By Dov Michaeli

If you are of the squeamish persuasion –stop right now! This post has to do with what my granddaughters would call ICKY.

A paper published in PLoS ONE (Nov27, 2011) by a team of scientists from the University of Colorado, Boulder, reports on something we all ought to know but were afraid to ask. They swabbed surfaces in a dozen public restrooms on the University of Colorado campus in Boulder. They came up with 19 different bacterial phyla, or types. That’s interesting, but less than useful. After all, if all the bacteria were found on the floor –that’s hardly news. But the investigators went a step further and mapped the “biogeography” of the restrooms. The surfaces sampled included door handles (into and out of the restroom), stall handles (inside and out), toilet seats, flush handles, faucets, soap dispensers and the floor
around the sink. Are you still here?

Turns out, there is some order to the seeming randomness of bacterial localization in the restroom. The bacteria clustered in three different communities: those on the toilet surfaces (“I must have gotten, fill in your favorite STD, from the toilet seat” –not!), the floor (nothing unusual about that), and those on door handles and hand-washing devices.

Last warning: the following can cause nausea, vomiting, or just plain disgust.

The bacteria around the toilet were types that live in the human gut, “suggesting fecal contamination of these surfaces…either via direct contact (with feces or unclean hands), or indirectly as a toilet is flushed and water splashes or is aerosolized.” So said the scientists. I have nothing to say that would ameliorate your reaction.

The flora on the floors consisted of soil bacteria, most likely tracked in by shoe soles. But surprisingly (or not) the flush handles contained soil bacteria as well. The source is likely people who use their feet to flush, in order to avoid touching the handles.

The most discouraging finding: door handles were contaminated, mostly by bacteria that colonize the skin: staph and strep. So you’d think you conscientiously washed your hands and your home free –not so fast: bacteria are everywhere, they are literally impossible to avoid.

The Howard Hughes Syndrome.

Has  anybody who hasn’t lived under a rock for the past 30 years not hear of the reclusive aviator, industrialist, and movie producer’s extreme obsession with germs and infections? He was probably more famous than the Kardashian sisters are today. The APA (the American Psychological Association) commissioned Prof. Fowler of the University of Alabama, and former president of the Psychological Association, to conduct a “psychological autopsy” on Hughes. Here are some excerpts:

“To complete the autopsy, Fowler interviewed Hughes’s former staff and evaluated newspaper reports, court depositions, old letters Hughes’s mother wrote about him and other documents ranging from transcripts of Hughes’s phone calls to his pilot logs.

[A picture gradually emerged of a young child who pretty much was isolated and had no friends, and a man who increasingly became concerned about his own health,” Fowler says.

That research led Fowler to believe that Hughes’s fear for his health most likely emerged from his childhood. Hughes’s mother was constantly worried about her son’s exposure to germs, terrified that he would catch polio, a major health threat at the time. His mother checked him every day for diseases and was cautious about what he ate.

In adolescence, Hughes was paralyzed for several months and unable to walk. After a few months, the symptoms disappeared. Fowler believes Hughes’s paralysis–for which no physical basis was found–was psychologically based and an early manifestation of his lifelong pattern of withdrawing in times of stress.

Hughes’s fear of germs grew throughout his life, and he concurrently developed obsessive compulsive symptoms around efforts to protect himself from germs, Fowler notes. For example, he wrote a staff manual on how to open a can of peaches–including directions for removing the label,
scrubbing the can down until it was bare metal, washing it again and pouring the contents into a bowl without touching the can to the bowl.

Ironically, Hughes ended up neglecting his own hygiene later in his life, rarely bathing or brushing his teeth. He even forced his compulsions on those around him, ordering staff to wash their hands multiple times and layer their hands with paper towels when serving his food].

“He didn’t believe germs could come from him, just from the outside,” Fowler explains. “He was convinced that he was going to be contaminated from the outside.”

Was he right, after all?

The answer is a resounding no! Not only was his obsession with germs pathological, it was misplaced. Germs are part of the environment, we can’t avoid them as much as we can’t avoid the air we breathe, nor should we.

Accumulating evidence shows that the growing incidence of childhood asthma is correlated with cleaner environment. The immune response learns to recognize invaders at a young age, and deprivation of exposure to those germs results in a dysfunctional immune response to them. The realization that exposure to infectious organisms at a young age was “good for you” led mothers to expose their children to patients with chickenpox. And let’s not forget the observation that children growing up on the farm, exposed to all manner of infectious organisms, were significantly less susceptible to the polio virus than their urban counterparts.

That’s not to say that we should seek out dirty restrooms. Washing your hands with soap is a prudent measure of avoiding infections. How do we deal with the door handle? You can use a paper towel. But to me this is getting uncomfortably close to Howard Hughes.


Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.



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