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Germ Warfare

When my newborn came home from the hospital two years ago, I underwent a miraculous transformation from slapdash housekeeper to one-woman antigerm militia. At maternal gunpoint, visitors were marched from the door to a bar of soap. I washed clothes, boiled bottles, and swabbed counters as if practicing the rites of a new religion.

How long did my piety last? Flash-forward eight months: There I am strolling my son down a New York City sidewalk  -- home, you can be sure, to an astonishingly multicultural horde of pathogens  -- when he hurls his bottle to the ground. I pick it up to put it away, but when he wails plaintively, I hesitate only briefly before wiping the nipple on my shirt and handing the bottle back. As I glance around to make sure no fellow parent witnessed my crime, I suppress the fear that I may just have exposed my baby to the infamous flesh-eating bacterium or the first case of a new, incurable plague.

If you've always been a clean fiend, you may never arrive at such a conflicted moment. For most of us, however, the hectic pace of parenthood leaves little energy to keep up the rigorous hygiene we're led to believe will protect our kids from infectious harm. Forget the time. Who has the presence of mind to make sure the cloth that wipes the high chair tray never skimmed applesauce off the floor? To scour the tub between baths or swab the bar on the shopping cart before your toddler tastes it?

But as terrifying words like Campylobacter and cryptosporidiosis steal headlines from political scandals, many of us want to know just how aggressively we need to muster our at-home defenses. Where are the places we should concentrate our germ-fighting firepower? What are the best weapons, and is there such a thing as overkill?

Julia Glass, winner of two Nelson Algren Fiction Awards, writes about health issues for several national magazines.

First, Relax

The good news is that there's no need to panic. Bacteria, viruses, parasites, and fungi  -- the four basic types of microbial loiterers we call germs  -- abound everywhere, but most germs on most household surfaces will die in a matter of minutes unless nourished by moisture, according to Lynne Sehulster, Ph.D., a research microbiologist at the Centers for Disease Control and Prevention (CDC), in Atlanta. For that reason, countertops, furniture, tiled walls, wood floors, doorjambs  -- in short, most surfaces in your home  -- don't play a significant role in spreading infections. Probably the hardiest germs you're likely to tangle with at home are cold viruses, which may remain viable in the air for as long as a couple of hours. (One reason that colds are so common.)

In protecting our children from grave infections, the most important precaution we can take isn't at home, but in a doctor's office: proper and timely immunization against common childhood diseases.

This is not to say, however, that we can completely let down our guard.

Take the Good With the Bad

Every healthy human being shares body space with some 400 species of microorganisms, which camp out benignly everywhere from our intestines and reproductive tracts to our nostrils and skin. From the native, nontoxic Escherichia coli that are found in the intestine, to the staphylococcus species that live on the skin cells, these microbes are all cousins to the numerous "bad" bugs that cause pneumonia, meningitis, food poisoning, and other serious illnesses.

Because the womb is a sterile environment  -- the first and last we'll ever know  -- a baby is born without these minuscule cohabitants; full "colonization," a necessary part of building the immune system, takes about six months. That's why we should, for that period of time:

 

     

  • Wash bottles, nipples, and breast pump accessories in a dishwasher with water at least 180 degrees Fahrenheit, or hand wash and then sterilize by boiling in a covered pot for ten minutes, removing with tongs, and air-drying on a clean towel.

     

  • Bring water  -- whether you use tap or bottled  -- to a gentle boil (as opposed to a full boil) for five minutes when making formula with powdered mix.

"Once colonization is complete, the good bugs, just by virtue of their taking up space, make it harder for the bad ones to move in," says Vincent LaBombardi, Ph.D., chief of microbiology at Saint Vincents Hospital, in New York City.

"Parents should also realize that there are certain infections, many of them asymptomatic, that young children are going to get  -- have to get  -- and that you shouldn't worry about," adds LaBombardi. "CMV, for instance, is a symptomless herpes virus that most kids get by age two." These invasions, too, are a normal part of maturing immunity.

Know Thine Enemy

But what about all the germs we don't need  -- the not-so-friendly pathogens just waiting to call us home; especially, you might wonder, those deadly molds, flesh-eating bacteria, and degenerative bovine-borne ills that seem to be cropping up everywhere?

