July 13, 2009 -- Bathrooms should be places of practicality and relaxation, a place to start and end the day. But there are a number of ways in which one room can pose potential threats.
A new study published today in the journal Pediatrics, for example, finds children are falling prey to bathtub injuries at surprising rates.
Lead by Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio, the study found that more than 43,000 children younger than 18 are treated in an emergency room each year after a bathroom- or shower-related injury.
"That's 120 kids a day," Smith said. "It's a big problem."
Smith said the injuries occur suddenly, with children often slipping and falling, even under adult supervision, but that there are strategies for prevention that can reduce the number of injuries.
But slips and falls are only one of the ways researchers say items in a bathroom can be hazardous. Some of the threats are founded and others are on shakier ground. The following is a list examining potential bathroom threats.
Bathtub Slips and Falls
Even under parental or other adult supervision, children get injured in bathtubs at an alarming rate, Smith said.
"Supervising your child isn't enough," said Smith, whose report showed that most injuries happen under adult supervision. "Slips and falls -- boom, they happen -- and there's nothing you can do once it starts to happen."
Smith said he conducted a study on similar data using admittance records from the emergency room of Nationwide Children's Hospital in 2005 and saw the number of bathtub-related injuries was unusually high, compared to other kinds of injuries.
"I thought, gosh, this is something we really didn't expect," Smith said he thought at the time.
That study led him to conduct a more thorough analysis on national data.
The most common cause of injury was slipping and falling, which accounted for 81 percent of all the injuries, Smith found, and the face is often most injured. The highest-risk age group was children younger than 5.
"The reason we haven't done well preventing injuries is we fundamentally don't think of this as a health problem," Smith said. "We know if we focus on the cause ... and think of this as a physical problem, we can resolve them. But the idea that they happen as accidents ... I really disagree with that."
For the time being, Smith said rubber bath mats and padding protruding objects could cut down on the number of injuries but recommended that manufacturers incorporate new design features, including slip-resistant surfaces, rounded edges and holding bars, into new bathrooms.
"You don't have to rely on the user to remember to put the mat down or step carefully each time they bathe because, then, the chances of effective prevention go down," Smith said. "If we design the problem out of existence, we've shown over and over in the field of injury prevention that we can dramatically decrease injury."
Shower Curtain Vapors
A shower curtain may be in order to preserve modesty in the bathroom. But could you be harming yourself at the same time?
An environmental group claimed in a study of vinyl shower curtains that some of them may release toxic chemicals into the air which could cause asthma, eye irritation or cancer.
"We have a clear-cut case that these products release elevated levels of harmful chemicals," said report co-author Michael Schade, PVC campaign coordinator for the Center for Health, Environment and Justice, and noted that his team found 108 different volatile organic compounds, including phthalates, which can affect babies in the womb.
But some health experts are not convinced that the study holds water. Of particular concern was that the study only tested five shower curtains, of which only one -- not one brand of curtain -- was subjected to complete testing for its chemical composition, as well as those it released into the air.
"It's a great example of how quickly a sound bite can become dangerous and contagious," said ABC News medical contributor Dr. Marie Savard.
"The idea that people should be tossing out their shower curtains based on a study that more or less focuses on a single shower curtain is absurd. This is scare science at its best, or worst, depending on how you look at it."
Schade maintained that many of the compounds found in the curtains have been linked with developmental problems in children, cancer and other health effects. But he conceded that whether the chemical levels emitted by the curtains could be directly linked to health effects was difficult to determine.
"It's really hard to say that because there are currently no standards for indoor-air quality," Schade said.
Consumer Product Safety Commission spokeswoman Julie Vallese said that unless a stronger link can be proven, consumers can probably put their minds at ease the next time they purchase a new shower curtain.
"In our busy lives, there are so many things that people should be or could be focused on to improve their health and safety," Vallese said. "Their shower curtains are not one of them.
"I think there are a lot of people out there sounding the false alarm," she said.
Chemicals in Shampoo
A report released in March 2009 from the Campaign for Safe Cosmetic Use highlighted the addition of the chemicals formaldehyde and 1,4-dioxane to many shampoos, both of which have been linked to cancer and a number of skin conditions.
"Companies can obviously do better, and we need to demand that they do better," said Stacy Malkan, co-founder of the Campaign for Safe Cosmetic Use and co-author of the report, released Thursday. "Many companies are already making great products that don't have any of these chemicals [and] many companies in the natural products industry have reformulated to get rid of that problem. We also know many companies are using preservatives that don't use formaldehyde."
According to the authors, the report, called "No More Toxic Tub," is the first to document contamination of bath products with the chemicals.
But while chemicals such as formaldehyde, which are added to many consumer products to increase their shelf life, have been linked to diseases such as cancer -- formaldehyde has been shown to cause cancer in laboratory rats, although no similar tests have been done on humans -- there is no definitive correlation.
There is, however, evidence that formaldehyde can cause skin irritation, characterized by red, burning skin and even allergic reactions, characterized by red, itchy, and blistered skin.
"There are a lot of [ubiquitous] chemicals and ingredients in common household consumer goods that have materials in them that cause allergic reactions," said Dr. Matthew Avram, chief of the Dermatology Laser Center at Massachusetts General Hospital in Boston. "The skin may have an allergic reaction to the chemicals or an irritant reaction."
A steamy shower might feel good, but the moisture left behind can ravage a bathroom and create health problems for people with respiratory problems.
Dr. Hale Yarmohammadii, an allergy and asthma specialist at Beth Israel Medical Center in New York City, said that mold can wreak havoc in two different ways.
"One is an allergic reaction, but not everyone gets this," she said. "And the other problem results from the toxins that mold secretes."
The kind of mold found in homes that can bring about asthma is called stachybotrys -- a black, sticky, slimy fungus. To grow indoors, it needs water, so it's often found around water pipes or in moist areas
People often get vague symptoms from mold exposure, Yarmohammadii said. They might get headaches or feel nauseous or have asthma symptoms.
"If you have mold in part of your house, you have mold spores everywhere," said Harriet Burge, a former professor at Harvard University and the University of Michigan who now serves as director of aerobiology for EMLab P&K, an indoor-air quality testing facility. "The general advice from the public health perspective is if there's mold in your home, remove it."
Dr. Maureen Lichtyeld, who chairs the department of environmental health sciences at the Tulane University School of Public Health and Tropical Medicine, said people with asthma should not be exposed to the mold and that people who were cleaning mold needed proper protection, such as masks and gloves, and people with asthma, especially children, need to stay on their medications.
Lychtyeld said a chlorine solution, plus proper ventilation to keep surfaces dry, should be enough to prevent mold forming in small areas.
Bathrooms are a haven for germs, but not in the way you may think. Toilets, for example, are a beacon of cleanliness because they are cleaned and disinfected on a regular basis.
But germs lurk in abundance in areas or on items that people neglect to clean or position far enough from potential microbes.
"You get a great spray out of the toilet when you flush it," said Charles Gerba, a professor of microbiology at the University of Arizona in Tucson. "This throws bacteria out of the toilet."
Fecal bacteria means the bacterium E. coli, which is found in fecal matter, among other things. Gerba's own research on bathroom microbes showed a spray coming out of toilets when they are flushed. That spray, which contains fecal bacteria, goes out but it is unclear how far it travels and where it might end up.
So, while it's not clear whether the toothbrush in a bathroom will be contaminated with anything from a toilet, it may not be a bad idea to put the lid down and flush.