Living a Clean Life in a Dirty World

I’m at Day +150 since my transplant and all is going extremely well. I’m back to work (part time), exercising quite a bit, and having no problems *knock on wood* with general health or graft versus host disease. I’ve been making a mighty attempt to follow the stringent diet and hygiene rules my caregiver and I were taught before I was released from the hospital. For people following along behind me in the transplant process, I thought I’d pass along some tips (and failures) from Kevin’s Big Adventure In Staying Germ-Free In A Very Dirty World.

Warning: If you’re a germophobe, you’d better skip this column unless you are a transplant patient. Most of the precautions I describe really aren’t necessary for Joe or Jane Typical. Our immune systems, generally, are pretty robust and day to day contact with germs is part of living on Earth. Transplant patients’ immune systems are a lot closer to newborn babies than adults.

I’d like to pass along some tips on touching things like floors, doors and public restrooms. This might get a bit tedious, but keeping an immune suppressed person from getting an infection requires attention to detail.

In public restrooms, I use a piece of toilet paper to lower the seat, if need be. When it’s time to flush, ditto. If I’m using a urinal and forgot to grab a paper towel on the way in, I use my elbow. You’re probably thinking, "Hey, wait a minute. You are going to wash your hands, right? Why worry about what germs are on them before you do?"

Well, what are the odds you might touch your hand to your clothing before going to the sink? 100 percent. I don’t know how long germs live on fabric, but we’re in the maximize-your-chances business here.

I also make sure to have a paper towel handy (often tucked under my arm) before I turn on the faucet. Wash, soap, wash, rinse, then use the paper towel to turn off the faucet. We definitely have a design issue with modern plumbing, since you grab the knob with your dirty hand, then your clean wet hand, making a nice dirt soup on the knob. If I forget the towel, I'll go get one and wash again.

Next, it’s back to the paper towel holder, where I use another part of the same paper towel to pull down the knob for more paper. Yes, I could use the part that’s wet from the knob, but hey, let’s stop the spread of dirtiness where we can! After drying my hands, I do like a lot of people do, and use the paper towel to open the door on the way out. I’m amazed at the number of people who do this, considering they just handled the faucet and paper towel holder with their bare hands.

Another thing that’s always in mind, since you can’t carry paper towels with you all day, (well you could, or you could wear gloves, but you have to draw the line of reasonableness somewhere), is thinking about where you grab something. For those “U” shaped door handles, I always grab at the very top or very bottom, where the handle meets the door. Everyone else grabs the middle, as intended. I work on the assumption that nobody is weird enough to grab the least convenient part. For doors with the "crash bar" opening system, I use my hip. For push type doors, I either use elbow or reach up, above head high, to push it open.

I’m a big believer in using the stairs as part of my post transplant exercise regime, and in always using handrails. Depending on the design, I’ll hang my arm over the rail, ready to grab it as I go down, but touching it as little as safely possible. If I have to hold it, (hurting yourself falling down is way more likely than getting an infection off a handrail) then at the bottom, I’m breaking out the hand sanitizer. Ditto if I went through a door with a regular knob. I always, always, have a little travel sized bottle in my pants pocket.

I’ve made it a pretty well-known saying at work, “no hugs, no handshakes” but sometimes life gets away from me. So, when handshakes do happen, it’s back to the sanitizer after a discrete time. I feel like a magician sometimes, distracting with eye contact and conversation while sneaking a squirt onto my hand.

The last thing I want to mention is picking things up off the floor. Yeah, guess what? Floors are dirty. Even when they’re clean. Around the house, anytime I pick up anything off the floor, any time I push open the trash can lid, or handle something "suspicious," it’s hand-washing time. We keep rolls of paper towels at every sink, since using hand towels are a no-no (Remember my comment about germs and fabric? Again, I haven’t read any studies, but a damp towel with germs just has to be a place I don’t need to be going).

Speaking of towels, they taught us to use a fresh towel with every bath. For most folks, using your own towel a few days in a row is fine. For KBAISGFIAVDW (hint: see the first paragraph!), seven towels per week is the new normal.

Next post, we’ll explore the Wonderful World Of Eating In Restaurants When Immune Suppressed And Other Interesting Food Rules. I’m not going to go acronym on this one, I promise!

Besides the other wonderful blogs on Cure Today’s site, I hope you'll visit my Taking Vienna site. I also recommend a T.J. and Jen Sharpe’s blog, Patient #1. For cancer patients and caregivers, and melanoma patients in particular, it’s a great resource. I also encourage readers to visit the Be The Match site to learn about registering as a potential stem cell donor.