Have you ever held your breath when someone coughed? Or tried to flush the toilet with your foot? Some of these tricks might help if you do them the right way, but they're often unnecessary and based mostly in paranoia. Here's the truth about avoiding germs in everyday life. Illustration by Tara Jacoby.
Holding Your Breath When Somebody Coughs or Sneezes
You're in the waiting room of a doctor's office and some kid decides to launch his snot into the air like he just don't care, so you react by closing your mouth and holding your breath until the "air clears". Does this help you avoid the nastiness that's just been spewed upon the waiting room's populace? In short, no. According to Resident Nurse Meagan Garibay (RN-BSN), you're not going to be able to hold your breath long enough to avoid the snot and saliva droplets that are hanging around in the air.
If anything, you're going to hold your breath just long enough for the droplets to approach and get sucked in as you take that first gasp of air. Whoops. That being said, Garibay suggests that if you can manage to rapidly move away from the area while holding your breath, you may get some protection. Of course, if you do that you'll also look like a chipmunk that just made off with a bunch of nuts, so it's your call. Covering your nose and mouth with a cloth can keep you from breathing in the droplets, but it would need to stay there for a while for it to work, and if it isn't clean you're just introducing different germs to your face. Furthermore, Garibay explains that, despite the gross factor, holding your breath probably isn't necessary to begin with:
The other side to that is, your body actually has self-defence mechanisms for this sort of thing - like your nose hairs. Those nose hairs work as first-line filters to (hopefully) trap germs before they get into your system. Your lungs have similar defence mechanisms as well. Most of the time if you catch something it's not going to be by breathing in droplets (there are exceptions, but in general everyday life, you're not going to catch it this way).
The exception, of course, is if your immune system is weaker than most people's. In that case, you should probably wear a mask or other type of protection when you know you'll be around other sick individuals.
Using Toilet Seat Covers, Kicking to Flush, and "Hovering"
The public toilet is one of those places most people associate with the nastiest of germs. Any place that deals with large amounts of human waste must be a nightmare realm of germs, right? The thought of sitting bare-butt on the same seat as god-knows-how-many people is enough for most of us to reach for the thin, tissue toilet seat covers.
As Garibay explains, however, they're mostly there for peace of mind, and hovering is just going to make you uncomfortable. No part of your body that could get you sick (like the mouth, eyes, nose, hands, etc.) should be anywhere near where you rest your bottom on the toilet. Even if the toilet seat is swarming with germs, your skin and the basic defences of your immune system pretty much have it covered. What about other stuff like herpes, hepatitis, and other serious infections? Garibay explains:
Herpes would require someone who currently has an active outbreak to rub said areas of outbreak all over the toilet seat, then would require someone else to rub areas that would be vulnerable to "catching" herpes all over the toilet seat, and even then they're more likely to acquire another, less permanent infection before they'd acquire herpes. Hepatitis is usually blood borne (or, bodily fluid borne), so the only way to catch it from a toilet seat is to have someone sit on the toilet seat with an area of broken skin right after someone who bled on the toilet seat... Most people are not going to sit on a bloody toilet seat, especially if they are vulnerable with broken areas of skin.
There is a form of hepatitis that can be transmitted through faecal matter (hepatitis A), but that is usually caused by ingesting contaminated food and water. The real concern in the bathroom is what you get on your hands, not your butt. And, as Garibay points out, your hands wouldn't normally be near the toilet seat UNLESS you were placing a toilet seat cover. Now, if you have a cut or open wound on any part of your body that touches the seat, that's a completely different story. In that case, you should definitely reach for the toilet seat cover or find a way to hover. That being said, you should do something to bandage or cover your wounds in addition to that, even if you feel somewhat protected by your pants.
When it comes to flushing the toilet, you may feel the need to use your foot for hitting the handle. Automatic flushers have made this less of an issue, but for older, dingy bathrooms, it isn't too farfetched. Using your foot can technically spare you the germs you'd get on your hand were you to use the flusher normally, but you need to think of what happens next. Plenty of people touch the toilet handle to flush and then touch the handle to the stall. As soon as you touch the stall door handle you've basically touched the toilet handle, so you might as well just flush normally. Plus, if you use your foot, whatever germs were on the toilet handle are now on your shoes that you may or may not walk on your home carpet with.
All in all, even if you do happen to touch the toilet seat, flush handle, or stall door handle, none of this matters if you wash your hands after going to the bathroom. Garibay can't emphasise that point enough, and notes that she can't think of anything you could catch from a toilet seat that would not be wiped out by washing your hands. In fact, you have more to fear from the handle on the restroom door than the toilet itself. After you've washed your hands you'll have to use the same door handle that others have used after (shudder) not washing their icky hands. If your instinct is to grab a paper towel and use it as a barrier, good call. Anything you can immediately throw away is great for turning off faucets, opening doors, and it will keep you hands clean just a little bit longer. Handkerchiefs, however, or anything you don't toss and keep on your person, is not good. You may protect your hands momentarily with a handkerchief, but as soon as it goes in your pocket, the germs still have a chance to make their way to your hands and face later.
Using the Back of Your Hand
Your hands are the primary way germs find their way to danger zones like the eyes, ears, nose, and mouth. So some people try to avoid that danger by using other parts of their hands. For example, I hit crosswalk buttons with the back of my hand instead of my fingers. It's something I've done for years, even though I have no idea if it helps or not. So I asked Garibay, and when it comes to using your hands, there's always a risk there:
...to address you hitting the crosswalk buttons with the back of your hand, does it actually help? Yes and no. Technically it's better than hitting it with the front of your hand, but even better than that would be hitting it with your elbow. The concern is the transfer of germs to your face - your hand, even the back of it, touches your face many times a day without you really being cognisant of it because it's just a habit (you brush hair off your face, you scratch an itch, you rub around your eyes or mouth or nose, etc). Your elbow, by contrast, usually doesn't even come close to your face.
