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Hand Washing Saves Lives

Dear Dr. Dave and Dr. Dee,

I was in a public restroom and noticed that while I was at the sink washing my hands, two women came out of their stalls and left without washing their hands. I was disgusted to think that people who do not wash after going to the bathroom are leaving with all those germs and bacteria on their hands. What do you think?


Disgusted by bathroom habits

Dear Disgusted,

Good hand washing is the easiest and most effective way to prevent the spread of disease. Up to 80% of all infections are transmitted by hands. Germs (bacteria and viruses) can live on the hands until cleaned, and some germs such as staph and MRSA can survive on surfaces such as plastic or fabric for days and months depending on temperature and humidity. Those germs are spread when hands touch others, or objects that others touch, use, or ingest (CDC-TV presents "Health Matters: Put Your Hands Together," 10/13/08; Neely, A.N. & Maley, M.P., "Survival of Enterococci and Staphylococci on Hospital Fabrics and Plastic, J Clin Microbiol. Feb 2000, 38(2): 724-726; ).

Unfortunately, the scenario you witnessed in the bathroom may be quite common. A study by the American Society for Microbiology found approximately 30% of US travelers do not wash their hands after using airport restrooms. Non-washers were higher among men. In Canada, almost all travelers, both men and women, washed their hands at Toronto International Airport (, "American Society for Microbiology Survey Reveals That As Many As 30 Percent of Travelers Don't Wash Hands After Using Public Restrooms at Airports" September 15, 2003).


According to the CDC, the norovirus causes more than 20 million gastroenteritis cases each year in the U.S. Gastroenteritis, also known as stomach flu, is characterized by diarrhea, vomiting, or abdominal cramps. However, the spread of norovirus can be stopped by proper hand hygiene, especially after using the toilet, before eating, or preparing food ( This also applies to more serious infections, like Hepatitis A, that are transmitted by the fecal oral route.

Just 20 seconds of washing hands can make a difference. The CDC reports that over a million deaths worldwide could be prevented with proper hand washing, stating, "clean hands saves lives" and "hand washing is the single most important thing you can do to help prevent the spread of infection and stay healthy and well" (CDC: "Put Your Hand Together,";

Simple hand washing with soap and water kills germs better than antibacterial gels and hand wipes because germs are washed down the drain. However, if hand washing is unavailable, then a hand sanitizer or hand wipes with 60% alcohol are better than doing nothing at all(Sickbert-Bennett, E.E., Weber, D.J., et. al. "Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses," Am J Infect Control, Mar 2005, 33(2): 67-77).


The Centers for Disease Control (CDC) advises to always wash hands when performing these tasks below (

1. After using the toilet

2. Before, during, and after preparing food

3. Before eating food

4. Before and after caring for someone who is sick

5. Before and after treating a cut or wound

6. After changing diapers or cleaning up a child who has used the toilet

7. After blowing your nose, coughing, or sneezing

8. After touching an animal, animal feed, or animal waste

9. After touching garbage


According to the CDC, the right way to wash hands is to:

1. Wet your hands with clean running water (warm or cold) and apply soap.

2. Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails.

3. Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.

4. Rinse your hands well under running water.

5. Dry your hands using a clean towel or air dry.

Also, when at home, always close the toilet lid before flushing because the cloud of bacteria and virus mist released during flushing can coat surfaces throughout the bathroom (see letter below, "Toilet Seat Lid Up or Down?").

For more information:

CDC video: