How to Avoid Germs on Airplanes
By Eric Milefchik, MD, Chairman of Infection Prevention Torrance Memorial
Air travel presents risk for infection due to the high occupant density
and the repeated use of airplanes. Seats and other surfaces accumulate
infectious agents. Airplanes are cleaned in between use, but cleaning
is limited by the turnaround time of the flights, with most airplanes
only getting a deep cleaning every several weeks.
Air filtration systems in most modern airliners are actually very good,
utilizing HEPA filtration which markedly limits circulating agents. This,
unfortunately, is not enough to protect passengers within 3-6 feet of
someone coughing who is infected with most viral respiratory pathogens
that spread by air droplets. These include influenza, parainfluenza, rhinoviruses
(common cold virus), respiratory syncytial virus (RSV), human metapneumonia
virus as well as the bacteria Group A Streptococcus (“strep throat”).
It is very important to remember that these agents spread as much as by
touching the droplets and then touching our faces, which we do often.
Here are some answers to popular questions about staying germ free during
What’s the germiest part on the airplane?
Bathrooms are by far where the most germs are found due to the number of
people using them and the increased contamination from enteric organisms
(bacteria found in stool) with the potential for exposure to organisms
causing gastrointestinal illness. These could include Clostridium difficile,
pathogenic E coli species, which are usually food borne (E coli O157,
Enteropathogenic E coli and others) and others.
Seats and seat fabric including the seat pockets where people place items
(like diapers and food) harbor bacteria that can stay for days including
Staphylococcus (this would include strains of Methicillin Resistant Staphylococcal
Aureus or MRSA which can cause spontaneous skin abscesses or other more
Pillows, tray tables and even touch screens will all have risk for bacterial
contamination given serial exposures from many passengers.
This knowledge is probably enough to make you want to cancel your vacation,
but there are ways to give your immune system a hand in not letting these
villainous germs get the better of you.
What are specific measures to avoid illness?
- Before flying, make sure you are well hydrated and well rested to assure
the healthiest immune system possible.
- Frequently wash your hands after touching surfaces, throughout the flight
and after using restrooms.
- An alcohol based hand de-sanitizer is helpful to avoid infections at times
when soap and water is not accessible. It is also best to avoid unnecessary
contact with any item on the plane, in the seat pocket or elsewhere.
- During the flight, try not to touch your face and avoid people who cough
by closely paying attention to who you’re sitting around, if possible.
Should I wipe down the seat?
This may offer some limited protection from lingering bacterial pathogens
which may cause some illnesses under certain situations, but does not
remove the higher risk of acquiring most respiratory pathogens by being
in the vicinity of people coughing or sneezing.
Bleach wipes probably offer the most protection but real disinfection requires
a surprisingly long and thorough exposure of the surface. Bleach generally
needs to soak for three to five minutes to disinfect a surface. Using
them on the armrest and tray table would offer limited protection from
what was left behind from previous passengers. The biggest threat is more
likely to be from someone coughing and aerosolizing droplets in that 3
to 6-foot range that are inhaled or subsequently touched by the hand that
then touches the face.
Should I wear a mask?
A mask will offer some protection from air droplet pathogens causing respiratory
illness but is not completely effective due to the potential for spread
from contact of the same droplets and touching the face. Ordinary surgical
masks are also inferior to N95 masks, which have a much tighter fit and
are uncomfortable to wear for long periods of time
Easier said than done, but If possible, it is more effective to convince
the coughing passenger to wear a mask, which offers better protection
for everyone within 3-6 feet. Wearing a mask ultimately comes down to
an individual decision about how far to go to be safe, knowing that there
are many other ways to acquire infection.
All this in mind, by all means, don’t be afraid to take that trip.
The positive benefits of R & R gained through your next vacation will
far outweigh your odds of catching a bug from the person in the seat next to you.