A week ago we asked the question, “Are You Concerned about Coffee Cup Contamination?” This was in response to a question by a visitor to this website who worried about catching a cold or the flu because the coffee barista touched the top of her cup and lid with bare hands. By the way, new research published in the journal Clinical Microbiology and Infection (Jan., 2014) suggests that flu viruses can linger on finger tips for at least half an hour.

Many of the comments that came in implied that worrying about coffee cup lid contamination is ridiculous and the whole “germ thing” has been blown way out of proportion.

Jennifer said: “No, I don’t want a worker sticking his contaminated finger on my cup, but it’s more of an psychological ick factor than an physiological one. I’m in the ‘challenge your immune system’ camp.”

R.M. stated: “I have no concern about this whatsoever. Stop being so paranoid.”

Just adds: “I understand the ‘barista and the lid’ anxiety, but it’s based on psychology and appearances, not science or medicine. If you SEE it, it becomes a worry, like the roach on the wall of the restaurant. Disgusting, and you may walk out. But if you never saw it, no big deal.”

We wonder if the “no worries” camp would be so cavalier if they came down with the extreme vomiting and diarrhea that affected over 600 passengers and crew on the Royal Caribbean cruise ship that recently made headlines because of a bad outbreak. Investigators suspect norovirus, which is easily spread from person to person by hand contact.

People often assume that this infection only affects those in close quarters, such as on cruise ships. But the CDC estimates that there are as many as 21 million cases of gastroenteritis linked to norovirus annually. Many occur in the community and are mislabeled as “stomach flu” or food poisoning.

Norovirus is especially contagious, but it is not the only “germ” that can be transmitted from one person to the next by dirty hands. Besides the obvious viruses that cause colds and flu, there are lots of other nasties out there including Clostridium difficile (C. diff), rotavirus and hepatitis A, to name just a few.

What About Doctors & Nurses?

For years, infection control experts have been calling for improved hand hygiene. Gradually, health care workers are complying, but there is a long way to go.

An article last fall in the Wall Street Journal (Sept. 30, 2013) by Laura Landro puts the situation into perspective:

“Yet despite years of efforts to educate both clinicians and patients, studies show hospital staff on average comply with hand-washing protocols, including cleansing with soap and water or alcohol-based gels, only about 50% of the time. Two new studies show patients aren’t much more comfortable today than a decade ago with the idea of asking doctors and medical staff to lather up.”

It turns out that most of us are afraid we might alienate our doctor or nurse if we ask about hand washing, even when there are signs in hospitals encouraging us to do so.

Other Sources of Contamination: White Coats & Stethoscopes?

As hard as it has been to get health professionals to wash their hands between patients, it has been far harder to get doctors to give up their white coats, ties, rings and watches. American male physicians are quite attached to their white coats, ties and the stethoscopes draped around their necks. All these items are potential sources of infection. To be blunt, they are frequently filthy, loaded with really bad bacteria, viruses and fungi.

Several years ago the National Health Service in the United Kingdom banned long-sleeved white coats and required physicians, nurses and other healthcare workers to get “bare below the elbows.” That’s because study after study has found that white coats are frequently contaminated with a range of unpleasant bacteria. Ditto for ties and jewelry. In the UK doctors have to leave their uniforms at the hospital or clinic, where they are washed regularly.

American hospital administrators have scoffed at the UK initiative, claiming there is inadequate evidence to support these safety measures. In the U.S. it is not uncommon to see doctors and other workers going home or stopping in the grocery store wearing their white coats or scrubs. Many hospitals do not even have a policy for when and how these uniforms need to be washed.

All that might change if administrators follow new recommendations from the Society for Healthcare Epidemiology of America (SHEA). In essence, this prestigious organization is encouraging American health professionals to adopt the UK standards, ie, “bare below the elbows.” Ditch the jewelry! If white coats are worn at all, they should be hung up before interacting with patients. Regular laundering of white coats with hot water and bleach is encouraged.

One other thing: the experts at SHEA say that stethoscopes “should be cleaned between patients.” When is the last time you saw your doctor really clean her stethoscope with alcohol before putting it on your chest or back? Stethoscopes are another source of contamination, but many health professionals rarely clean their stethoscopes between patients.

We suspect that implementation of these voluntary recommendations will take years. There is often resistance to change. And patients often feel powerless to speak up. They may believe that asking a doctor to take off a white coat, wash his hands or clean a stethoscope is tantamount to waving a red flag in front of a bull.

