 1851, George Jennings installed his Monkey Closets in the Retiring Rooms of The Crystal Palace. These were the first public toilets, and they caused great excitement. During the exhibition, 827,280 visitors paid one penny to use them; for the penny they got a clean seat, a towel, a comb and a shoe shine. "To spend a penny" became a euphemism (now archaic) for going to the toilet.

When the exhibition finished and moved to Sydenham, the toilets were to be closed down. However, Jennings persuaded the organisers to keep them open, and the toilet went on to earn over £1000 a year. He opened the first underground convenience at the Royal Exchange in 1854. He received a patent in 1852 for an improved construction of water-closet, in which the pan and trap were constructed in the same piece, and so formed that there was always a small quantity of water retained in the pan itself, in addition to that in the trap which forms the water-joint. He also improved the construction of valves, drain traps, forcing pumps and pump-barrels. By the end of the 1850s building codes suggested that most new middle-class homes in British cities were equipped with a water closet.

Another pioneering manufacturer was Thomas William Twyford, who invented the single piece, ceramic flush toilet. The 1870s proved to be a defining period for the sanitary industry and the water closet; the debate between the simple water closet trap basin made entirely of earthenware and the very elaborate, complicated and expensive mechanical water closet would fall under public scrutiny and expert opinion. In 1875, the "wash-out" trap water closet was first sold and was found as the public's preference for basin type water closets. By 1879, Twyford had devised his own type of the "wash out" trap water closet, he titled it the "National", and became the most popular wash-out water closet.

By the 1880s, the free-standing water closet was sold and quickly gained popularity; the free-standing water closet was able to be cleaned more easily and was therefore a more hygienic water closet. Twyford's "Unitas" model was free standing and made completely of earthenware. Throughout the 1880s he submitted further patents for improvements to the flushing rim and the outlet. Finally in 1888, he applied for a patent protection for his "after flush" chamber; the device allowed for the basin to be refilled by a lower quantity of clean water in reserve after the water closet was flushed. The modern pedestal "flush-down" toilet was demonstrated by Frederick Humpherson of the Beaufort Works, Chelsea, England in 1885.

The leading companies of the period issued catalogues, established showrooms in department stores and marketed their products around the world. Twyford had showrooms for water closets in Berlin, Germany; Sydney, Australia; and Cape Town, South Africa. The Public Health Act 1875 set down stringent guidelines relating to sewers, drains, water supply and toilets and lent tacit government endorsement to the prominent water closet manufacturers of the day.

Contrary to popular legend, Sir Thomas Crapper did not invent the flush toilet. He was, however, in the forefront of the industry in the late 19th century, and held nine patents, three of them for water closet improvements such as the floating ballcock. His flush toilets were designed by inventor Albert Giblin, who received a British patent for the "Silent Valveless Water Waste Preventer", a siphon discharge system. Crapper popularized the siphon system for emptying the tank, replacing the earlier floating valve system which was prone to leaks.

Spread & further developments

Although flush toilets first appeared in Britain, they soon spread to the Continent. The first such examples may have been the three "waterclosets" installed in the new town house of banker Nicolay August Andresen on 6 Kirkegaten in Christiania, insured in January 1859.

The toilets were probably imported from Britain, as they were referred to by the English term "waterclosets" in the insurance ledger. Another early watercloset on the European continent, dating from 1860, was imported from Britain to be installed in the rooms of Queen Victoria in Ehrenburg Palace (Coburg, Germany); she was the only one who was allowed to use it.

In America, the chain-pull indoor toilet was introduced in the homes of the wealthy and in hotels, soon after its invention in England in the 1880s. Flush toilets were introduced in the 1890s.William Elvis Sloan invented the Flushometer in 1906, which used pressurized water directly from the supply line for faster recycle time between flushes.

The Flushometer is still in use today in public restrooms worldwide. The vortex-flushing toilet bowl, which creates a self-cleansing effect, was invented by Thomas MacAvity Stewart of Saint John, New Brunswick in 1907.

Philip Haas of Dayton, Ohio, made some significant developments, including the flush rim toilet with multiple jets of water from a ring and the water closet flushing and recycling mechanism similar to those in use today.

