I agree with you about sanitation on this issue for sure. I can’t speak for all facilities but in reality I have seen so much ineffect when it comes to infection control in bathrooms. Many times the people using them don’t cleanse the toilet, and there is certainly not enough staff anywhere to monitor toilet use and ensure someone wipes a toilet between uses. A toilet may be used several times by various people before it get cleaned. By then , the chain has already started despite it eventually getting cleaned. Just an unfortunate reality. But as for your breakdown of hierarchy of control, you pretty much covered it.