It's the same reason you're told to sneeze into your elbow pit instead of your hands, but in reverse. When you sneeze into your hands, you pass germs along whenever you touch another surface or shake someone's hand. Very few people are going to be touching your elbow, including yourself, so it's much safer that way. Recent studies suggest the amount of germs you transfer directly relates to the amount of surface area in contact and the duration of said contact. Basically, a long handshake is going to share more germs than a quick fist bump. Garibay notes, however, that maintaining good hand hygiene is still important regardless of how you choose to greet others. And a fist bump isn't ideal for professional situations, so you're better off just keeping some hand sanitizer around.
Wearing Gloves and Surgical Masks in Public
Because your hands are the main concern when it comes to avoiding germs, you might think that wearing gloves is a simple workaround. And gloves might seem like an especially good idea if you ride public transportation since you hold onto a lot of poles, railings, handles, and what have you. Unfortunately, gloves only really help when you're coming in direct contact with bodily fluids (blood, vomit, poop, urine, and other fun stuff).
As Garibay explains, gloves only prevent you from germ exposure for a short time. As soon as you take them off your protection comes crashing down. When you remove them you might touch the outside of them. And do you remember the last time you washed a pair of your winter or driving gloves? Plus, you can still inadvertently touch your face with your gloves while you're wearing them. Or you'll hold your cell phone with them only to touch your cell phone later with your bare hands (or bring both your dirty gloves and cell phone right up to your face when you make a call). Unless your hands are cold, you're better off just washing your hands.
Surgical masks, on the other hand, have a tiny bit more going for them. They can be very beneficial for those who are severely immunocompromised, and can block the droplets that Dr Weiswasser explains cause respiratory viruses (like colds, bronchitis, and the flu). For most of us, however, avoiding direct contact of a sick person is enough to keep us safe. You have enough protection built in to fight off the germs you get from just breathing the same air as other people, even when you're trapped on an aeroplane for several hours. The real danger is touching their saliva or snot, or objects like tray tables and arm rests covered in that stuff, and then touching parts of your face (like the eyes, nose, ears, and mouth). If you absolutely must wear gloves and masks for your own peace of mind, Dr Weiswasser notes that you're better off cycling through disposables. But even then, he explains that is pretty extreme and not necessary except for a very select crowd. Surgical masks, however, can be very useful if you're the one who's sick. In many countries, it's common practice to wear them when you're ill so you can prevent infecting others.
Germs Cannot Be Completely Avoided (and That's OK)
The bottom line is that you can't really avoid germs...but that's perfectly fine. From the moment you're born to the moment you die, you are surrounded by them 24/7. Garibay points out that not all germs are bad germs (many are non-pathogenic), and most of the bad ones never really have a chance to harm you:
You're exposed to so many germs in the course of a day that you don't even realise. If you're healthy, though, your immune system is pretty much a badass at staving off the invaders. They're in and gone with very little fanfare.
Your body fighting off germs is just business as usual. In fact, there's a possibility that limiting your body's exposure to germs will do more harm than good. You get sick when your immune system runs into an invader it's never seen before and is too weak to immediately eradicate it. The "hygiene hypothesis" suggests it's possible to properly calibrate and strengthen your immune system through germ exposure so that happens less frequently, but Dr Weiswasser admits the theory is a bit controversial. Still, if you're a perfectly healthy individual, there is such a thing as being "too clean." Garibay explains that, while you probably shouldn't intentionally expose yourself to germs, normal exposure is necessary to build a healthy, functioning immune system. Like a muscle, it can't get stronger if it never gets used. This is especially important with the new germs that keep popping up due to the overuse of antibacterial products.
The Strategies You Should Actually Focus On
Avoiding germs and staying healthy is actually pretty simple. The world isn't the germy minefield it may appear to be, and keeping illness at bay doesn't need to be a constant balancing act of tricks and avoidance maneuvers. Dr Weiswasser and Garibay both have a few tips that will do most of the hard work for you:
- Wash your hands: Washing your hands before you eat, cook, or touch your face is the single greatest thing you can do to avoid illness-causing germs.
- Use hand sanitizer when you can't wash your hands: Garibay suggests the key to properly using hand sanitizer is remembering to actually use it. Keeping it around doesn't do much if you forget to bust it out before eating or after you blow your nose. When you use it, rub your hands together until it dries, at least for 15-20 seconds, covering all surfaces of the front and back of your hands and between your fingers. However, if your hands are visibly dirty or oily, a good hand washing is necessary to clean away the bad stuff.
- Avoid touching your face: This isn't easy to do (I struggle with this constantly), but the less you touch your face and the vulnerable openings around your face (eyes, ears, nose, mouth) the better off you'll be. The same goes for touching other people's faces.
- Stay away from sick people: This may be difficult to do if you live with them, but the logic is sound. The less you're around sick people the less likely you'll contract what they have. The same goes for when you're sick! Don't go to work or out in public when you're not feeling well. No need to spread a nasty bug just to prove how well you can handle it.
- Focus on the basics: Dr Weiswasser emphasises the importance of getting plenty of sleep, eating well, and exercising to keep your immune system strong and healthy.
That's pretty much it! Your body's natural defences will handle the rest. Last but not least, Dr Weiswasser recommends you stay up to date on you and your family's immunizations, and he recommends anyone over the age of six months get flu shots every fall.
Meagan Garibay is a Resident Nurse (RN-BSN) and Clinical Educator at Comanche County Memorial Hospital.
Dr Daniel Weiswasser is a board-certified internist and pediatrician who's been in outpatient practice in Western Massachusetts for nine years. They offered their expertise with this feature, and we thank them both.