Here we are once again in the peak of cold and flu season – in the middle of a pandemic – and every caregiver needs to take precautions to prevent the chain of infection from making its way through our homes, causing illness for us and our loved ones.

I still remember the exam in nursing school where we had to illustrate how germs invade our bodies. By germs, I refer to the infectious agents capable of causing disease or illness, such as bacteria, viruses, or parasites. The place where these agents live, grow, and reproduce are known as reservoirs and include people, pets, wild animals, food, soil and water. The germs escape through a portal of exit such as the mouth (vomit, saliva); cuts in the skin (blood); and during diapering and toileting stool (excretions). 

Germs then find a mode of transportation such as physical contact (hands, objects including cell phones); droplets (when you speak, sneeze or cough); and airborne transmission. They seek a portal of entry – mouth, cuts in the skin, eyes – of the next susceptible host. Risk is determined by factors such as age, overall physical condition, weak or strong immune system, and immunization status, but anyone can become a host to germs.

It is estimated that Americans spend nearly five billion dollars each year to combat illnesses caused by germs. Yes, they are nasty little creatures that lie in wait for us to put down our guard so they can enter our mortal portals. (I cannot believe I just wrote that; someone must have slipped me some caffeine.) Seriously…

Most of us have been told to wash our hands well and often; so often during the past two years that, surely, we always do. Right? It is the most important way to prevent germs from entering our body. Just in case hand washing is going by the wayside, here are a few specifics to remind and encourage you:

• When returning home from anywhere – even your backyard or neighbor’s home – wash you hands well. Warm water, soap, under nails, sing Happy Birthday to yourself as a timer, dry well.
• Wash your hands frequently while preparing food, especially before and after touching poultry, meat, seafood and raw eggs.
• Wash your hands before eating and when assisting someone else with food or drink.
• Wash your hands after going to the bathroom…and before and after assisting your recipient to the bathroom or providing incontinence care.
• Before providing any type of personal care for another (changing a bandage, assisting with bath, dressing, etc.) wash your hands, even if you don gloves. 
• When your loved one has an illness, be especially vigilant about hand washing.

Here are two other guidelines related to hand hygiene:

Keep nails short and trim them often. Glamourous nails may look appealing, but long and fake nails provide a welcoming reservoir for germs and may easily cause skin tears on the delicate, aged skin of recipients.

You should wear disposable gloves when you will be in contact with your recipient’s body fluids or waste. Wear a pair only once and dispose of them in a lined trash can. In nursing school, we were taught to take gloves off inside-out by pulling the top down over the fingers, rather than pulling off at the fingertips. Works well. Always – dare I say it – wash your hands after removing gloves.

Although proper hand washing is not the only step we can take to prevent spreading germs, it is the most important one. Here are some other suggestions for stopping germs in their tracks.

• Try to keep your hands way from any part of your face – scratching, picking, rubbing – unless it is necessary and do so only after washing your hands. Encourage your recipient and other family members to do likewise. If you have a tooth-picker or finger-licker in your house, this could be a challenge. It may help to show them the illustration of the germy hand.
• Frequent handwashing requires frequent hand drying. Wash hand-towels frequently or consider using disposable ones in the bathroom, especially for guests. Kitchen dishcloths and towels should be replaced with clean ones daily or when soiled as they can serve as a source of cross-contamination.
• Launder bath towels at least every few days. Wash-cloths should only be used once as bacteria is often left on the surface since they are used to scrub off dirt and germs.
• Clean often-used surfaces such as doorknobs, light switches, remote controls, phones, countertops, and tables daily, using an appropriate cleaner. Disinfectant wipes are convenient for this purpose.
• Give special attention to keeping your kitchen and bathroom(s) squeaky clean.
• Consider not allowing outdoor shoes to be worn inside your home. Provide a comfortable and supportive pair of inside-only shoes for family members. It really is okay to go a step further and request guest to remove their shoes at the door. I have done this for years (with a few exceptions). Why? Research shows that shoes pick up nasty germs (such as fecal coliforms and E. coli and other gut-dwelling bacteria) as well as other bacteria and viruses. Do you really want to bring everything you step on out there – think public restrooms – into your living area? Leaving shoes at the door also cuts down on dust, dirt, and allergens in your home. I once read a statistic that as much as 90% of dirt brought into the average home comes in on shoes. Another number worth pondering – 96% of shoes examined in one study were germier than a toilet seat.
• Speaking of toilets, don’t just lower the seat but also the lid. Research (do you ever wonder who does this research?) reveals that a “toilet plume” occurs when the toilet is flushed that contains microbes from whatever is in the toilet bowl. High concentrations of Shigella, Salmonella and norovirus have been identified. This plume may even play a role in the transmission of influenza. These pathogens can survive on surfaces for weeks or even months. The study concluded that it is a good thing to close the toilet seat before flushing to prevent airborne transmission. The closing statement read, “Especially if that toilet is anywhere close to your toothbrush.” Gotcha. And do not overlook the need to thoroughly disinfect the flush handle.

To prevent illness and stay healthy, we need to be aware of the chain of infection and do our best to stop providing transportation for those pesky germs!