Travelers are much more sanitary than health care workers and visitors. That's a fact I gleaned from recent experience:
* the rest stops along I-81 were very busy, usually 2 or 3 men in the restroom at a time. Very seldom did someone urinate and leave; the pattern I observed was that everyone washed.
* in the upstate NY hospital I was visiting, the vistor's lounge had its own bathroom, which seemed to be used both by hospital staff and visitors. Sitting in the lounge you could hear the toilet flush and the sink run. But much of the time, I'd say at least half, you only heard the flush and no running water.
Why the difference? I'd guess it's the visibility. While you don't look at each other in the restroom, you're very conscious of others so you live up to the norms they display. In the bathroom, you're by yourself and easily forget that your activities can be heard. So you don't wash your hands, which is the cause of much death in hospitals.
If I understand correctly, Islam doesn't have this problem because it's taken specialization to the point of dedicating the left hand for sanitation. Failure to comply may be a sin.
As a true American, I'd suggest that we put a sign outside bathrooms. Most new public bathrooms have motion recognition triggering the flow of water, that that to the sign and to the door. The sign goes dark when the door closes, lights up when it opens if the water has run and says: "last user washed hands". I offer the idea free in the interests of improving life expectancy.
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