How to care for someone without getting sick yourself.

By Leanna Skarnulis
WebMD Feature

Are you caring for someone who has a contagious infection? Good luck. Taking precautions to protect yourself at this point can be like closing the barn door after the horse got out.

People are often too late to guard against infection because they were probably exposed to the disease before symptoms appeared. For example, flu can be contagious about a day prior to the onset of symptoms, while strep throat can be contagious as much as five days prior to onset.

Children who are normally healthy are ill about five days each year. Their illnesses are likely to be flu, pink eye, gastroenteritis, and other contagious diseases, which readily spread to other members of the family.

Bacteria and viruses are the main culprits, and they're not easily contained. WebMD talked to three experts about what a caregiver should do to try to stay well.

What to Watch Out For

Controlling contagions and getting kids back to school as soon as they were well was the reason the role of school nurse was created more than 100 years ago. "School nurses have been behind vaccinations that have reduced or eliminated diseases such as smallpox, measles, mumps, rubella, diphtheria, tetanus, pertussis, and polio," says Wanda Miller, RN, MA, executive director of the National Association of School Nurses (NASN) in Castle Rock, Colo.

But contagious diseases often confound the best efforts to control them. While adults are urged to get vaccinated for flu, the vaccines aren't always 100% effective. And flu can lead to serious respiratory complications, such as pneumonia.

Now there's concern about a resurgence of whooping cough (pertussis). "Babies are routinely vaccinated, but new evidence shows that vaccine effectiveness wanes after five or 10 years," says Dee-Dee Vallez, RN, MS, NASN continuing education director. "We made a recommendation on adolescent pertussis vaccination in the spring, and the Food and Drug Administration's Advisory Committee for Immunization Practices is currently looking at adult vaccinations."

Basic Prevention Strategies

Prevention begins with basic hygiene:

Approach hand washing as a survival skill, which it is.
Never touch your mouth, nose, or eyes without washing your hands.
Teach your kids not to share, as in guzzling milk from the carton or double dipping chips.
Family members should cover their mouths with a tissue when they cough or sneeze, and dispose of the tissue themselves.
You should also avoid sharing personal items like toiletries, towels, and pillows.

It seems ironic to say that staying in good health is one of the best ways to keep from getting sick. But it's true, says Miller. "For example, about one-fourth of all kids test positive for strep without being sick themselves. If you're ill with something else and your resistance is down, you could get strep throat. Getting proper rest and good nutrition can help improve resistance."

Advice From a Germ Freak

Allison Janse, author of The Germ Freak's Guide to Outwitting Colds and Flu, shares tips with WebMD on staying well when a spouse or child comes home with a bug. "Be prepared. Stock up on supplies before you need them."

Your arsenal should include:

A thermometer for each child
Extra toothbrushes and personal tubes of toothpaste
Plenty of tissues, toilet paper, and paper towels
Throat lozenges and anything else that makes the sick person comfortable

As soon as someone in your house shows symptoms, keep your distance from their coughs, sneezes, and objects they touch. Janse, who is a freelance writer and trade book editor in South Florida, says:

Use paper towels instead of community towels in the bathroom and kitchen.
If your spouse is ill, sleep on the couch or in the guest room, and use a different bathroom.
If a sick child crawls in bed with you, sleep behind them to avoid their coughs or sneezes.
Avoid contact with counters, utensils, phones, and other objects the sick person has touched.

Hand Washing, Hand Washing, Hand Washing

The experts who talked to WebMD echo what you've heard before: Frequent hand washing is the single most effective way to prevent catching a communicable disease. Guidelines from the CDC recommend washing:

Before and after you prepare food
Before you eat
After you use the bathroom
After handling animals or animal waste
After coughing or sneezing
When your hands are dirty
More frequently if someone in your home is sick

SLIDESHOW

A Cold or The Flu? How to Tell the Difference See Slideshow

To wash properly:

Wet your hands and apply liquid or clean bar soap.
Place bar soap on a soap dish that allows it to drain.
Rub your hands together vigorously, scrubbing all surfaces for 15 to 20 seconds. That's about how long it takes to hum "Happy Birthday" twice.
Rinse well and dry your hands. In a public restroom, use the air dryer or paper towels.
In the absence of soap and water, use alcohol-based disposable hand wipes or gel sanitizers.

The Antibacterial Soap Debate

Antibacterial soaps kill germs on contact while ordinary soap releases germs from the skin so they're washed down the drain or wiped off on towels. The jury is out on whether antibacterials, which now account for one-third of the soap market, are more effective against germs than soap and water. Manufacturers claim they are, but a recent CDC study of 224 households over a one-year period showed that antibacterial users were no healthier than soap users.

The jury is also out on whether overuse of antibacterials promotes development of super-germs resistant to antibiotics. The FDA will hold hearings to address both questions.

