PODCAST: Are Germaphobes Right to Be So Worried?

ZACH: We're here with Dr. Ashley Drews, the epidemiologist at Houston Methodist Hospital. Thanks for taking the time to talk to us today. Dr. Drews.

DR. DREWS: Absolutely.

ZACH: What is like the most accurate medical definition of what germs are?

DR. DREWS: So, germs are microscopic living organisms that are present everywhere, and they can cause disease.

ZACH: So, we're talking viral and bacterial?

DR. DREWS: Yes, germs can be viruses, bacteria, parasites — but they are small microorganisms that we can't see with the naked eye that are present that can cause disease.

ZACH: Now, when it comes to germs in public, germs in private, like where should we be more concerned about the germs? I mean, intuitively, I would think the germs in public, correct?

DR. DREWS: Yeah. I think people are more concerned about germs that are present in the public. But really, germs are everywhere. They are present in the air. They're on surfaces. They're on food. Plants. They're in our homes. And all of those germs can be pathogenic and cause disease in us. So, we have to worry about the germs that are both in our homes and outside of our homes.

ZACH: Okay, well, let's start inside and work our way out. So, in your home, I'm going to guess the bathroom, the kitchen, perhaps, are the most germ-infested areas?

DR. DREWS: Absolutely. The bathroom and the kitchen are the most germ-infested areas. And some of the really high touch surfaces are really loaded with germs. So, think about doorknobs, handles, you know, TV remote controls. In the kitchen, you know, the countertops, the sink, things of that nature, are really covered with germs.

ZACH: So, talking about those two areas, right, you usually have a lot of towels in those areas, right? Things that you use on a daily basis, like drying your hands off. And obviously you dry your hands off after you've washed your hands. But even those towels collect germs over time? So, is there a recommended rotation of how long you should leave linens and those things, you know, in those areas in your home?

DR. DREWS: Yeah, that's a great question, actually. Dish towels and hand towels can be some of the most dirty surfaces in our home because they carry the germs. And, so, you do want to launder them frequently. And the recommendation would be approximately every 3 to 5 days, depending on how frequently you're drying your hands. But obviously, if they're visibly soiled, then you need to go ahead and wash them and replace with a clean towel at that time.

ZACH: What are some of the less obvious places in your home that germs might be maybe living?

DR. DREWS: Some of the less obvious places would be — again, as I said — you know, doorknobs, the countertops. You're going to think about the TV remote control. I think we've all heard about this one, but what’s really very germy would be your cell phone. So, you know, those areas are high touch surfaces that can be really covered with germs.

ZACH: Yeah. Your cell phone. I don't think anyone goes anywhere without their smartphone these days. You bring it everywhere, right. And I think about that, too, because you take it out and you’re — I don't know — you're out at the park and you put it down on a park bench and you pick it up and then, you know, you go to the restroom and it's in your pocket or maybe not in your pocket in the restroom, right. And then you come back home and maybe it's the last thing you look at before you go to sleep. So, you're laying in your bed, looking at your phone, and you're carrying this device that's been with you all day long, everywhere you've gone. And I don't disinfect my phone every day. I'm going to guess a lot of people don't. Is there a recommendation on what you should do to cleanse your phone, so to speak?

DR. DREWS: Yeah, there is. Honestly, I don't disinfect mine every day either, but the official recommendation is to disinfect your phone on a daily basis with an alcohol-based rub, usually containing 70% alcohol. You want to make sure that you take your phone out of the case to clean it. And you don't want to get any of the liquid into the ports and make sure that you let it air dry before you put it back in the case.

ZACH: Mhmmm….so, maybe every other day…is a good compromise…?

[Laughter]

DR. DREWS: Every other day would be great compromise. But, again, the official recommendation would be every day. But something is better than nothing. And you know, a lot of people really aren't cleaning their phones on any type of regular basis. So, every other day would be a great start.

