Shopping centers that teem with people also teem with germs. But alcohol-based hand sanitizers and good hand washing can defeat most common microbes.
"My wife won't go anywhere without hand sanitizer in her purse. I put some into my jacket pocket. You just use those frequently when you're out and about," said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn.
He said he doesn't obsess about germs, he's just "attentive to them."
Before hitting the mall, it pays to plan how you'll deal with germy hot spots:
Hand sanitizers and hand washing cannot protect you from what's floating in the air, Schaffner said. "The great hazard is being that close to so many people and being in everyone's breathing space."
"It's not too late, by any means, to get your influenza vaccine," he said. "If you're out and about, all those pharmacies are open and they would welcome your coming in and giving you your influenza vaccine.
"We live in a world that's not sterile, but what we'd like to do is be hygienic, so let's try to avoid the obvious coughers and sneezers in the crowd. Go to another counter until they've passed," Schaffner added. "If you are coughing and sneezing, put off your shopping a bit, which would be the kindest thing from a public health point of view."
If you must sneeze or cough, do so in the crook of your elbow, a technique publicized during the 2009 swine flu pandemic and mastered by lots of schoolchildren, said Dr. Jeffrey Boscamp, a pediatric infectious diseases specialist at Hackensack University Medical Center in New Jersey. You may not be doing your fellow men and women any favors if you cough into your hand because "the next thing you know, you're shaking hands."
Public restrooms can be a germ-laden nightmare, but they're also where you can wash away unwelcome microbes. Although soap dispensers and faucet handles "can be a little nasty," after being touched by people who have just done their business in the stalls, you can wash your hands thoroughly, then grab a paper towel and quickly turn off the faucet with the towel, Schaffner said.
Boscamp pointed out a bigger bathroom risk from germ-laden door handles. Even if you wash your hands, you're "at the mercy of people who don't wash theirs," he said. "Sometimes I've been crazy enough to keep my paper towel in my hand."
Food Court Tables
Think about how many people have touched the tables, napkin dispensers and chair backs at a mall food court or restaurant, and you have another reason to wash your own hands or use a hand sanitizer. Just as kitchen sponges offer a warm, moist environment that lets food bacteria to multiply, the rags used to wipe down dirty tabletops are "a decent medium for bacteria to dwell in," Boscamp said.
Most people grip the handrails when riding escalators inside malls and stores, leaving behind normal skin bacteria plus other germs picked up from rubbing their noses or mouths. Schaffner said he's not too worried about this particular hazard.
"If you use your hand sanitizer periodically during your afternoon safari at the mall, I think you'll be pretty well-protected," he said.
Boscamp thinks of escalator handrails the way he thinks about the metal bars subway riders hang onto.
"It's probably a good idea after contact with things like that to be thinking about Purell," he said.
All those sniffling tots inside toy stores, along with the healthy ones who just like to put everything in their mouths, can leave invisible coatings of germs behind -- not to mention what they spew into the air when they sneeze or cough.
"The number of hygienic children in the United States I can count on the fingers of my hands," Schaffner said. "I have to admit, children are the great disseminators of respiratory viruses. They do so because, first of all, when a virus infects a child, the child actually breathes out a lot of virus, more so than adults. They do so for a longer period of time."
Although most toys remain in the boxes and packages in stores, any that are unwrapped and available for children to touch, lick or rub against their runny noses could become infection-spreaders, Boscamp said. That's why his medical center and others request that any holiday donations of toys for sick hospital patients be in original, sealed packaging.
"We don't take chances," he said.
The slick surfaces of smart phones and tablet computers can harbor a variety of germs, including staph, capable of living several hours. However, just because environmental hygienists can swab such surfaces and find a variety of bacteria doesn't mean they necessarily will make you sick, said Schaffner.
"Try out your candidate iPhone, look at it, play with it, and then do your hand sanitizer thing," he said.
Some Surfaces Not to Worry About
Although women frequently hear they should avoid shared testers at makeup counters, "infections associated with shared makeup are virtually nonexistent," Schaffner said. "They are not a recognized public health problem."
Worries about picking up germs from ATMs at the mall might be exaggerated, too, even if you've never see a bank employee wiping down ATM keys.
"If for some reason, you're a little queasy [about uncleaned keys], go to the ATM, get your cash and use your hand sanitizer," Schaffner said.
Schaffner made his comments just before heading off to the gym, where he relies on hand washing and hand sanitizer.
"I don't rub down machines," he said. "By protecting ourselves with our hand sanitizers, I don't think we have to go around sani-wiping the world."