Bruce Thompson, working for Caroma in Australia, developed the Duoset cistern with two buttons and two flush volumes as a water-saving measure in 1980. Modern versions of the Duoset are now available worldwide, and save the average household 67% of their normal water usage.

Flush toilets

Operation

A typical flush toilet is a vitreous, ceramic bowl containing water plus plumbing made to be rapidly filled with more water. The water in the toilet bowl is connected to a hollow drain pipe shaped like an upside-down U connecting the drain. One side of the U channel is arranged as a hollow siphon tube longer than the water in the bowl is high. The siphon tube connects to the drain. The bottom of the upside-down U-shaped drain pipe limits the height of the water in the bowl before it flows down the drain. If water is poured slowly into the bowl it simply flows over the bottom of the upside-down U and pours slowly down the drain—the toilet does not flush. The water in the bowl acts as a barrier to sewer gas entering and as a receptacle for waste. Sewer gas is vented through a vent pipe attached to the sewer line.

When a user flushes a toilet, a valve opens and allows the tank's water to quickly enter the toilet bowl. This influx from the tank causes the swirling water in the bowl to rapidly rise and fill the U-shaped drain. The siphon tube mounted in the back of the toilet. This full siphon tube starts the toilet's siphon action. The siphon action quickly (4–7 seconds) “pulls” nearly all of the water and waste in the bowl and the on-rushing tank water down the drain—it flushes. When most of the water has drained out of the bowl, the continuous column of water up and over the bottom of the upside-down U-shaped drain pipe (the siphon) is broken when air enters the siphon tube. The toilet then gives its characteristic gurgle as the siphon action ceases and no more water flows out of the toilet. After flushing, the flapper valve in the water tank closes; water lines and valves connected to the water supply refill the toilet tank and bowl. The toilet is again ready for use.

At the top of the toilet bowl is a rim with many slanted drain holes connected to the tank to fill, rinse and induce swirling in the bowl when it is flushed. Mounted above the toilet is a large holding tank with about (now) 1.6 to 1.2 US gallons (6.1 to 4.5 L) of water. This tank is built with a large drain 2.0 to 3.0 inches (5.08 to 7.62 cm) diameter hole at its bottom covered by a flapper valve that allows the water to rapidly leave the holding tank. The plumbing is built to allow entry of the tank’s water into the toilet in a very short period. This water pours through the holes in the rim and a siphon jet hole about 1.0 inch (2.54 cm) diameter in the bottom of the toilet. Other toilets use a large hole in the front of the rim to allow fast filling of the bowl.

Manufacture

A toilet's body is typically made from vitreous china, which starts out as an aqueous suspension of various minerals called a slip. It takes about 20 kilograms (44 lb) of slip to make a toilet.

This slip is poured into the space between plaster of Paris molds. The toilet bowl, rim, tank and tank lid require separate molds. The molds are assembled and set up for filling and the slip-filled molds sit for about an hour after filling. This allows the plaster molds to absorb moisture from the slip, which makes it semisolid next to the mold surfaces but lets it remain liquid further from the surface of the molds. Then, the workers remove plugs to allow any excess liquid slip to drain from the cavities of the mold—this excess slip is recycled for later use.

The drained-out slip leaves hollow voids inside the fixture, using less material to keep it both lighter and easier to fire in a kiln. This molding process allows the formation of intricate internal waste lines in the fixture—the drain's hollow cavities are poured out as slip.

At this point, the toilet parts without their molds look like and are about as strong as soft clay. After about one hour the top core mold (interior of toilet) is removed. The rim mold bottom (which includes a place to mount the holding tank) is removed, and it then has appropriate slanted holes for the rinsing jets cut, and the mounting holes for tank and seat are punched into the rim piece. Valve holes for rapid water entry into the toilet are cut into the rim pieces. The exposed top of the bowl piece is then covered with a thick slip and the still-uncured rim is attached on top of the bowl so that the bowl and hollow rim are now a single piece. The bowl plus rim is then inverted, and the toilet bowl is set upside down on the top rim mold to hold the pieces together as they dry. Later, all the rest of the mold pieces are removed. As the clay body dries further it hardens more and continues to shrink. After a few hours, the casting is self-supporting, and is called greenware.