ZACH: You know, if you have cases, I think that's a great point there. Sometimes my phone has a case, sometimes it doesn't. So what I used to do to try to be somewhat, you know, cleanly and conscious about that is I used to kind of, okay, I'm home now, I'm going to take it out of the case. And then the case — like the case is this travel thing that accumulates all the germs, I'll leave it over here.

DR. DREWS: Right. But, as I said, there are germs inside of our home also. So, again, people are worried about the germs outside of the home, but there are germs inside the home as well. So, you still need to disinfect your phone even if you take it out of the case whenever it's in your home.

ZACH: That's right. So, I mean, you're talking about cleaning it off from the germs, even in your home that are already there. So, yeah, it's not safe inside the walls of your own home even.

DR. DREWS: Unfortunately, no.

ZACH: And, you know, thinking of where germs can accumulate and be absorbed and live, you know, hardwood floors or tile floors versus like carpets. Is there like a better or a worse breeding ground for germs?

DR. DREWS: Yeah, there is a difference. Obviously, carpets are harder to clean, and they tend to carry more germs — particularly if you have pets that are tracking dust and dirt in from the outside. That will settle in the carpet. And, so, hardwoods and tile tend to be cleaner surfaces than carpet.

ZACH: So, a lot of people get air purifiers with the hope of not only purifying their air but keeping their home germ free. Is that something you've seen a positive return on investment on?

DR. DREWS: I personally don't I don't have an air purifier at my own home. I think if you have somebody who lives in your home who has a respiratory illness, they have frequent exacerbations of asthma, then that might be a reasonable consideration. But, for the routine population, I don't think that it has a reasonable return on investment.

ZACH: Okay. Okay. Interesting. Speaking of the home and the family unit, you know, when your kid and maybe you get like a cut and your dad spits on it and rubs it in and it’s like, oh, that’ll disinfect it. Family germs…is that an urban legend? That they don't really infect you the way that outside germs would?

DR. DREWS: That actually is an urban legend. You know, we carry a lot of bacteria in our mouth and, you know, we are not immune necessarily to those that our parents carry. So, you still can get infection from germs that are inside the home and inside your family. So, again, handwashing and all those appropriate hygiene recommendations stand both inside the home and outside the home.

ZACH: Even like sharing a straw, for instance…

DR. DREWS: Even like that.

ZACH: Okay, fair enough. Fair enough. And then, you know, I don't have a beard myself — I've tried to grow beards before, unsuccessful — but I've heard, like, men's beards can actually accumulate a lot of germs as well.

DR. DREWS: Surprisingly, they can. So facial hair also needs to be managed and kept clean. So, you want to make sure that you're using a nice shampoo or a facial soap and water to keep that clean on a regular basis as well.

ZACH: So, you leave your home, usually in your car. Your car, again, has your food and other things, bags that you carry in and out of different places or set in your car. Who knows what clothes, you know, where your clothes have been, where you’re in that same seat the next day. You go home, you take a shower, you put on new clothes, but you're in that same seat you're in yesterday when you were dirty. Should you be routinely cleaning your car for the same germ-free ideal.

DR. DREWS: For the same reason you're going to worry about the high touch surfaces, so not so much your car seat, but you're going to worry about the steering wheel, the stick shift, the radio buttons — things of that nature, things that you touch with your hands. Those are the most concerning for you. And it would be reasonable to disinfect those with some type of regularity.

ZACH: Yeah, I remember when I was a kid, my mom used to keep baby wipes in the car. We went to, like, the gas station or just in general, like to kind of, you know, wipe your hands, clean your hands. And of course, today we have hand sanitizer. We have, you know, quote unquote, adult wipes. I mean, maybe in the eighties, they didn't have adult wipes, I'm not sure. But I just grabbed that blue box in the backseat, right?

DR. DREWS: Right. Yes. Now we have hand sanitizer, which really goes a long way to help with disinfecting the hands and creating a germ-free environment.

