DC Medical Malpractice & Patient Safety Blog

When the media glommed onto a news release issued by the American Society for Microbiology last month, America responded with a collective “ewwww.”

The study tallied the location and number of germs in the average hotel room. Researchers from the University of Houston concluded that the items most heavily contaminated with bacteria were television remotes, and that bacteria were transmitted from room to room aboard housekeeping equipment.

The point of this effort was to improve general hotel hygiene by standardizing cleaning procedures industry-wide.

According to the news release, “The study was designed as the first step in applying the Hazard Analysis and Critical Control Points (HACCP) system to hotel room cleanliness. Originally developed by the National Aeronautics and Space Administration, HACCP is a systematic preventive approach that identifies potential physical, chemical and biological hazards and designs measurements to reduce these risks to safe levels.”

Wow. That’s lofty.

As might be expected, toilets and bathroom sinks were pretty germy, but researchers also found high levels of bacterial contamination on the TV remote and the bedside lamp switch. Some of highest levels of contamination were found on items in the housekeepers' carts, including sponges and mops, which offer handy transportation for bacteria. Surfaces with the lowest contamination included the headboard, curtain rods and the bathroom door handle.

Holy hotel, Batman, what’s a traveler to do?

Fuggedaboudit, suggested Andrew Bender, writing on Forbes.com. “The viral spread over the last few days of a study on bacteria in hotel rooms has left me a little queasy. Not from the germs, but from the hype.

“…Try examining the story under the microscope.”

Despite such search engine-grabbing headlines as “Hotel rooms often contaminated with fecal matter,” Bender claimed, there’s no story here. That’s because of the more than 4.8 million hotel rooms in the United States, the researchers examined exactly … 9. Three rooms in one hotel in each of Texas, Indiana and South Carolina.

“That’s 0.000187 percent of the hotel rooms in America,” Bender reported, “and results varied from room to room. It would be comparable to saying that the combined citizenry of Chicago, Dallas and San Jose (about 4.84 million) was all, say, fans of the Kardashians, based on asking three people living on one block in each city.”

Not quite, but his point is well taken. Hotel rooms actually might be little germ factories with the potential to make you sick. But we can’t tell from this study. (The researchers, by the way, did acknowledge the limited nature of their work.)

“I’m all for hygiene,” said Bender, “but I think the fear-mongering based on such a self-admittedly inconclusive study was kind of inexcusable.”

One study with a sample so small you can barely see it with the naked eye does not a scientific conclusion draw.

Still. A lot of people have trafficked through your hotel room, and who knows how many of them are sneezing into their hands, then clicking the remote to watch “Keeping Up with the Kardashians”? It couldn’t hurt to take a packet of sanitary wipes on your next trip…

Most people who find air travel unpleasant object to the long lines, intrusive security, price gouging and cramped quarters. Thanks to so many people jammed into such a small space, what they also should be concerned about is sharing their fellow travelers’ germs.

Conventional wisdom says that sitting an airplane with sick people puts you at risk. But there’s slim scientific pickings to quantify the risk or how to reduce it, so researchers from the Georgia Institute of Technology and Emory University have set out to define just how infectious diseases might be transmitted onboard commercial airliners.

Infectious diseases transmitted during commercial flights have been of concern particularly since 2002, when 20 people on an international flight were infected by a single SARS patient. Severe Acute Respiratory Syndrome is a viral pneumonia that can lead to respiratory failure. Symptoms include high fever, malaise, dry cough and shortness of breath.

Sponsored in part by Boeing and Delta Air Lines, the three-year study will document how passengers move around aircraft cabins, and inventory the microbes found in the air and on surfaces including tray tables and lavatory fixtures. Researchers hope to establish patterns that will enable airlines to implement procedures that improve the health and safety of crew and travelers.

The SARS episode, according to the information from Emory, demonstrated how air travel can promote the rapid spread of known diseases and emerging infections. On airplanes, bacteria (which respond to antibiotics) and viruses (which don’t) can be transmitted in three ways:

• inhaling small droplets coughed or sneezed by infected people that carry throughout cabin air;


• inhaling larger droplets within about 3 feet of their source; and


• transferring droplets from surfaces into the eyes or noses of susceptible individuals. This method accounts for as many as 8 in 10 disease transmissions, thanks to passengers touching contaminated surfaces, such as seat tray tables, lavatory door knobs or sink handles.

Although researchers have studied how microbes find their hosts, the airplane environment poses special challenges. In medical facilities, such as hospital emergency rooms, radio-frequency identification tags (RFID) are used to record how people interact. But that technology isn’t available at 30,000 feet because it might interfere with airline communications.

Instead, researchers will use sophisticated sampling equipment that collects information about the contents of cabin air. They’ll also swipe surfaces, and analyze the samples with polymerase chain reaction (PCR--a molecular biology technique that amplifies a single or a few copies of a piece of DNA or RNA to generate a large amount for more specific examination) and mass spectrometry (which identifies chemicals within a substance by their mass and charge, essentially by weighing molecules).

The processes can detect as many as 1,500 different microbes, including 300 different respiratory viruses and 1,200 different bacteria.