What do you think? Could you ever bring yourself to ask your doctor to:

Wash his hands? Remove his white coat? Clean the stethoscope? Share your thoughts below:

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  1. Bev K
    Reply

    I lived in Hawaii (Oahu) for several years (2003-2009. At that time, I had just read that Hawaii has the highest amount of MRSA in the U.S. That being said, I had cut my finger and needed stitches so off to the ER I went to the largest hospital on the islands. While waiting in the room, I thought I should wash my hands only to find there was no soap in the dispenser or sink area (Big Taboo).
    The nurse came in and when I told her about it she said she would have someone fill it. Then she preceeded to start taking my vitals which involved touching my wound as well. I immediately stopped her and said no, not until she washed her hands. And without checking to see if there was any soap she left the room in a huff. 25 mins later the DR. came in and I told him about the soap. Same as the nurse when I told him about it, he says, “Do you want me to fix this injury or not”. My reply, only if he washed his hands… he then left in a huff.
    Someone finally came in and filled the dispenser, another DR came in shortly after, I motioned that he wash his hands and did so respectfully then preceeded to take care of the wound. I learned NEVER to assume the medical staff had clean hands and always check the soap dispenser when entering the room. It was really scary to see the attitude when it was really my health and maybe my life and they could really care less. So whatever you do, DON’T get sick in Hawaii!!

  2. Geoff
    Reply

    A story related to Patti’s comment: During a campaign to improve hand washing a decade ago my clinic focused on education. One of the things was a 5×7 yellow card posted at each sink. The card had 2 silhouettes of hands, front and back, with black areas on them where we frequently miss when washing. The caption explained and told us to be sure all the hand was washed. I thought this simple card a silly waste of time, perhaps appropriate for an early elementary school but we doctors know how to wash hands. I washed my hands, looked at the yellow card, looked at my hands (before rinsing), and… saw dry areas on my hands coinciding with the black areas on the hand silhouettes. I had missed the areas the card said we are likely to miss. What an eye opener! I humbly rewashed my hands. That “silly waste of time” has changed my hand washing technique ever since. If we could combine the yellow card with Patti’s idea of a dye to make our error obvious we would make progress. It might also be a good program at an elementary school.
    Geoff,

  3. Patti Cake
    Reply

    I like the idea of a sterilizer box of sorts. But what about a cost effective cleanser that would leave a non-staining color to show that all areas of the hands are cleaned and sanitized?
    I remember when the red chewable tablet was given to kids to show how the color would adhere to plaque on teeth. Thereby, showing kids where they missed brushing. If only the opposite were true, a color to show the areas that have been cleaned!
    If hand sanitizers and/or soap could leave a color to indicate cleaned areas on hands….well I’d check every healthcare worker, restaurant cooks, social worker, school faculty…etc the list is endless.
    I would like to see that you have clean hands before you spread the nasty’s!
    Patti Cake

  4. Cindy M. B.
    Reply

    I’ve written this before but I’m tempted to say it again: I think it all depends on how well you’ve bolstered your immune system. Since most folks don’t do a very good job of that, then taking all those precautions is probably vital.
    As for me, all my life I’ve eaten everything, licked everything, eaten and licked stuff off the floor and the ground, absentmindedly nibbled on all kinds of stuff in public places, eaten dirt, kissed thousands of animals, licked my cats when they were feeling down, NEVER thought to wash my hands, NEVER taken any precautions whatsoever.
    And I am simply never, never sick. I do find people who, e.g., use a paper towel to turn off faucets in washrooms, absolutely laughable (and wasteful!) — but then again, if their immune system isn’t up to snuff, then I suppose they should do this. (But please, bring your own hankie or something… don’t murder the poor trees!)

  5. SCC
    Reply

    I agree with the sales rep above who said he’d have no problem asking a doctor to wash hands or about his stethoscope. Years ago at the beginning of the AIDS pandemic, I had a regular dental cleaning visit and asked the technician how they sterilized their instruments. She left the room and in a short time the dentist came in with an obvious attitude in place and asked me if I had a problem with something.
    I told him that I merely asked about their sterilization practices. He was so huffy and aggressive that I never found out anything about their practices except that he didn’t want to talk about it. Needless to say, I never went back (he had been my dentist for about 15 years). My next dentist was very open to discussions and, on my second visit to his office, I noticed framed statements of sterilization practice in each room with a statement about adhering to the recommendations of the ADA. For years I enjoyed sharing information back and forth with that dentist.
    This is a long way of saying that we consumers can affect practice by being willing to ask and to change providers if we don’t like how our questions are handled.
    I am a retired RN and a vocal proponent of hand washing in all settings. One of the first lessons for my grandchildren was how and when to wash hands.