After the molds are removed, workers use hand tools and sponges to smooth the edges and surface of the greenware, and to remove the mold joints or roughness: this process is called "fettling". For large scale production pieces, these steps may be automated. The parts are then left outside or put in a warm room to dry before going through a dryer at about 93 °C (200 °F), for about 20–36 hours.

After the surfaces are smoothed, the bowls and tanks are sprayed with glaze of various kinds to get different colors. This glaze is designed to shrink and contract at the same rate as the greenware while undergoing firing. After being sprayed with glaze, the toilet bowls, tanks, and lids are placed in stacks on a conveyor belt or "car" that slowly goes through a large kiln to be fired. The belt slowly moves the glaze-covered greenware into a tunnel kiln, which has different temperature zones inside it starting at about 200 °C (400 °F) at the front, increasing towards the middle to over 1,200 °C (2,200 °F) degrees and exiting around out 90 °C (200 °F). During the firing in the kiln, the greenware and glaze are vitrified as one solid finished unit. Transiting the kiln takes glaze-covered greenware around 23–40 hours. After the pieces are removed from the kiln and fully cooled, they are inspected for cracks or other defects. Then, the flushing mechanism may be installed on a one-piece toilet. On a two-piece toilet with a separate tank, the flushing mechanism may only be placed into the tank, with final assembly at installation. A two-piece attaching seat and toilet bowl lid are typically mounted over the bowl to allow covering the toilet when it is not in use and to provide seating comfort. The seat may be installed at the factory, or the parts may be sold separately and assembled by a plumbing distributor or the installer.

Water usage

Various forms of flush toilets have become widely used in modern times The amount of water used by modern toilets is a significant portion of personal water usage, totaling as much as about 90 liters (24 US gal) of water per capita per day.

When a toilet is flushed, the water flows into a sewage system and eventually ends in a water treatment plant. Here the water is cleaned, sanitized and possibly re-used.

Modern low flush toilet designs allow the use of much less water per flush—1.6 to 1.2 US gallons (6.1 to 4.5 L) per flush—but may require the sewage treatment system be modified for the more concentrated waste. Dual flush toilets allow the user to select between a flush for urine or feces saving a significant amount of water over conventional units. The flush handle on these toilets is pushed up for one kind of flush and down for the other. In some places users are encouraged not to flush after urination. Flush toilets, if plumbed for it, may also use greywater (water previously used for washing dishes, laundry and bathing) for flushing rather than potable water (drinking water). Some modern toilets pressurize the water in the tank which initiates flushing action with less water usage. Heads (on ships) are typically flushed with seawater.

Other toilet types

Pit toilets or pit latrines

A pit latrine is a dry toilet system which collects human excrement and urine in a pit or trench and ranges from a simple slit trench dug in the ground to more elaborate systems with seating or squatting pans and ventilation systems. They are more often used in emergency, rural and wilderness areas as well as in the rural or peri-urban areas of much of the developing world. The waste pit or trench, in some cases, will be large enough that the reduction in mass of the contained waste products by the ongoing process of decomposition allows the pit to be used for many years before it fills up. When the pit becomes too full, it may be emptied or the hole covered with earth. Pit latrines have to be located away from drinking water sources (wells, streams, etc.) to minimize the possibility of disease spread via groundwater pollution. Army units typically use a form of pit toilet when they are in the field and away from functional sewerage systems.

The use of correctly located pit toilets were found to prevent much of the spread of various diseases which used to kill many more soldiers than the bullets and artillery used in pre-1940 warfare.

Dry toilets

Dry toilets, which use very limited or no water for flushing include the pit latrine (a simple hole in the ground, or one with ventilation, fly guards and other improvements), the composting toilet (which mixes excrement with carbon rich materials for faster decomposition), the incinerating toilet (which burns the excrement), and the tree bog (a simple system for converting excrement to direct fertiliser for trees). The pig toilet from the Indian State of Goa which consists of an outhouse linked to a pig enclosure by a chute is still in use to a limited extent but the subsequent use of the pigs for food carries a significant risk for human health.