As described by Vicki Hertzberg, professor at Emory’s school of public health, the researchers “will be actively looking at who’s getting up and down, when they are doing it, and where they are going when they do."

They plan to begin collecting data in the autumn to coincide with what’s typically the start of the cold and flu season.

To reduce the chances of catching somebody’s else’s germs, take a few precautions whenever you fly:

• Carry sanitary wipes and use them on your tray table, arm rests and storage bin handles.


• Wash your hands. A lot. Wipe off the lavatory surfaces before touching them.


• Avoid touching your eyes, nose and mouth, and encourage your children to follow this practice.


• If you’re seated near a coughing or clearly ill person, ask to be reseated. If that’s not possible, consider using face masks that cover your nose and mouth; generally, they’re available at hardware and often drug stores. Yes, they look odd and may not be impervious to bugs that can make you sick. But isn’t a bit of precautionary goofiness worth it?

There’s ignorance, and then there’s dangerous, irresponsible, willful ignorance.

In a series of posts, the website HealthNewsReview exposed the bone-headed actions of Delta Airlines in showing an onboard video sponsored by an anti-science organization minimizing the importance of flu shots. The video “urges viewers to become informed about influenza and how to stay well during the flu season without resorting to the influenza vaccine.”

As you might imagine, the response has been vigorous, including an online petition to “tell Delta Airlines to stop putting their passengers’ health at risk.” The medical establishment weighed in formally in a letter to Delta CEO Richard Anderson from Dr. Robert W. Block, president of the American Academy of Pediatrics (AAP). He wrote:

“The American Academy of Pediatrics (AAP) objects to the paid advertisement/public service message from the National Vaccine Information Center (NVIC) being shown throughout the month of November on Delta’s in-flight programming….
While hand washing and covering sneezes are parts of a larger strategy to prevent the spread of influenza, influenza vaccine continues to be the best way to protect against the disease. It is especially important in enclosed settings where disease droplets can easily spread to passengers sitting in close quarters, especially infants and children and those with special health care needs.

The AAP and many other child health organizations have worked hard to protect children and their families from unfounded and unscientific misinformation regarding vaccine safety. The influenza vaccine is safe and effective.

By providing advertising space to an organization like the NVIC, which opposes the nation’s recommended childhood immunization schedule and promotes the unscientific practice of delaying or skipping vaccines altogether, you are putting the lives of children at risk, leaving them unprotected from vaccine-preventable diseases. Diseases like influenza can have serious consequences. From September 2010 to August 2011, 115 children died from influenza disease, most of whom were unvaccinated.”

Another physician, Val Jones, blogged about this dereliction of corporate responsibility as well, noting that the airline had ignored the righteous outcry and committed to running the video ads through November.

“Every year the influenza virus kills as many as 49,000 Americans and 500,000 individuals world-wide,” she writes. "… I don't understand why Delta, having been duly informed of their mistake, would continue to run ads from a group that misinforms Americans about vaccine-preventable illness. I wanted to believe that they would do the right thing….”

“Which means that I will NOT be flying Delta in the foreseeable future and I hope you won't either. When US physician organizations are flat out ignored by corporate executives, it leaves us with only one choice—to speak with our feet. Sadly, the bottom line may matter more to them than the health and safety of their passengers.”

If you wish to sign the online petition, link here. You may also Tweet your feelings to #DontFlyDelta hashtag.

If you've been on an airplane recently, and if your trip lasted for more than seven hours, you may remember that the flight attendants warned you at the beginning of the trip about the risk of getting deep vein thrombosis (DVT) and told you to do exercises with your calf muscles to keep this from happening.

DVT is the formation of a blood clot in a "deep vein," a vein that is deep inside the body (as opposed to veins that are close to the body's surface). Usually DVT occurs in a leg vein. If the clot embolizes--that is, if it starts traveling through the blood stream--there is the risk of it blocking arteries within other organs and severely damaging them. Often the lungs are affected, and when this happens the blood clot is called a pulmonary embolism. DVT is sometimes also called deep venous thrombosis.

Often people get DVT by sitting in one place for a long time, such as on plane rides, which is why flight attendants give you that warning. Sitting in one place for a long time can be bad for circulation, while exercise increases it and discourages formation of blood clots.

All of this has been common knowledge among medical professionals for some time. But a new study shows that the risk of DVT on long plane flights is greater than was previously confirmed: on long-haul airplane flights (7 hours or longer), the risk of DVT is roughly tripled. In the study, the mean age of the participants was 40, which makes the researchers suspect that the risk is actually greater in the general population. They do not recommend drugs to pre-empt DVT for most travelers, but say that such measures may be warranted in rare cases of extremely high-risk individuals. Ordinary passengers should take care to follow the crew's instructions for calf exercises, and also get up and walk around every so often.

For more information:

Medline: Deep Venous Thrombosis

National Heart, Lung and Blood Institute: Animation demonstrating deep vein thrombosis

Dvt.net: Protection and Treatment, with prevention guides, checklists and suggestions for in-flight fitness.