With the exception of the toxic strain of E. coli that has infected the food supply, the prominence of all these seemingly new killers is a distortion created by our hunger for news of the lurid. "Most of the diseases people panic about are very rare or very difficult to acquire," says the CDC's Lynne Sehulster.

What ills should concern us? "The illnesses pediatricians deal with most often are gastrointestinal and respiratory diseases  -- and there are precautions you can take to discourage the spread of both," says Jan Edwin Drutz, M.D., associate professor of pediatrics at Baylor College of Medicine, in Houston.

GASTROINTESTINAL DISEASE

Some ailments that bring on diarrhea and vomiting are bacterial. They are also the most preventable, since many of the bugs that cause them get into our bodies when we eat food that's been mishandled or inadequately cooked (often by us). For toddlers  -- especially those in daycare and preschool  -- bugs that wreak havoc on the digestive tract are also readily spread when people who change diapers or assist in toilet training fail to follow a few simple precautions: mainly, washing their own hands (and the child's) immediately afterward. Because dehydration from diarrhea and vomiting will debilitate a small child much faster than it will an adult, these bugs are also among the most dangerous for infants and toddlers.

Such germs, however, are readily vanquished once you take a hard look at the ways  -- and the places  -- they operate.

RESPIRATORY ILLNESS

In its high season, influenza is very common, though less so than wily cold viruses (of which there are hundreds). These germs infect us by entering our respiratory system and, of course, can be "caught" when we breathe the air into which someone has sneezed or coughed. Yet sharing airspace with a cold sufferer is not the most likely way you're going to inhale that bug.

"A study was done among college students with colds to find out which was the likeliest means of transmission: talking, kissing, or shaking hands," says LaBombardi. "The answer? Shaking hands." We constantly touch our nose, mouth, and eyes; if we have a cold, we pick up infectious secretions and spread them onto everything  -- and everyone  -- we touch.

"If I have one piece of advice, it's: Wash your hands!" says Dr. Drutz. "And get your kids to do the same." Blood-borne diseases (like hepatitis B) and vector-borne diseases (like Lyme disease) may be exceptions, but many common germs will be stopped dead by washing thoroughly  -- with plain old soap and water  -- and often.

Get Them Where They Live

Focus your most zealous energy on three regions of your household: your kitchen; anywhere diapers get changed; and your pets and their favorite hangouts. Elsewhere, your normal, nonphobic cleaning routines are probably just fine.

THE KITCHEN

"Wherever we eat or prepare food is where we're most vulnerable," says Sehulster. So this room is the one place, if anywhere, you should bring in the clean marines. Begin by heeding these tips:

 

     

  • Handle and cook all poultry, meat, and eggs  -- even shells  -- as if contaminated (most poultry and eggs contain salmonella, but that doesn't make them inedible).

     

  • Maintain a separate cutting board for raw meat only; scrub all boards with soap and water between uses.

     

  • Thoroughly rinse all produce, regardless of cleanliness claims on packaging.

     

  • When feeding infants and toddlers, try to stick with foods you can cook or peel.

     

  • If you have to answer the phone or attend to a child while preparing food, wash your hands first unless it's an emergency.

     

  • Use paper towels to clean counters or dry washed hands after food preparation, as well as to clean a high chair and tray. (Bacteria absorbed by a wet cloth or sponge may thrive there, to be spread onto the next surface wiped.)

     

  • Never wash an infant in your kitchen sink; you're risking not only fecal contamination of food and dishes but contact of the baby's sensitive skin with residues of harsh cleaning products.

     

THE CHANGING TABLE

In a daycare center or preschool, where numerous children are cared for, this is a prime hot spot for infections to spread, so hygiene must be militant. In your home, however, following a handful of precautions with each change will suffice:

 

     

  • Lay out fresh diapers and changes of clothing beforehand, to minimize touching furniture while hands are dirty.

     

  • Put fresh paper toweling or a clean cloth under the baby, to protect the changing-table pad from germs.

     

  • Don't put anything in your mouth (e.g., diaper pins) before washing your hands.

     

  • Dispose of diapers in a tightly sealed pail with a child-proof lid.