  6. Laurie Matson
    Reply

    At my Clinic, when I go to see my Doctor he always wears Bow Tie’s and before we are touched they apply hand sanitizer. Now I know why my Doctor wears Bow Tie’s- so they don’t get in the way and get contaminated!!! Not sure about those stethoscopes though!!!

  7. MJ Theo
    Reply

    I worked in health care for eight years as a sales rep, and I would have no problem asking a DR to wash his hands, or remove his coat, or put on gloves.

  8. JBG
    Reply

    Washing hands many times a day has got to be hard on the hands. And doing it right takes a minute or two each time – hard psychologically on people who are chronically pressed for time.
    I’d say what is needed is an invention that provides a person with hand cleansing that is quick, effective, and requiring of little concentration or effort. The process could be designed to be as easy as possible on the hands.
    Think of a box the size of a microwave oven with a pair of slots in the front. You put in your hands, they’re sprayed several times in succession, then quickly air-dried (speed hand dryers already exist), and perhaps micro-sprayed once again with something good for the skin.
    I think such a thing is feasible, and its installation by hospitals and clinics would constitute quite a strong directive to it usage.

  9. S.M.D.
    Reply

    Medicine is big business where I live, and getting bigger with the construction of a Medical Corridor. I try to stay out of doctors’ offices and avoid tests and hospitals, and I think I’m already considered a difficult patient for that reason.
    It’s so hard to do, but if I thought a doctor had been in contact with something really hazardous, I’d like to think that I’d say something. Otherwise, I have to trust that my doctors are hygienic. That is, I don’t think it’s wise to march in and say, “Did you just wash your hands up to the elbows? What about your stethoscope? You’ve worn that watch for years!!!” They know what they are SUPPOSED to do, I’m sure, and some of them wash their hands right in front of me, or wear gloves, which I really appreciate.
    I can only go on recommendations, but I have had evaluation appointments at the Cleveland Clinic heart center (3 hours from where I live) because I hear that in addition to excellence, they are committed to cleanliness.

  10. AA
    Reply

    I don’t believe the coffee cup contamination issue has been blown out of proportion. I would ask for a new cup lid if a barista touched the part of the lid that I was going to put my mouth on.
    I don’t enjoy vomiting and/or diarrhea (or possibly worse) and generally try to avoid it. For the record, I am rarely sick.
    If you don’t mind that a person with unknown possible contaminants on their hands touches your cup lid opening so be it but please don’t berate and criticize those of us that do. People’s Pharmacy only asked if you would be concerned. They didn’t ask for your comments or criticism on those with differing opinions.

  11. FP
    Reply

    As a former hospital worker (infection control) I say “thank you” for the article. I also say to everyone, “Stop touching your face!” You just touched the doorknob, pencil, phone, whatever — and you cannot handwash after EVERYthing (Try, though!), but you can stop rubbing your nose, touching your chin, etc.

  12. Donnie
    Reply

    I was in a ladies room and saw the cook from the restaurant come in, use the toilet (for #1 and 2). She left the stall and walked out the door. She never went near the sink. I wondered if she would wash her hands in the kitchen, before preparing food. I decided I didn’t want to eat there, after all.
    So many people are too lazy, or too ignorant, to wash their hands properly. That can make other people sick, as well as the dirty one. I’m not germophobic, but I do use common sense about handwashing, as most sensible people do. I knew one family who had frequent food poisonings because they couldn’t be bothered to wash their hands, or use safe food handling. They developed kidney failue due to food poisonings.
    It only takes a couple of minutes to wash hands with soap and water, to be on the safe side. The life you save may be your own, or that of your child.

  13. DS
    Reply

    I’d like to see all comments.
    When I was a child I my father would not take us to the doctor when we were sick so we could avoid infected waiting rooms but he had the doctor make a house call.
    Even if the doctor lathers up his office is a breeding place for germs.

  14. Gin
    Reply

    What about the auxiliary workers in the hospitals one sees in the break rooms, halls, etc who are wearing scrubs and shoe liners. Those guys obviously are working in “sterile” areas. Those workers are everywhere in those “get ups.”

