Section 28 of SUPERBUG: The Fatal Menace of MRSA, by Maryn McKenna. From interviews with Dr Tom Keating:

But in schools, chronically squeezed for money, containing MRSA proved much more challenging. Which was why, on a hot morning in May, 2008, Tom Keating, Ph.D. was standing in a high school bathroom in an Atlanta suburb with a look of distaste on his face.
"The bathroom's three stalls had no doors. The water inn one of the toilets was yellow with urine, and the toilet-paper bracket in a different stall was empty and wrenched half-off the wall. Wadded-up paper towels covered the floor and had been crammed into one of the sink drains. The two soap dispensers were empty."
"And this is one of my better schools," Keating said.

Keating, Tom, "Toilet Etiquette: It All Starts at Home, But It Doesn't End There." School Planning and Management, May 2010.

"Before we ask why students are thoughtless, the reader may already have thought 'it all begins . . . .' Remember however, students from 6 to 16 or older are compelled to attend school. The law mandates attendance, certain responsibilities and many requirements. Is there not an obligation by the State, through its district and local schools, which stand in loco parentis, to do something about the nasty condition of too many school restrooms?”

Keating, Tom, "Measured Success: Measuring cleanliness can foster feelings of respect among students and the staff responsible for keeping schools clean and healthful", American School and University, October 2009.

Microbe measurement Because of heightened concerns about invisible pathogens such as MRSA and swine flu, improved technologies are available to measure bacteria or organic matter that feeds bacteria. Progressive custodial departments are using these devices — known as ATP meters (used to measure levels of adenosine triphosphate — the energy molecule present in all living cells) — in their day-to-day cleaning rounds. Custodians in many schools have professionalized their approaches, training and equipment, and integrated the use of measured cleaning methods to foster enhanced respect for their roles.

Keating, Tom, "It's OK to Talk About Toilets at the Table" School Planning and Management, March 2009.

Keating, Tom, "The Last Day Before The First Day Is Too Late", School Planning and Management, July 2008.

"Consider a personal experience I observed near Atlanta (however I have seen similar conditions from California to Delaware, in Huntsville (AL) and Pittsburgh)."

"I saw the following at noon on the Friday before a Monday opening in a summer school program with about 445 diverse ninth through 12th graders. There were sinks on the floor and lavatories askew from the wall or hanging wobbly from weak supports. Both erotic and gang graffiti splattered the walls. Each set of restrooms for men had doors, toilet paper, and dispensers missing, and the rooms for women had sanitary product receptacles without bags and trash cans still half full."

Keating, Tom, "Watch Out Broadway: True Dat - A Skit About America's Public School Restrooms" , School Planning and Management, April 2008.

"Imagine 20 middle schoolers — seventh and eighth graders — practicing for a spring dramatic performance in a suburban Atlanta. Not unusual, unless these boys and girls are performing the first skit in America about public school restrooms. That is unique.

"Yet, in April and May 2007, in Clayton County, GA, selected Babb middle school students, an outstanding teacher, and Project CLEAN wrote, rehearsed, performed, and filmed a DVD about public school restrooms.

Keating, Tom, "A Memorable Visit", Clean India Journal, January, 2008

Keating, Tom, "Georgia Needs to Start Talking Toilets", Atlanta Journal-Constitution, December 28, 2007.

When I told friends I was going to New Delhi, India, to the World Toilet Summit, most did not snicker, they frowned. Two years earlier, when the same meeting was held in Belfast, Ireland, they did laugh.

Since then, however, fellow Decaturites have seen print and media notices about the convocation in the world’s largest democracy.

Educators in Georgia, India and developed and developing countries know the importance of school sanitation. The summit highlighted children and restrooms with 13 talks, including mine titled, “Leading Students from Soap to Citizenship to Improve Wellness.”

"Improving Students' Perspective of Restrooms", Clean India Journal, November, 2007.

Keating, Tom, "Harmony Through Diversity", School Planning and Management, November, 2007.

"American Teacher Takes the Restroom to the Classroom",Times Of India Mumbai; Times City Section, Page 4, October 30, 2007.