Urine diversion toilets

Urine diversion (UD) toilets have two compartments. One for urine and one for the feces. A urine diversion toilet, UD toilet or UDT, flushes one or both compartments with water. A urine diversion dry toilet (UDDT) is a form of dry toilet. UDDTs can be linked to systems which recover water or utilize treated human excreta as a fertilizer or biofuel. Astronauts use a UDDT to recover potable water in the space station.

Flying toilets

The unsanitary 'flying toilets' are used in African informal settlements where plastic shopping bags are first used as a container for excrement and are then thrown as far away as possible."

This practice, coupled with the solid waste problem of discarded plastic bags, has led to the banning of the manufacture and import of such bags in Uganda, Kenya, and Tanzania.

Chemical toilets

Chemical toilets which do not require a connection to a water supply are used in a variety of situations. Examples include passenger train toilets and airplane toilets and also complicated space toilets for use in zero-gravity spacecraft.

Public toilets

A public toilet, frequently called a restroom, is accessible to the general public. It may be within a building that, while privately owned, allows public access. Access to a public toilet may require a fee, (pay toilet), or may be limited to business's customers.

Depending on culture, there may be varying degrees of separation between men and women and different levels of privacy. Typically, the entire room, or a stall or cubicle containing a toilet is lockable. Urinals, if present in a men's toilet, are typically mounted on wall with or without a divider between them. In the most basic form, a public toilet may be not much more than an open latrine. Another form is a street urinal known as a pissoir after the French term (see Urinal).

In more luxurious variations there may be an attendant, towels, showers, etc. A fairly common feature in more modern toilets is an area to change baby diapers.

A charge levied in the UK during the mid-20th century was one British penny, hence the generally adopted term "spend a penny" meaning to use the toilet.

Portable toilets

The portable toilet is used on construction sites and at large outdoor gatherings where there are no other facilities. They are typically self-contained units that are made to be easily moved to different locations as needed. Most portable toilets are unisex single units with privacy ensured by a simple lock on the door. The units are usually light weight and easily transported by a flatbed truck and loaded and unloaded by a small forklift. Many portable toilets are small molded plastic or fiberglass portable rooms with a lockable door and a receptacle to catch waste in a chemically treated container. If used for an extended period of time they have to be cleaned out and new chemicals put in the waste receptacle. For servicing multiple portable toilets tanker trucks (vacuum trucks), often called "Honey Trucks", are equipped with lage vacuums to evacuate the waste and replace the chemicals.

High-tech toilets

"High-tech" toilets include features such as: automatic-flushing mechanisms that flush a toilet or urinal when finished; water jets, or "bottom washers" like a bidet; blow dryers; artificial flush sounds to mask noises; and urine and stool analysis for medical monitoring. Matsushita's "Smart Toilet" checks blood pressure, temperature, and blood sugar. Some feature automatic lid operation, heated seats, deodorizing fans or automated paper toilet-seat-cover replacers. Interactive urinals have been developed in several countries, allowing users to play video games as with the "Toylet", produced by Sega, that uses pressure sensors to detect the flow of urine and translates it into on-screen action.

Floating toilets

A floating toilet is essentially an outhouse built on a platform built above or floating on the water. Instead of wastes going into the ground they are collected in a tank or barrel. To reduce the amount of waste that needs to hauled to shore, many use urine diversion. It was developed for residents without quick access to land or connection to a sewer systems. It is also used in areas subjected to prolonged flooding. The need for this type of toilet is high in areas like Cambodia where the World Bank cited in 2008 that nearly 10,000 people died as a result of poor sanitation.

Chamber pots

A chamber pot is a receptacle in which one would excrete waste in a ceramic or metal pot. Among Romans and Greeks, chamber pots were brought to meals and drinking sessions. Johan J. Mattelaer said, “Plinius has described how there were large receptacles in the streets of cities such as Rome and Pompeii into which chamber pots of urine were emptied. The urine was then collected by fullers.” This method was used for hundreds of years; shapes, sizes, and decorative variations changed throughout the centuries. This method is no longer used in developed countries, with the exception of hospital bedpans.

Before the introduction of flush toilets it was common for people to use a chamber pot at night and then to dispose of the 'nightsoil' in the morning; this practice (known as slopping out) continued in prisons in the United Kingdom until recently and is still in use in the Republic of Ireland. The garderobe was used in medieval times, and replaced by the privy midden and pail closet in early industrial Europe.

