Dirty toilets and thugs stop children washing hands
Stinking toilets so bad they make the surrounding corridors smell. Empty soap dispensers, graffitied walls and cubicles frequented by smokers and thugs.
This is probably not everyone's experience of secondary school toilets, but it is a worrying fact that it is anyone's.
The London School of Hygiene and Tropical Medicine, quizzed more than 300 secondary school children and found many were worried about using their toilets because of the filth and the threats, leaving them unable to wash their hands and vulnerable to diseases, such as E.coli and gastroenteritis.
"There are six toilets in the year nine block of toilets at my school and only one of them is useable," said one child.
Another agreed saying he would like to see cleaner, safer toilets, with regular teacher inspections.
"People are always smoking in there, plus a boy was attacked in the toilets once, so they lock them at form time which prevents a lot of people from using them."
The children said they wanted soap and toilet paper all the time, regular cleaning, toilet locks, seats in every cubicle and good lighting.
Dr Val Curtis, director of the London School of Hygiene and Tropical Medicine's Hygiene Centre, which carried out the survey, said children had the right to clean and safe toilets which were well supplied with soap.
But she said secondary schools, in particular, were failing their students who could not wash their hands adequately.
"It would be easy to blame laziness on the part of the kids for this state of affairs, but clearly the problem lies with inadequate and dirty facilities, particularly in secondary schools.
"The hands are like a 'highway'. They vector infection from one person to another. Our research shows that you could reduce diarrhoeal diseases by nearly 50% by washing hands with soap.
"We have over 10m episodes of what people call food-related infection a year but most of those are probably related to not washing hands after going to the toilet.
"Handwashing is highly habitual - a routine behaviour if you can instil at an early age you have children for life."
Friday has been designated Global Handwashing Day, an annual, global initiative which seeks to promote handwashing with soap - the most effective and cheap way of preventing diarrhoea and acute respiratory infections.
These two diseases, in combination, cause the majority of child deaths, killing millions in developing countries each year.
Secondary school risk
In its study LSHTM quizzed over 450 children - 152 primary and 305 secondary school.
The primary school children were found to be significantly more likely to always use soap when they wash their hands compared to those of secondary school age (63.8% compared to just 39%).
Nearly 30% of secondary school boys reported never using soap at school, placing them at significant risk of contracting a diarrhoeal disease.
More than a third of secondary school children (36%) said their toilets were never clean, with 42% saying there was sometimes soap available, and almost a fifth (19%) saying there was never any soap.
And 38% of secondary school girls reported "holding it in" so they didn't have to go to the toilet, while 24% of all secondary school children said the toilets were so disgusting they avoided them if possible.
In a bid to improve children hand washing City eHealth Research Centre has created some computer games Educational Games 4 ALL to increase children awareness and understanding of good hand and food hygiene.