ZACH: And I think, after the pandemic, I feel like everyone probably does or should have some hand sanitizer in their car. I mean, when I first started working here at Houston Methodist — all the hand sanitizer stations, everywhere, I thought it was great because I like being clean. It just it feels very refreshing no matter where you are. Like, you accumulate dirt, germs, whatever it may be over the day and like, oh, good, I'm rounding the corner and I can clean my hands off, you know? And I feel just a little refreshed there. So not that we need to put hand sanitizing stations in every room of your home or whatever, but just in a public place like that I've really appreciated the fact that you can go stores, restaurants, you know….that is a plus side of the pandemic right now. There is hand sanitizing stations a good portion are places you go.

DR. DREWS: Yeah, they're much more widely available. And hand sanitizers are great. They're not a substitute for washing your hands with soap and water, though. Soap and water is still the very best mechanism for removing dirt germs from your hands. But, when you don't have access to soap and water, then hand sanitizer is a great substitute. If your hands are visibly soiled, if you're working with, you know, chemicals, insect repellant, other oily substances, then the hand sanitizer is not as effective. And so those are times that you really want to make sure that you're using soap and water. After using the restroom, that's also a time to use soap and water instead of hand sanitizer.

ZACH: Is this a bad analogy? But, you know, sometimes you're too lazy to brush your teeth. So, you use mouthwash, right? So, it helps a little bit, but you definitely want to do the full thing when you can.

DR. DREWS: Yeah, I think that's a good analogy.

[Music plays to signal a brief interjection in the interview]

KATIE: We've been talking a lot about hand sanitizers since they're a convenient alternative when washing your hands with soap and water isn't possible. So, what are some things to keep in mind when choosing a hand sanitizer? For starters, know what you're purchasing. The Centers for Disease Control and Prevention, also known as the CDC, recommends using alcohol-based hand sanitizers that contain at least 60% alcohol. Not all products out there for purchase contain this amount. You'll also want to be aware of alcohol-based hand sanitizers that are packaged in containers that may appear as food or drinks — such as children's food pouches, water bottles and beer cans, or with food flavors like chocolate or cinnamon — as this may lead to inadvertently eating or drinking hand sanitizer, which can cause injury or death. Call the poison helpline at 1-800-222-1222 if you or someone you know has ingested hand sanitizer. You might also wonder if you should just make your own hand sanitizer at home. The FDA does not recommend this. If made incorrectly, hand sanitizer can be ineffective or worse. For example, there have been reports of skin burns from homemade hand sanitizer. One more safety tip. Keep hand sanitizer away from heat and flames. When using hand sanitizer, rub your hands until they feel completely dry before performing activities that may involve heat, sparks, static electricity or open flames.

[Music ends]

ZACH: So, you're in your car, right? You go to the gas station, right? I have a feeling, again, like the gas station and perhaps a public restroom are probably the two most prevalent public areas that you would encounter germs up close and personal?

DR. DREWS: Obviously, you can imagine how many people are touching the gas pump and all of the buttons. And so that's a great time after you've been there to use hand sanitizer in your car to make sure that you're safe before you start touching your steering wheel and you know all of the dials and buttons in your own car. And public restrooms, certainly you want to use soap and water. And it's a great idea to use the towel to actually open the door instead of touching the door with your hands after you've cleaned them.

ZACH: Yeah, I've noticed that a lot of places now they have that little device that you can open the door with your foot, right?

DR. DREWS: Yes. That's fantastic. Or the hand plate where you can wave so that it opens. The touchless door opening is a great new invention.

ZACH: Another thing I've seen is we have more hot air hand dryers now than paper towels, which is great for the environment. I'm sure there's, you know, a trade off there, but it's, I don't know, I feel just like I've been more successful cleaning my hands when I have the towel, like the tactile, like, okay, it's been wiped off. And sometimes like I feel like it just if it's blowing air everywhere, perhaps it spreads germs more places? Is that just an irrational fear or thought I have or…?

DR. DREWS: So, you want to make sure when you're washing your hands — you bring up, you know, rubbing your hands with the towel. So, when you're washing your hands with soap and water, it is important to rub them. So that friction is an important component of washing your hands. But if you've done that while you're washing, then using an air dryer to dry them is satisfactory as long as you make sure that you do get them nice and dry. One of the problems with those air dryers is sometimes it takes a while for your hands to get fully dry and people don't have the patience to wait. I know sometimes I don't feel like waiting the full time to get my hands dry. And wherever there is moisture, then you can accumulate dirt and germs in that area. So, for that reason, they're not as effective.

