By Bunky Bernstein, M.D., ret. | Contributor
Last fall, we were in New York City, heading for the airport. We took the subway to Grand Central Station to pick up the JFK shuttle. The subway stop was two floors below street level. A wide staircase ascended.
Carrying our luggage, we reached out for the hand rail by the stairs. The thought occurred to me: “Should I touch that handrail?” Would you touch that handrail? In an informal survey, a third of my Facebook friends who responded said, “No way.”
Considering the current political scene, one might conclude that Americans are a pretty phobic lot. Politicians capitalize on the fear of terrorist attack, while statistically Americans are far more likely to be harmed in a neighborhood shooting. Returning to my subway survey, was I seeing a realistic health safety concern or a phobic fear of contagion?
Perhaps few of us encounter the New York subway regularly, but most of us visit supermarkets. By the door is the dispenser of alcohol wipes. There is no doubt of the effectiveness of alcohol hand-cleaner in certain circumstances. “The Berkley Wellness Newsletter” noted in 2014 that office workers who used hand-sanitizers at least five times a day were less likely to get sick than those who casually washed their hands. And families that used hand-sanitizers routinely had 60 percent fewer GI infections.
Do you reach for the sterilizer pads before you touch the handle of the grocery cart? Do you disinfect your hands before leaving the store? Should you? Bacteria and yeast can live on surfaces for up to four months, but flu and cold viruses are transmitted in droplets through air, so cleaning the supermarket cart with an alcohol wipe will not prevent the most common contagious conditions. Let’s look at germs, hands and disease.
The human body is home to more than 10,000 species of microorganisms—bacteria, yeasts, protozoa, viruses. The genes of these bugs outnumber our own DNA by 100 to 1. Carried predominately on the skin, in the mouth and gut, this personal community of germs is called your microbiome. The microbiome is affected by organisms in foods you eat, air you breathe, surfaces you touch, people around you, pets in your household.
The microbiome is an important factor in health, and balance among the various microorganisms maintains a defense against the dangerous germs among them. The balance is disturbed when bacteria are killed indiscriminately by antibiotic drugs, alcohol solutions and antibacterial soap.
Scientists believe that a healthy collection of inner germs may help prevent or moderate certain autoimmune and allergic diseases. Reporting in the Journal Pediatrics in 2015, Hesselman and others concluded that hand-washing (vs. machine-washing) of dishes, along with eating a diet rich in fermented foods like yogurt and food brought directly from farms, reduced the risk of childhood asthma and allergy. Taking in more microorganisms from the environment seems to combat the increase in allergic diseases common in affluent, increasingly “clean” societies since the latter half of the twentieth century.
Hospital studies have found that hand-washing is critical to reduce the spread of infection among patients. However, when staff wash their hands frequently, the balance of skin organisms is disturbed, and cultures, when positive, are more often associated with dangerous bacteria.
Other studies found that hospital rooms supplied by internal ventilation systems had a higher percentage of pathogenic bacteria than those supplied by outdoor air with a balance of various organisms. When your mother told you to go play outside, she may have been practicing good medicine.
To get back to the question of the Grand Central staircase: “Should you touch the railing?”
My personal answer to the latter would be “Yes.” In general, a healthy person with a normally functioning immune system will unlikely be harmed by casual exposure to most pathogens. This does not hold for people with immunity weakened by chronic disease, steroid therapy or some cancer chemotherapy. For most of us, exposure to our neighbors, to foreign cities with unfamiliar microbiota, to pets and to the outdoors is a good thing because it augments our personal microbiomes.
Although I wouldn’t wash my hands after petting the dog or receiving one of his doggie kisses, the Center for Disease Control recommends hand-washing before, during and after preparing food; before eating; before and after caring for someone who is sick; after using the toilet; after changing diapers; after blowing your nose, coughing or sneezing; after touching an animal or animal waste or pet food or treats; after touching garbage. When necessary, I believe that plain soap and water with vigorous scrubbing to remove surface grime conducted in a common sense manner (i.e., no need for compulsive hand sterilizing) is the best prescription.