Garderobes

Garderobes were toilets used in the Middle Ages, most commonly found in upper-class dwellings. Essentially, they were flat pieces of wood or stone spanning from one wall to the other, with one or more holes to sit on. These would go into pipes that would lead outside the castle or manor. Garderobes would be placed in areas away from bedrooms to shun the smell and also near kitchens or fireplaces to keep the enclosure warm.

Urinals

Although it is possible for urinals to be used by females, they were originally designed for males. They are intended for the disposal of liquid waste, not solid waste. Urinals are meant to be used for the convenience of male users in a standing position. They typically have no door or stall enclosure, and thus take up less space. These fixtures are most commonly found in public places, but can occasionally be found in a private home. Urinals are usually water flushed, although waterless urinals are also becoming more popular particularly in countries where conserving water resources is aimed for, like in Germany for example.

Squat toilets

The squat toilet (also called “squatter” or “squatty-potty”) consists of a hole in the ground. However, common modern versions flush like a modern seated toilet, and are not to be compared to a contemporary portable toilet with no plumbing. To use this toilet, one is in a squatting position rather than sitting, by placing one foot on each side of the toilet and squatting over it. Modern versions are in separate stalls when they are in public lavatories, and include toilet tissue rolls for the user's convenience. The squatting method is accompanied by advantages as well health benefits that connect to easiness of procedures such as child birth. The squat toilet is most commonly found in Asia, Africa, and the Middle East but can also occasionally be found in some European (Romania, France), Mediterranean, and South American countries.

Role of sanitation

Toilets are one important element of a sustainable sanitation system. Diseases, including cholera, which still affects some 3 million people each year, can be largely prevented when effective sanitation and water treatment prevents fecal matter from contaminating waterways, groundwater and drinking water supplies. Infected water supplies can be treated to make the water safe for consumption and use. There have been five main cholera outbreaks and pandemics since 1825. In London alone, the second killed 14,137 people in 1849, and the third took 10,738 lives in 1853-54. In 1849 the English physician John Snow published a paper On the Mode of Communication of Cholera, in which he suggested that cholera might be waterborne. During the 1854 epidemic, he collected and analyzed data establishing that people who drank water from contaminated sources such as the Broad Street pump died of cholera at much higher rates than those who got water elsewhere.

To this day, many people in developing countries have no toilets in their homes and are resorting to open defecation instead. The Joint Monitoring Programme (JMP) for Water Supply and Sanitation by WHO and UNICEF is the official United Nations mechanism tasked with monitoring progress towards the Millennium Development Goal (MDG) relating to drinking-water and sanitation (MDG 7, Target 7c), which is to: "Halve, by 2015, the proportion of people without sustainable access to safe drinking-water and basic sanitation" and publishes figures on access to sanitation worldwide on a regular basis.

Toilet

The word toilet came to be used in English along with other French fashions. It originally referred to the toile, French for "cloth", draped over a lady or gentleman's shoulders while their hair was being dressed, and then (in both French and English) by extension to the various elements, and also the whole complex of operations of hairdressing and body care that centered at a dressing table, also covered by a cloth, on which stood a mirror and various brushes and containers for powder and make-up: this ensemble was also a toilette, as also was the period spent at the table, during which close friends or tradesmen were often received. The English poet Alexander Pope in The Rape of the Lock (1717) described the intricacies of a lady's preparation.

The word toilet may also be used, especially in British English to describe the room containing the fixture, for which euphemisms such as restroom or bathroom are used in American English. Prior to the introduction of modern flush toilets, most human waste disposal was done through the use of household chamber pots, or took place outdoors in outhouses or latrines. Pail closets were introduced in England and France in an attempt to reduce sewage problems in rapidly expanding cities.

These various senses are first recorded by the OED in rapid sequence in the later 17th century: the set of "articles required or used in dressing" 1662, the "action or process of dressing" 1681, the cloth on the table 1682, the cloth round the shoulders 1684, the table itself 1695, and the "reception of visitors by a lady during the concluding stages of her toilet" 1703 (also known as a "toilet-call"), but in the sense of a special room the earliest use is 1819, and this does not seem to include a lavatory.

Through the 18th century, everywhere in the English-speaking world, these various uses centred around a lady's draped dressing-table remained dominant. In the 19th century, apparently first in the United States, the word was adapted as a genteel euphemism for the room and the object as we know them now, perhaps following the French usage cabinet de toilette, much as powder-room may be coyly used today, and this has been linked to the introduction of public toilets, for example on railway trains, which required a plaque on the door. The original usages have become obsolete, and the table has become a dressing-table.

Vestiges of the original meaning continue to be reflected in terms such as toiletries, eau de toilette and toiletry bag (to carry flannels, soaps, etc.). This seemingly contradictory terminology has served as the basis for various parodies e.g. Cosmopolitan magazine ("If it doesn't say 'eau de toilette' on the label, it most likely doesn't come from the famed region of Eau de Toilette in France and might not even come from toilets at all.")

The word toilet itself may be considered an impolite word in Anglophone North America, while elsewhere the word is used without any embarrassment. The choice of the word used instead of toilet is highly variable, not just by regional dialect but also, at least in Britain, by class connotations. Nancy Mitford wrote an essay out of the choice of wording; see U and non-U English. Some manufacturers show this uneasiness with the word and its class attributes: American Standard, the largest manufacturer, sells them as "toilets", yet the higher priced products of the Kohler Company, often installed in more expensive housing, are sold as commodes or closets, words which also carry other meanings. Confusingly, products imported from Japan such as TOTO are referred to as "toilets", even though they carry the cachet of higher cost and quality. When referring to the room or the actual piece of equipment, the word toilet is often substituted with other euphemisms and dysphemisms (See toilet humor).

As old euphemisms have become accepted, they have been progressively replaced by newer ones, an example of the euphemism treadmill at work. The choice of word used to describe the room or the piece of plumbing relies as much on regional variation (dialect) as on social situation and level of formality (register).

Lavatory

The term lavatory, abbreviated in slang to lav, derives from the Latin: lavātōrium, which in turn comes from Latin lavō ("I wash"). The word was originally used to refer to a vessel for washing, such as a sink/wash basin, but eventually came to mean a room with such washing vessels, as for example in medieval monasteries, where the lavatorium was the monks' communal washing area. The toilets in monasteries however were not in the lavatorium but in the reredorter. Nevertheless the word was later associated with toilets and the meaning evolved into its current one, namely a polite and formal euphemism for a toilet and the room containing it. Lavatory is the common signage for toilets on commercial airlines around the world, see Aircraft lavatory.

Loo

The origin of the (chiefly British) term loo is unknown. According to the OED, the etymology is obscure, but it might derive from the word Waterloo. The first recorded entry is in fact from James Joyce's Ulysses (1922): "O yes, mon loup. How much cost? Waterloo. Watercloset".

Other theories are:

• That it derives from the term "gardyloo" (a corruption of the French phrase gardez l'eau! (or maybe garde l'eau!) loosely translated as "watch out for the water!") which was used in medieval times when chamber pots were emptied from a window onto the street. However the first recorded usage of "loo" comes long after this term became obsolete.

• That the word comes from nautical terminology, loo being an old-fashioned word for lee. The standard nautical pronunciation (in British English) of leeward is looward. Early ships were not fitted with toilets but the crew would urinate over the side of the vessel. However it was important to use the leeward side. Using the windward side would result in the urine blown back on board: hence the phrases 'pissing into the wind' and 'spitting into the wind'. Even now most yachtsmen refer to the loo rather than the heads.

• That the word derives from the 17th century preacher Louis Bourdaloue. Bourdaloue's sermons at the Saint Paul-Saint Louis Church in Paris lasted at least three hours and myth has it that wealthier ladies took along "travelling" chamber pots that could be hidden under their dresses whenever the need arose to avoid the need to leave. Due to the popularity of the myth the bowls became known as Bourdaloues after the preacher and the name became corrupted to portaloos and sometimes just plain loos due to the habit of shortening words in slang.