     

  • Immediately afterward, wash your hands  -- and the child's if he's touched his genitals, bottom, or the soiled diaper. (Wiping your hands with a premoistened towelette is not a substitute for soap and water.)

But don't go crazy disinfecting the area, says Sehulster, because germs are unlikely to survive long enough to infect the next diaper changer who comes along. So for the wipes box, diaper pail, and knobs on your child's dresser drawers, occasional routine wiping  -- and cleanup of visible soiling whenever you see it  -- is adequate.

What about the bathroom? During hit-or-miss potty training, you'll need to keep all surfaces near the toilet extra-spotless, but otherwise, a decent cleaning once or twice a week should do, says Dr. Drutz; it's highly unlikely anyone will catch an infectious disease from your toilet seat or bathtub. Hang towels and washcloths out to minimize drying time, he adds, since bacteria and fungi (such as athlete's foot) thrive in a warm moist environment, like your often-steamy bathroom. Launder after every two or three uses.

FAMILY PETS

To avoid catching anything from a pet:

 

     

  • Schedule yearly checkups with your veterinarian; be sure pets are vaccinated and kept on a flea, tick, and worm control program (especially where Lyme disease and Rocky Mountain spotted fever are prevalent).

     

  • Clean litter boxes and cages often, and keep them out of toddlers' reach.

     

  • Never keep a caged pet in the kitchen.

     

  • Never let children play with a pet while eating.

     

  • Instruct children never to let an animal lick wounds or skin abrasions.

     

  • Forbid sharing of toys between pets and babies.

A special note on reptiles: Like chickens, snakes, lizards, turtles, and tortoises often carry salmonella, so they're not appropriate pets for small children and shouldn't be kept in daycare centers or preschools. With older children, enforce thorough hand washing after every handling.

Don't Overdo It

Moderation is important, even in germ warfare. When it comes to sanitizing our environment (and our bodies), too much of a good thing can be counterproductive. "People go overboard when they forget that the substances we use to combat germs can be toxic themselves," says Sehulster. "Microbes are tiny pests, so every chemical we apply to get rid of them is essentially a pesticide."

Especially around small children, she says, it's unwise to use bleach and other harsh chemicals too freely or to scour every doorknob, light switch, and towel bar daily. Remember: Infectious germs don't spread widely via household surfaces.

For sinks, bathtub, and shower, an occasional wash with a diluted bleach solution (followed by a thorough rinse) is a good disinfectant measure, but on most surfaces that a small child frequently touches  -- rails on crib or changing table, the floor near a toy box  -- mild soaps will do the job without leaving potentially toxic residues. Another form of overkill, say microbiologists, are antibacterial soaps and coatings on everything from countertops to toys. "There are no data to show these will make us healthier," says Sehulster.

Nor should antibacterial coatings on toys, knives, and other objects inspire great confidence, says LaBombardi: "There's not a lot of the chemical there in the first place, so who knows how long it lasts? And if the blade of a knife is coated, what about the handle? That's just as much a source of contamination." Such products may even create a false sense of security: Sharing an "antibacterial" bulldozer with a sneezy playmate, for instance, won't protect your child from his cold (a virus, not a bacterium).

Save Yourself Too

Don't forget about your own health. Especially once they start daycare or preschool, kids are the family members most likely to bring germs home.

So is it time to move into a shrink-wrapped glass bubble, forswear fresh fruit, wear surgical gloves when we venture out into the world? Hardly, say those who battle germs for a living. "From the news, you might get the impression that there are more diseases out there than when we were kids," says Dr. Drutz. "That's a misperception. It's just that we're more aware of them than we once were."

I take perverse consolation in listing to myself some of the things I've seen my son lick, taste, or chew over the past year: the soles of his shoes, the soles of my shoes, the wheels on his stroller, a slimy dog bowl, his fingers after smearing them on the hubcaps of several cars, the chrome flushometer at the back of our toilet (he loves touching tongues with his reflection). In that time, he's had one bad cold, a viral rash, and a handful of sniffles. Call it Russian roulette, but I like to think part of the time-honored business of childhood is getting down and dirty  -- mostly, no matter what we do, when parents aren't looking.

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