Think about all the places you visit in a typical week: your office, your favorite restaurant, your child's school. Do you ever look around and worry your surroundings are less than sparkling clean?
Rod Moser, PA, PhD, does. In his WebMDblog, the veteran primary care physician assistant lists 12 places where poor hygiene could give germs a leg up. For a closer look at this "dirty dozen," WebMD asked public health officials to discuss the risks in each place, along with strategies for protecting yourself and your family.
Germy Place No. 1: Public Bathrooms
The risk: "It's prudent to assume virtually any surface in a public restroom carries germs," says Craig Conover, MD, MPH, medical director of the Illinois Department of Public Health. These germs may include intestinal bacteria, such as E. coli and Enterococcus, which cause diarrhea. The main risk of infection comes not from sitting on the toilet, but from touching the seat, stall door or sink with your hands and then touching your eyes, nose, or mouth -- the usual points of entry for common germs.
Your defense: "If you want to leave with clean hands," Conover advises, "wash your hands for the proper amount of time -- 15 to 20 seconds -- and avoid touching contaminated surfaces afterward." If the sink is not motion-activated, use a paper towel to turn off the faucet so you won't contaminate the hands you just washed.
Lennox K. Archibald, MD, hospital epidemiologist for Shands HealthCare affiliated with the University of Florida, tells WebMD healthy people are not likely to get sick from a public bathroom if they "wash their hands properly with soap and water." He adds that the elderly, people undergoing chemotherapy, and anyone with a compromised immune system should be especially diligent about hand washing. This includes children.
Germy Place No. 2: Restaurants
The risk: We've all seen the signs requiring restaurant employees to wash their hands after using the bathroom, but who's checking up on this? Improperly washed hands can easily taint food with fecal matter, introducing infectious bacteria or viruses.
Raw foods can also expose you to a wide range of bacteria, including Salmonella, Shigella, and Campylobacter, Archibald says. Even ordering your food well done is not a guarantee against exposure. If a kitchen worker handles raw foods and then touches your dinner plate or freshly baked rolls, he can contaminate your cooked food.
Your defense: "Choose which restaurants you patronize," Conover says. Check with your local government for inspection results or look for the inspection certificate on site. In addition, avoid raw or undercooked foods. Always order your hamburger well done and send it back if it's pink in the middle.
Germy Place No. 3: Your Workplace
The risk: Phones, desks, and computer keyboards are germ magnets, according to a study by University of Arizona microbiologist Charles Gerba, PhD. The study, funded by the Clorox Company, suggests surfaces used by teachers, accountants, and bankers are the germiest.
Your defense: Moser recommends disinfecting your workspace yourself, particularly if you share your desk, computer, or phone with other employees. One option is to coat surfaces with a disinfectant spray, "but don't wipe it off. You have to let it dry."
Germy Place No. 4: Airplanes
The risk: When you have so many people in close quarters for hours at a time, germs thrive, says Archibald. He tells WebMD upper respiratory viruses and intestinal bacteria can spread easily during a flight. In addition to the obvious risk of a neighbor with a bad cough, the surfaces throughout the cabin and particularly in the lavatory can harbor germs.
Your defense: Moser and Archibald recommend disinfecting your seat when you board. Wipe the arms, tray, and window with alcohol-based antiseptic wipes. Use a hand sanitizer after visiting the lavatory, and if you need to change your baby's diaper, disinfect the changing tray first. Moser also suggests avoiding the lavatory on short flights, bringing your own magazines, and staying hydrated to help protect against respiratory illnesses.
Germy Place No. 5: Hotels and Motels
The risk: You may have heard that the bedspreads in hotels are never washed, but don't worry. Archibald says these are not likely to spread germs. Bigger concerns are bathrooms that have not been properly cleaned, contaminated surfaces such as doorknobs or phones, and bed bugs living in the mattress or headboard.
Linn Haramis, PhD, an entomologist with the Illinois Department of Public Health, tells WebMD that bed bugs are becoming an increasing problem in many areas of the country. He says they are not disease carriers, but "the bites can cause allergic reactions, and the 'ick factor' is not something most people are happy with."
Your defense: Ask the manager for a different room if the bathroom doesn't seem clean, or if there are brownish-black spots along the mattress seams or headboard -- bed bug excrement. Even if the room looks clean, Moser recommends using a disinfectant spray on the phone, nightstand, bathroom counters, and other surfaces you might touch with your hands.
Germy Place No. 6: Swimming Pools
The risk: The CDC has recorded an increase in recreational water illnesses over the past decade. The most common problem is infectious diarrhea, which can be caused by germs such as Giardia, Shigella, Norovirus, E. coli, and Crypto, short for Cryptosporidium. A pool is easily contaminated when someone with diarrhea goes swimming, and chlorine doesn't always kill the germs immediately. Crypto can survive for days even in a properly disinfected pool.
Your defense: The CDC offers these tips:
- Avoid swallowing pool water or getting it in your mouth.
- To protect others, don't swim when you have diarrhea.
- Shower before swimming.
- Wash your hands before returning to the pool after using the toilet or changing a diaper.
- Don't let your child swim if he or she has diarrhea, and use rubber pants for young children who are not potty trained.
Germy Place No. 7: Movie Theaters
The risk: Similar to an airplane, movie theaters draw many people into close quarters for a couple of hours. Moser points out that viral infections can be contagious a day before symptoms appear, so people with colds or flu may go to the movies without knowing they are sick.
Your defense: Avoid touching your eyes or nose during the movie and wash your hands after leaving the theater. To protect others, watch movies at home when you are ill.
Germy Place No. 8: Day Care Centers
The risk: During a diaper change, children may get fecal matter on their hands and then touch a toy. When another child plays with the same toy and then sucks his or her thumb, infection can occur. This is called fecal-oral transmission, and Archibald says it's a common source of diarrheal illness in children. Since young kids love to put things in their mouths, shared toys can also become contaminated with saliva.
Your defense: Ensure your children are immunized appropriately and avoid sending them to day care when they are sick, Moser advises. In addition, make sure your day care provider washes children's hands after a diaper change.
Germy Place No. 9: Schools
The risk: As Moser puts it, "Any gathering of children is a place of questionable hygiene." Even though school-aged children may have grown out of habits like thumb sucking or putting toys in their mouth, they may be less than diligent about washing their hands when they should.
Your defense: Set a good example by washing your hands often at home, Moser suggests. Teach kids why it's important to wash hands after using the bathroom or before eating meals, and show them how to do it properly.
Germy Place No. 10: Your Home
The risk: You don't have to leave home to have a close encounter with germs -- just travel as far as your kitchen or bathroom. According to Moser, raw foods frequently contaminate kitchen surfaces with bacteria, which aren't killed when you wipe off the counter with a wet cloth or sponge. As for the bathroom, intestinal pathogens can contaminate the toilet seat, flush handle, towels, doorknobs, sink, and other surfaces you might touch after using the toilet.
Your defense: Keep in mind that cleaning is not the same as disinfection, Moser says. His advice:
- Clean kitchens and bathrooms regularly with bleach or a color-safe disinfectant spray.
- After handling raw foods, wash cutting boards and knives with soap and hot water.
- Microwave wet sponges for one minute to kill germs.
- Change hand-drying towels often.
- Close the lid before flushing the toilet to keep germs from contaminating nearby surfaces.
Germy Place No. 11: Your Doctor's Office
The risk: You may not think of your doctor's office as germy, but remember that you are sharing a small space with many people who may have infectious illnesses. Waiting room chairs, doorknobs, toys, and even your doctor's clothing can become contaminated. According to Archibald, those most at risk for picking up germs at the doctor's office are patients who have some type of medical procedure.
Your defense: Try to avoid touching doorknobs or other surfaces, or wash your hands afterward. When taking your child to the pediatrician, bring toys and books from home. Speak up if you don't see your health care provider wash his or her hands before your exam or procedure, Moser warns. "Say, 'I don't want to be disrespectful, but would you please wash your hands.'"
Germy Place No. 12: Hospitals
The risk: "More people die from hospital-related infections every year than from car accidents," Moser says, citing CDC data. This is not because hospitals are unsanitary, but because there is a high concentration of germs and vulnerable people in the same place. There is also increased risk of exposure to bacteria that are resistant to treatment with antibiotics.
"The area of hospitals with the most infections is the ICU (intensive care unit)," Archibald tells WebMD. Intensive care patients may have compromised immune systems, along with surgical wounds or medical devices that can introduce germs. "Patients need to realize this is a risk," Archibald says.
Your defense: The Committee to Reduce Infection Deaths recommends looking for hospitals and surgeons with a low infection rate ahead of any planned procedure. In addition, always ask hospital staff and visitors to wash their hands before touching you.
The Universal Germ Fighter
All of our experts stress that there is one simple strategy for fighting germs in almost any setting: Wash your hands. "Do it often and do it correctly," Moser says. "That can't be overemphasized."