  15. Mac
    Reply

    If medical personnel cannot comply with best practices established by research, they are not competent enough to be treating patients! Someone too ill or shy to remind the doctor to do his job correctly must run more risk of disease?

  16. MMT
    Reply

    I would think the Dr and Nurses would be glad to contribute to not spreading bacteria, viruses and fungi…it would protect them as well. How many medical professionals get sick from patients? It should help them also! They use disposable covers for thermometers etc. why not for stethescope? I am sure it will add to cost…but if it cuts down on disease maybe it is cost effective?

  17. Geoff
    Reply

    As a retired physician, I have seen and been guilty of everything you mention in your article. I agree strongly with all you have said.
    Nevertheless, I can’t resist a couple of comments. 1) Did the study about white coats compare the culture of the coats to cultures of the medical attendant’s arms? Anything the coat would touch the bare arm will touch. Skin is a great culture media. It’s warmer than the coat sleeve, moister, and has nutrients (protein) all things the bacteria love.
    I think Cal and CMW are on the right path. 2) Much of infection risk we face is a direct result of our mobility and social aggregation. In any given day we see more people, touch more people, touch more public things, breath in more “exposed” air, than ever before in our history. Thus much of infection control is our own responsibility.
    Think of AAA.
    Awareness; Be aware of what might be contaminated. How many people have touched the door handle to the mall before I came?
    Avoidance; Stay away or alter your activity as needed.Touch the door handle/bar where most people don’t. (the part that’s not shinny.
    Ask; Learn how responsible others are and, when necessary, ask them to change. How often does the mall wipe the doors with disinfectant. Dr. will you please…

  18. LJ
    Reply

    Last year I had a bug that resulted in prolonged coughing spells and it lasted almost a month. After three weeks I went to the doctor, actually physician assistant, who did not wash her hands before checking my throat, ears and neck. Maybe she washed before entering the examining room but she didn’t once there. I didn’t say anything. Probably should have but who knows what retaliation goes on.
    If only 50% of patient contacts are made with clean hands there is a big problem in the medical/industrial complex. But then, as with any private enterprise, why would those profiting encourage a practice that might cut their profits?
    Medical workers answer to insurance companies, not the public. In the past a person could take their business elsewhere; now it’s hard to do that except for the once a year choice period and by then it’s often too late. Also, so many “choice” options aren’t really much of a choice. Insurance companies as a lobby are extremely powerful and sometimes it seems they are either above the law or make their own laws.
    Think of how it is if you have an automobile accident or an insurance claim of any kind: you notify your agent and the insurance companies decide what’s going to happen in terms of assigning fault and what–or whether–they’ll pay. Individuals have no recourse unless they have very deep pockets.
    These are hard times for individual people in general.

  19. Donna
    Reply

    I have found nurses in hospitals who are asked to wash their hands when entering a room have later ignored the patient. This happened on three instances when staying with my daughters in two different hospitals.

  20. JM
    Reply

    Interesting, but the actual article quotes the lead author of the study as saying “studies have demonstrated the clothing of healthcare personnel may have a role in transmission of pathogens, the role of clothing in passing infectious pathogens to patients has not yet been well established”, so the recommendations are actually very tentative.
    So based on that I wouldn’t be too concerned about the practices of my physicians, who do seem to make a strong effort to sanitize equipment and promote sanitation in general.
    In the broader discussion I tend to fall on the side of allowing more exposure outside of areas with special needs, like hospitals. I have however started using my own pen during flu season, rather than pens in general use at banks, restaurants, clinics and other public places for signing your bills. I’ve seen some discussion of sanitizing public keyboards in places like libraries, but it seems to me these public pens get far more multiple use.

  21. cmw
    Reply

    I fully agree with “cal.” It is my belief that patients will not or may not be able to ask doctors to wash their hands, remove their white coats, or clean their stethoscopes. The responsibility is within the medical community to protect patients as best it can, particularly inside a medical facility. Disposable gowns, even if the same gown is used for the same patient for a few wearings, seems to be a great starting place to alleviate this very valid concern.

  22. cal
    Reply

    I don’t think bare below the elbows will stop cross-contamination from neckties or clothes. Why can’t medical personnel put on throw-away gowns before having contact with a patient. They could even use the same gown for the same patient through several wearings?

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