Dirty Hands Can be Scary! is a hand-hygiene campaign designed by the St. Louis County Department of Public Health, in conjunction with the City of St. Louis Health Department to promote and educate on the importance of hand-washing, and to prevent the spread of disease. It was developed primarily to show how something as simple as washing your hands for 20 seconds, can help prevent respiratory illnesses, diarrheal illnesses, foodborne illnesses and travel-related illnesses.

“Handwashing can reduce the risk of respiratory infections by 16%.”1

Respiratory infection is a leading cause of seeking medical care, and occurs in up to 20% of all travelers.2 Practicing proper hand-hygiene and general cleanliness has been listed as a top preventative measure.

“Viral pathogens are the most common cause of respiratory infection in travelers; causative agents include rhinovirus, respiratory syncytial virus, influenza virus, parainfluenza virus, human metapneumovirus, measles, mumps, adenovirus, and coronavirus.”2

CDC’s Top 14 Vaccine-Preventable Diseases for Infants and Children

While diarrheal illnesses may not sound like a serious problem, the statistics show quite the opposite, and the mode of transmission for these illnesses should be disturbing enough to make everyone want to wash their hands before every meal.

“Diarrhea kills 2,195 children every day—more than AIDS, malaria, and measles combined.”1

Most diarrheal illnesses and deaths are preventable by simple interventions, such as washing your hands. Roughly 88% of deaths associated with diarrheal illnesses are a result of inadequate sanitation, insufficient hygiene, and unsafe water.1

“Most diarrheal germs are spread from the stool of one person to the mouth of another. These germs are usually spread through contaminated water, food, or objects.”1

A good majority of diarrheal germs are spread from lack of hand-washing after using the bathroom. It is especially important for those preparing food to wash their hands before cooking.1

“A single gram of human feces—which is about the weight of a paper clip—can contain one trillion germs.”1

Check the CDC’s webpage on diarrheal illness for additional information.

It is important to remember that all raw foods have the potential to be contaminated and can carry intestinal pathogens. This includes undercooked meat, fish, and shellfish. A common mode of transmission for foodborne illness is through lack of sanitation and proper hand hygiene2. For example, this can occur after preparing raw meat, such as chicken, and then continuing to prepare other foods, such as salads, fruits and vegetables, or deserts without washing your hands.

“A large percentage of foodborne disease outbreaks are spread by contaminated hands. Appropriate hand washing practices can reduce the risk of foodborne illness and other infections.”1

Top 5 pathogens resulting in hospitalization from foodborne illness include: Salmonella, Norovirus, Campylobacter, Toxoplasma gondii, and E.coli (STEC) O157.

“CDC estimates that each year roughly 1 in 6 Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases.”1

Top 5 pathogens resulting in death from foodborne illness include: Salmonella, Toxoplasma gondii, Listeria monocytogenes, Norovirus, and Campylobacter.

Check the CDC’s webpage on foodborne illness for more information.

Travelling, whether it be domestic or international, can have serious consequences if a person is not careful. It is important to research your destination and make sure you are taking the proper precautions in preventing potential infection of any disease in that area. This is especially important if you are travelling to, or within areas that may not have the same access to health care, such as underdeveloped countries, or even travel by cruise ships.

Recently occurring illnesses in travelers caused by the Norovirus had been primarily responsible for acute gastroenteritis throughout the United States. The virus had caused 19-21 million illnesses, 56,000-71,000 hospitalizations, and 570-800 deaths each year, according to the CDC, and can be serious in young children and older adult.1

“Reported outbreaks are usually associated with common exposure in hotels and cruise ships or among tour groups. A few pathogens have been associated with outbreaks in travelers, including influenza virusL. pneumophila, and Histoplasma capsulatum.”2

CDC’s Advice for Travelers, Updates, and Travel Health Notices


A majority of the most dangerous infectious diseases can be reduced, and even prevented by simply washing your hands. Respiratory illnesses alone, can cause epidemics. In 2003, SARS (Severe Acute Respiratory Syndrome) presented itself in Asia, affecting roughly 8,000 people, and killing around 780.3,1 In the spring of 2009, the first cases of Swine Flu (H1N1) were reported, eventually leading to a pandemic threat, which caused global panic, and an estimated 60.8 million cases, and 12,469 deaths between 2009 and 2010.3,1

“Researchers in London estimate that if everyone routinely washed their hands, a million deaths a year could be prevented.”1

The CDC recommends washing with soap and clean, running water to significantly reduce the amount of germs on a person, as well as preventing the spread of germs from one person to another. If soap and water are not available, alcohol-based hand-sanitizers can be used as an alternative method, but shouldn’t be solely relied upon to remove all germs or chemicals.1


The length of time recommended to effectively hand wash, is 20 seconds. The WHO has produced an effective technique to ensure all areas of the hand are adequately washed during this time, and no areas are missed. Commonly missed portions of the hands consist of the thumbs, fingernails, and tops of the hands. To avoid recontamination, consider using a paper towel to turn off the faucet after washing.

Wet hands with water.

Apply enough soap to cover all hand surfaces.

Rub hands palm to palm.

Rub right palm over left dorsum with interlaced fingers and vice versa.

Rub palm to palm with fingers interlaced.

Rub backs of fingers to opposing palms with fingers interlocked.

Continue with rotational rubbing of left thumb clasped in right palm and vice versa.

Continue rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa.

Rinse hands with water.

Dry hands thoroughly with a single use towel.

Use towel to turn off faucet.

Now your hands are clean and safe.


  • Before, during, and after preparing food
  • Before eating food
  • Before and after caring for someone who is sick
  • Before and after treating a cut or wound
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After touching garbage

Check the CDC’s webpage on hand-washing for additional information.


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