Germs: Here, There, and Everywhere

Germophobes and hypochondriacs should stop reading right here because today’s column is a Cook’s tour of the many common places where pathogens and other disgusting bugs can be found. Some of them are in your home. Consider the lowly shower curtain. A San Diego State University study discovered a variety of potentially pathogenic microbes growing on shower curtains. This comes as no surprise to anyone who has lived in a college dorm, but the study suggests shower curtains might be a possible route of infection for people with weakened immune systems. Warm water, protein-rich shampoos and soaps, and a menagerie of microbes from skin, hair and water pipes could be the ingredients needed to build large populations of persistent germs. The study authors recommended glass shower doors or regular replacement of shower curtains. Hot tubs and whirlpools are other potential sources of bacteria that can cause skin rashes and respiratory infections. Researchers at Texas A&M found that a teaspoon of typical hot-tub water contained about 2.2 million bacteria. One particular bug, Mycobacterium avium, has been linked to a condition called “hot-tub lung.” Last year, Norm Pace, a well-known microbiologist, found M. avium accounted for more than one third of the bacteria in hot-tub water and 80% of the bacteria in the misty air above the water. Other potential hot-tub party animals include Pseudomonas and Legionella bacteria, numerous fungi, and fecal E. coli. Then there is the ubiquitous cell phone. When it’s not blaring out show tunes at inappropriate times, it may be quietly harboring a bacterium called, Acintobacter baumannii. It is a tough little bug that can persist for weeks on inanimate surfaces. A few years ago, an Israeli doctor studied some of his hospital colleagues and their cell phones. He found 12% of their cell


phones and 24% of their hands where contaminated with antibiotic-resistant strains of A. baumannii. Dr. Gilad, the study author, said cell phones might play a role in the transfer of drugresistant bacteria to hospital patients. It might be possible to ban cell phones from certain places, but what about computer keyboards. Various types of bacteria can survive for many hours on keyboards. A study of hospital computer keyboards in Chicago found three different types of dangerous bacteria able to persist on keyboards and contaminate gloved and ungloved hands. ICU and burn unit keyboards also were contaminated with A. baumannii. Chicago epidemiologist Gary Noskin told Reuters the best defense against keyboard contamination was frequent hand washing. What about contaminated feet? Some nail salons recently have been identified as sources of nail infections, athlete’s foot, staph infections, and other types of skin infections. In 2000, the Centers for Disease Control and Prevention investigated a California outbreak that affected 100 women. The culprit was a whirlpool footbath contaminated with a cousin of the tuberculosis bacterium. These bacteria cause boils and skin ulcers, and the infections often take months to clear up. Interestingly, one way to reduce the risk of infection—aside from avoiding footbaths— is not to shave your legs before the appointment. Nicks and cuts can provide easy entry for bacteria. I don’t like wearing neckties, and Steve Nurkin at New York Hospital Medical Center recently gave the tieless another excuse to remain so. He found that half the neckties of healthcare workers were contaminated with potentially pathogenic bacteria. Ties have always been good for catching crumbs and coffee drips, dangling into salad bars and office equipment, and reducing blood flow to the heads of overweight executives, but now they may be transferring


bacteria to patients as tie-wearing physicians make their rounds. This may not be a serious public health threat, but it could be good news for bowtie sales. If your mother ever warned you about playing in the mud she was probably thinking about the mess and not the microbe. In Australia a few years ago, a “mud football” competition sent 26 people to the emergency room with infected skin abrasions and pustules. A waterborne pathogen called Aeromonas was isolated from the muddy patients. In American football, where mud is optional, abrasions from turf have led to skin abscesses from drug-resistant staph. In 2003, eight such infections occurred among St. Louis Rams players. The same bacteria also were found in the team’s whirlpools. If you feel the urge to run to the grocery store to stock up on bleach, soap, and disinfectants, you should watch out for the shopping cart handles. According to the Korea Consumer Protection Board the cart handles have about 1,100 bacteria per square centimeter. The Board also sampled bus hand straps, bathroom doorknobs, elevator buttons, and computer mice and keyboards. Suffice to say, the phrase, “germ-free,” should not be tossed about lightly. Few things are germ-free. And maybe that’s good. The “hygiene hypothesis” suggests that early and frequent exposure to germs primes the immune system, and reduces the chances of developing aberrant immune responses such as allergies. The polio epidemics of the early 20th century, for example, and increases in asthma and hay fever in industrialized countries are thought to be due to a combination of improved sanitation and under exposed immune systems. Too clean or not too clean? That is the question. Go wash your hands while you’re thinking about the answer.