Mumbai: How often do school authorities ask students whether they’re satisfied with the restrooms? Or teach children how to use a Western-style loo? Or ensure that the restrooms never run out of soap and towels?
That’s exactly what Dr Tom Keating, a US-based school restroom expert asked students, teachers and principals from a cross-section of schools in Mumbai last week. His visit to the schools, which was facilitated by Clean India Journal—a Mumbai-based magazine dealing with the cleaning industry—included visiting both municipal schools as well as upmarket private institutions such as Podar International School at Santa Cruz, Jamnabai Narsee School at Juhu and Hiranandani School, Powai.

Keating, Tom, "Leading Students in School Restrooms From Soap to Citizenship to Improve Wellness," presented at the World Toilet Summit, Mumbai, India, November 3, 2007.

This presentation has two sections. Part One summarizes the history of Project CLEAN in the United States. Part Two describes conditions and selected issues concerning government school restrooms in Belize, Ethiopia, Ireland, Peru, and the United States of America.

The major emphasis will be on efforts, which move students from concrete aspects of restrooms such as soap, towels, tissue, receptacles, doors to more abstract characteristics such as school pride and climate, respect, wellness, and citizenship.

Ramakrishnan, Renu “Project CLEAN for cleaner school restrooms.” Clean India Journal, October 2006.

"With about forty percent of middle and high school children holding off going to bathroom all day, it is an issue that can have serious health implications," says Dr. Tom Keating, who has served as a school board member, college instructor and teacher. He is perhaps single-handedly changing the face of restrooms in schools across America.

"It isn't just a national issue", says Keating, "it's an international issue. One out of two persons in the world has not used a proper toilet. It's time for me to shift my focus to them. I really should be helping someone in rural India or in Africa.", adds Keating, with a sense of passion, urgency and determination.

Robin, Rico et.al., Three Posters by Students on Restroom Etiquette, 2006.

Inspired by creativity and concern, students can put talent to work for safe, clean and sanitary restrooms. Here are three examples by high school students in Georgia. All three can be downloaded.

Keating, Tom, “Attitudes Can Help Clean School Restrooms.” CM/Cleaning & Maintenance Management, August 2006.

The traditional approach does not seem to effectively handle the use and abuse seen in public school restrooms - acknowledged by almost everyone as the most difficult area to clean and maintain.

A more comprehensive approach should be considered - one that not only cleans and maintains restrooms but also addresses the attitudes and behaviors of those who use the restrooms and the attitudes of those who clean and maintain those same restrooms.

Fazzone, Jim, “Consider an alternative approach to school restroom cleaning.”, Editorial by Jim Fazzone in CM/ Cleaning & Maintenance Management, August 2006.

What Project CLEAN attempts to do is change the attitude of the students who use school restrooms as well as the attitudes of the custodial staff, facility director and administrators about the importance of well-maintained facilities.

Can you imagine a student writing up a work order for the head of maintenance to fix restroom fixtures and then having that student following up to make sure the job got done?

Project CLEAN helped make that happen in a high school in Portales, NM.

Keating, Tom, "Four Senses’ Restroom Inspection." Self-published, 2005.

Keating, Tom, Georgia School Administrators’ Restroom Checklist, included in “School Restrooms: A National Disgrace”, by Jerry Enderle, School Planning and Management, December 2005.

The first Restroom Checklist for School Building Leaders has 38 items in four categories.

1. Reviewing Restroom Conditions;
2. Supplies;
3. Graffiti;
4. Communicating About Restroom Conditions.

Enderle, Jerry, “Improving School Restroom Facilities.” School Planning and Management, March 2004.

Gewertz, Catherine, “Bathroom Blues.” Education Week.12 February 2003.

Keating, Tom, Project CLEAN: Safe, Sanitary School Restrooms. Phi Delta Kappa Educational Foundation, Forty Page Booklet, 2002. Reprinted by Bobrick Washroom Equipment, Inc., 2003.

Tomsho, Robert, “This Man Thinks School Restrooms Lack Class.” Wall Street Journal, 27 June 2002.

Keating, Tom, Resource Guide for Students, Parents, and Custodians. English and Spanish, Self-published, 1998.