• That the word comes from the French word lieu (place), as in lieu d'aisance (literally: "place of ease", a common euphemism for lavatory) or lieu à l'anglaise (literally: "English place"). From around 1770 the term lieu à l'anglaise began to appear in France, referring to this English invention which was sometimes installed for the benefit of English visitors. (Ashenburg p. 138)

WC

The WC refers to the initial letters of Water Closet, which, despite being an English language abbreviation, is not in common use in English-speaking countries – but is widely used internationally: in France (pronounced "le vay-say" or "le vater"), in Italy (pronounced "vi-ci" or "vater"), Romania (pronounced "veh-cheu"), the Netherlands (pronounced "waysay"), Germany, Switzerland and Hungary (pronounced "ve-tse"), Denmark (pronounced "ve-se"), Norway (pronounced "vay-say"), Poland (pronounced "vu-tse"), Spain (pronounced "uve-cé" or "váter"), China, and others.

Other

Lexicographer Eric Partridge derives khazi, also spelt karzy, kharsie or carzey, from a low Cockney word carsey originating in the late 19th century and meaning a privy. Carsey also referred to a den or brothel. It is presumably derived from the Italian casa for house, with the spelling influenced by its similar sound to khaki. Khazi is now most commonly used in the city of Liverpool in the UK, away from its cockney slang roots. An alternative derivation is from Christopher Chippindale, who States that khazi derives from Army slang used by expatriate officers of the British Empire who took a dislike to the habits of, and steaming rain forest inhabited by, the Khasi people of the Khasia hills on the northern frontier of India.

The Dunny is an Australian expression for an outside toilet or outhouse. The person who appeared weekly to empty the pan beneath the seat was known as the "dunnyman". The word derives from the British dialect word dunnekin, meaning "dung-house". It is now an informal word used for any lavatory and is most often used referring to drop or pit lavatories in the Australian bush, which are also called thunderboxes.

The Privy is an old fashioned term used more in the North of England and in Scotland; "privy" is an old alternative for "private", as in Privy council. It is used interchangeably in North America for various terms for the outhouse.

The netty is the most common word used in North East England. Many outsiders are often bemused when a Geordie or a Mackem States they are "gannin te the netty" (going to the bathroom). The etymology of the word is uncertain, but it is believed to be either derived from a corruption of "necessity" or from graffiti scrawled on Hadrian's Wall. It is linked to the Italian word gabinetti meaning "toilets" (singular gabinetto).

Latrine is a term common in the military, specifically for the Army and Air Force for any point of entry facility where human waste is disposed of, which a civilian might call a bathroom or toilet, regardless of how modern or primitive it is. Traditionally the Royal Navy along with the United States Navy and Marine Corps use the nautical term "Head" to describe the same type of facility, regardless of whether it is located on a ship or on the land.

The Jacks is Irish slang for toilet. It perhaps derives from "jakes", an old English term.

The standalone toilet enclosure has been variously known as a "back house", "house of ease", "house of office", "little house", or "outhouse". The house of office was a common name for a toilet in seventeenth century England, used by, among others, Samuel Pepys on numerous occasions: October 23, 1660: ...going down into my cellar..., I put my foot into a great heap of turds, by which I find Mr Turner's house of office is full and comes into my cellar.

In the Philippines the abbreviation CR (Comfort Room) is commonly used.

Culture

There are many different ways to clean oneself after using the toilet, depending on national mores and local resources. An important part of early childhood education is toilet training.

In the Western world, the most common method of cleaning after using a toilet is by toilet paper or sometimes by using a bidet. In the Middle East and some countries in Asia, and South Asian countries such as India and Pakistan, the custom is to use water, either with or without toilet paper. Traditionally, the left hand is used for this, for which reason that hand is considered impolite or polluted in many Eastern countries. The Islamic faith has a particular code, Qaḍā al-Ḥājah describing Islamic toilet etiquette.

Toilet humour is a name given to a type of off-colour humour dealing with defecation, urination, and flatulence.

Standing vs. sitting

A systematic review meta-analysis on the effect of voiding position on the quality of urination found that in elderly males with benign prostate hyperplasia, the sitting position was superior compared with the standing. Healthy males were not influenced by voiding position. A literature review found cultural differences in socially accepted voiding positions around the world found many differences in preferred position: in the Middle-East and Asia, the crouching position was more prevalent, while in the Western world the standing and sitting position was more common. These findings mean that in the decision of choosing between different toilets, factors about health and social acceptance need to be considered.