ZACH: Okay. Okay. So be patient when you’re in the restroom.

DR. DREWS: Be patient, yes. Yes.

ZACH: Gotcha. Now, we've mentioned washing your hands a couple of times. Now, let's take a step back and talk about the best amount of time or procedure to wash your hands, because it's something that we all do. Like when we were kids, you know, when you go home, your mom's like, “Hey, wash your hands before you do anything once you come home.” Which is great advice. Shout out to all the parents out there that have their kids wash their hands when they get home. But you get older and maybe you're in a hurry and you start forming bad habits about washing your hands. It maybe becomes such a preprogramed thing that you don't really think about it. And if you could maybe almost step us through like the procedure — if that's the right term — and then also how long you should be washing your hands for?

DR. DREWS: Yeah, that's a great question. So, you want to start with obviously clean running water. It doesn't have to be hot, as long as it's clean. And, so, you'll get both of your hands wet. Then you want to use, you know, anti-microbial soap and make sure that you get a good lather. So, you're going to rub your hands together and make sure that you cover all of the surfaces of your hands to really work up a good foamy lather. And time is important. And, so, this is not something we can just rush through. You need to really wash them and continue to rub them together and against all of the surfaces for 20 seconds. And a good rule of thumb that we say so is that, you know, to hit 20 seconds is to kind of hum or sing the Happy Birthday song all the way from the beginning to the end two times, and that's generally about 20 seconds. Then you want to go ahead and rinse all of that off and then use a clean towel or one of those air dryers to get your hands good and dry.

ZACH: Okay. Okay. Is there a reason why they have hand sanitizers outside of restrooms? I feel like that's redundant and sometimes sends the wrong message, because it's like I didn't wash my hands, I'll just grab some hand sanitizer on the way out.

DR. DREWS: Right. Yeah, I'm not sure. Again, you know, as I said, hand sanitizers are helpful. And, you know, it's better than not sanitizing your hands at all. But, particularly after using the toilet, it's a better time to wash your hands with soap and water rather than using a hand sanitizer.

ZACH: Yeah, and emphasis on soap because a lot of people like, Oh, yeah, I just ran my hands out of some water for like ten seconds.

DR. DREWS: Soap and water — 20 seconds.

[Laughter]

ZACH: And so, singing the Happy Birthday song in your head. That's a good trick. Everybody should try that out.

DR. DREWS: I think if you do it, we'll find that most of us are really not washing our hands for long enough. Because that's a pretty long time.

ZACH: Yeah, it's like the whole brushing your teeth for two minutes thing, right?

DR. DREWS: Yes.

ZACH: It just feels so long to do that. And, you know, same thing with washing your hands. And we're just — patience, here again, like you're talking about. None of the, my hands aren't dry but I'm out of here, that sort of thing. Just this. This is your health and your cleanliness here, take the time, right?

DR. DREWS: Right. Take the time to take care of yourself.

[Commercial plays]

ZACH: Back to our talk with Dr. Drews. We've talked a lot about bad germs, right? There are good germs out there that it’s good to have on our body, on our person, correct?

DR. DREWS: Absolutely. So not all germs are bad, and some germs that live inside of us are really very beneficial. They help to break down our nutrients. They help to protect us from bad bacteria. And so, you know, those bacteria are really important to have.

ZACH: Is it possible to, like, shower too much and get rid of those bacteria?

