Clean Public Toilets Curb Outbreaks

Background

Public toilets provide an essential service, especially in cities where a single facility may be used by thousands of people each week. When these facilities are not properly cleaned, they can contribute to the spread of infectious diseases. Outbreaks that begin abroad can cross borders and threaten the health of Americans.

In 2024, public health officials in Nakuru County, located in central Kenya, approached CDC and Washington State University (WSU) to partner in establishing cleaning and disinfection protocols and trainings to improve the cleanliness of the public toilets it oversees. The county is responsible for the health and safety of more than 50 public sanitation facilities in the city of Nakuru alone. However, these facilities are independently managed by community business organizations. This makes oversight, monitoring, and training challenging.

The challenge

There were many challenges to maintaining cleanliness in toilets identified in this pilot program, including:

• A high turnover of workers who clean public toilets, resulting in demand for ongoing training
• Low morale among workers who clean the facilities
• Inconsistent cleaning of high-touch surfaces, with some workers skipping disinfection altogether

Findings from previous studies highlighted the importance of training through reinforcement to enhance workers' knowledge and maintain effective cleaning and disinfection practices.

Intervention

Working with county health officials, CDC and WSU initiated a pilot program in the spring of 2025 that included 18 public toilet sites in the city of Nakuru. In addition to distributing cleaning and disinfection protocols and visual aids, the program incorporated a training approach proven to improve job performance and satisfaction among healthcare facility workers. The training approach called supportive supervision emphasizes routine monitoring, skill building, one-on-one reinforcement, and two-way communication.

Prior to the pilot program, public health officers typically visited public toilets only after a complaint was filed, often to issue citations. During the pilot, officers began visiting facilities regularly. They assessed how well workers understood and performed their jobs and helped them improve performance on tasks that required additional attention. Public health officers also learned from workers and facility managers about the challenges of keeping toilets clean and helped develop collaborative solutions.

Impact and results

• After only three months, the pilot resulted in cleaner public toilets and improved job performance of sanitation workers, leading to greater satisfaction from people using the toilets.
• Nakuru's public health department is expanding the program to include public toilet sites in other locations.
• To prevent further spread during a 2025 monkeypox outbreak, the cleaning and disinfection protocols and materials developed as part of the pilot program were used to train 300 additional public health officers and cleaners across Nakuru County.

Other impacts

• Workers who clean and maintain public toilets showed increased pride in their work to protect the health of people using the facilities.
• Workers welcomed the reinforcement training and constructive feedback from public health officers.
• Both public health officers and workers who clean and maintain public toilets cited collaboration as a factor for improved cleanliness. This collaboration grew gradually with each visit and helped workers master more challenging tasks, including the proper use of personal protective equipment and preparation of disinfectant solutions.

Lessons learned

Ensuring that people around the world have a clean toilet helps prevent diseases and outbreaks before they reach the United States. This pilot program in Kenya shows that embedding cleaning and disinfection practices into job training initiatives and duties can produce cleaner public toilets.

The program also supports the importance of professional relationships built on collaboration and constructive feedback. Workers participating in the pilot program who cleaned public toilets and had regular visits and positive reinforcement had higher job performance and were less likely to quit. The people who rely on public toilets also were more satisfied.

The lessons learned from the pilot can be adapted for other communities and settings, resulting in less illness and fewer outbreaks.

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