DR. DREWS: You know, you can't necessarily shower too much, as far as getting rid of the bacteria. But there are people who, you know, obsessively wash their hands and you can, you know, wash or shower too much and that can cause your skin to become dry and cracked. And, unfortunately, that can predispose you to actually developing more infection and colonization with bacteria because your skin is not forming that normal barrier. So, you know, there can be too much of a good thing. So, we say usually people should wash your hands, you know, the time that you should wash your hands, you really want to do it like when you walk in the house, when you walk into, you know, someplace new, when you're preparing food, before you prepare the food, after you've prepared food, before you eat, after you eat, after using the restroom, when you're taking care of somebody sick. You know, if you're touching your face or your eyes, all of those are good times. And really, for most people, all of those times that you should wash your hands should add up to about, you know, 8 to 10 times a day. If you find that you're washing your hands more than 10 to 15 times a day, that's probably too much. And so, some people, as I said, do have a problem with more compulsive washing. And so you might want to, you know, think about that.

ZACH: And even beyond just the medical part of it — it just dries your hands out, right?

DR. DREWS: Exactly.

ZACH: Wash your hands raw, is the term I've heard before. So, you don't want to be in that situation either.

DR. DREWS: Yes.

ZACH: Well — speaking of water and on your skin — pools, right? You go out there when it has some sort of, you know, sterilizing agent cleanliness in there, but that does not substitute for a shower or washing your hands just because you went in the pool and there were some chlorine. You should still wash your hands, perhaps take a shower, wash that off your body after you come home from the pool. Is that right?

DR. DREWS: Yes, you should. Yeah, that's a great point. One of my children's friends, whenever they spent the night, the parents said, you know, they went in the pool, they had their baths. And, not exactly.

[Laughter] 

DR. DREWS: Yeah, so, swimming in the pool does not really substitute for bathing or washing your hands. And when you get out, you should, you know, shower and you should also wash your hands.

ZACH: Same applies to the hot tub. Anything with water…

DR. DREWS: Absolutely.

ZACH: The ocean, salt water, all that good stuff. You probably want to wash the salt water out.

DR. DREWS: Yes, and the sand.

ZACH: But yeah soap and water, that's the key there. So, when it comes to organic matter, like your food, right. Vegetables, we should be washing those off?

DR. DREWS: Yes. It is important whenever you bring your produce in to go ahead and wash that with water, you don't necessarily need to buy a produce cleaner, but you do want to make sure that you are washing that well with water before you eat it.

ZACH: Yeah, I've tried several different versions of that. Just water for one. On occasion, like a veggie wash of some kind. Also, salt, lemon juice, that kind of thing. Is that more helpful really than just water?

DR. DREWS: Clean water should be sufficient.

ZACH: Okay.

DR. DREWS: If you like the, you know, veggie juice or if you prefer the taste of the lemon water, then that's, you know, certainly OK also.

ZACH: Okay, it’s got that tactile-ness. Because I feel like, okay, you get that salt and you’re rubbing that tomato and it just feels like whatever's on there, I've gotten it off.

DR. DREWS: Yes.

ZACH: So, really, this all comes to just personal hygiene and cleanliness, because these all play into each other. You come home and you wash your hands and you wash your vegetables. And, as you said, like every step of the way, preparing food, serving food — you're going to be okay. Every now and then, of course, things are going to come up. You might get a bad piece of lettuce or something like that, but if you follow the steps, you can avoid not only, you know, disease, but, you know, food poisoning, things like that.

DR. DREWS: Yes, exactly. And with lettuce and cabbage, it's, you know, helpful just to take off those outer layers. So, if you just take off the outside leaves, then that also helps.

ZACH: Yeah, I feel like sometimes I feel like I get rid of too much of the onion, but I'm like, you know what, better safe than sorry. I don't know how long it's been sitting here on the shelf. I don't know how many other people have touched it. That's the other concern. A cantaloupe, an apple, whatever. I guess the cantaloupe, you don't eat the outside. But apples and things like that where people are touching it and, you know, looking at it and tapping it. It's like, well, I'm going to be extra clean when I eat those. So, any other tips you have for us about avoiding germs or things to be mindful of when we're trying to be clean?

DR. DREWS: I think you've really hit the nail on the head with good questions. So, just be sure to take the time to take good care of yourself.

ZACH: All right. Well, thank you for your time today, Dr. Drews.

DR. DREWS: Thank you.

[End of interview]