Every Day Is Wash Day

Containing illness is hard work. Janse advises washing towels, washcloths, pillows, and bedding daily. She also washes the stuffed animals that her 3-year-old twins clutch and cuddle.

What to Disinfect and How

Germs are sneaky. Not only are they invisible, but they can lurk on surfaces from a few hours for viruses up to three days for bacteria. And they laugh at our feeble attempts to wipe them out with a soapy rag. You have to think like a detective to figure out all the places they're hiding.

Take toothbrushes. In most homes, they sit in a common holder where they can flop onto one another. Janse disinfects them with hydrogen peroxide, then segregates the offender from other family members' toothbrushes as it air dries.

She advises using a commercial disinfectant on all of the following:

Phones
Remote controls
Microwaves and refrigerator handles
Door handles
Toilet seats and handles
Faucets
Light switches
Toys

The CDC likes old-fashioned chlorine bleach, which is effective against viruses. Add one-fourth of a cup of bleach to one gallon of warm water and allow the mixture to sit on the surface for 10 minutes before rinsing.

Whenever disinfecting surfaces, you should wear rubber gloves, ventilate the area, and, if you're sensitive to chemicals, wear a mask. Wash your hands after removing the rubber gloves.

A Short List of Contagious Diseases

Acute Bronchitis. Acute bronchitis is a lung infection usually caused by a virus and spreads when an infected person coughs, sneezes, or talks. Symptoms, which include a cough and mild fever, usually appear three to four days after an upper respiratory infection, such as a cold or flu. Acute bronchitis can lead to chronic bronchitis or pneumonia.

Health News

Chickenpox. If you didn't have chickenpox as a child and haven't been vaccinated, you could get it from caring for a sick child. The disease is most contagious from two to three days before symptoms appear and until the blisters have crusted over. It's spread through mucous membranes of the nose and mouth, sneezing and coughing, and sometimes through exposure to the fluid from the blisters themselves. An adult with chickenpox should see a health care professional.

Flu. The influenza virus often spreads when an infected person coughs or sneezes. Symptoms can include a runny nose, cough, fever, chills, and body aches. In adults, the disease is contagious about one day before symptoms appear and five days after. Flu can lead to bronchitis or pneumonia. The best prevention is a flu shot.

Pinkeye. Pinkeye is highly contagious, although usually not serious. The cause can be viral or bacterial. It's spread when you touch your eye after coming into contact with something that an infected person has touched. Besides redness, the disease can cause itching, burning, and drainage. Never touch your eye without washing your hands. Don't share eye makeup or towels.

Stomach flu (viral gastroenteritis). Cramps, diarrhea, and vomiting are the hallmarks of highly contagious gastroenteritis, which gains notoriety when it tears through cruise ships, conventions, etc. Symptoms appear one or two days after exposure to the virus, which is carried in the stool of an infected person. Failure to wash hands after using the bathroom and before handling food or touching surfaces spreads contamination. Several types of viruses are the culprits, and they tend to target certain age groups. Adults are most vulnerable to the Norwalk variety. Children are more commonly associated with rotavirus, but remember that anyone can catch it. So wash your hands.

Strep throat. Strep throat, a very common disease in children, is caused by airborne bacteria and is spread when an infected person breathes, coughs, or sneezes. Symptoms include inflammation and pain in the throat and tonsils. The disease can be contagious from three to five days prior to the appearance of symptoms. The contagious period lasts until 24 hours after a child starts an antibiotic.

Whooping cough (Pertussis). In spite of widespread vaccination against whooping cough, the highly contagious disease is coming back. The CDC reported 20,000 cases in 2004 compared with 1,000 cases in 1976. Adolescents who were vaccinated as babies account for 40% of the new cases. The greatest risk of complications is to unvaccinated babies. Caregivers should be aware that the disease can be difficult to recognize because the adolescent's cough isn't the high-pitched "whoop" that characterizes the disease in younger children. Coughing -- and contagion -- can persist for up to 10 weeks.

Published Oct. 24, 2005.

SOURCES: Allison Janse, co-author, The Germ Freak's Guide to Outwitting Colds and Flu. Wanda Miller, RN, MA, executive director, and Dee-Dee Vallez, RN, MS, continuing education director, National Association of School Nurses (NASN), Castle Rock, Colo. CDC, Morbidity and Mortality Weekly Report, March 21, 2005. WebMD Medical Reference from Healthwise: "Chickenpox (Varicella)." WebMD Medical Reference from Healthwise: "Influenza." WebMD Medical Reference from Healthwise: "Whooping Cough (Pertussis)." WebMD Medical Reference from Healthwise: "Pinkeye." WebMD Medical Reference from Healthwise: "Acute Bronchitis." WebMD Medical Reference from Healthwise: "Strep Throat." WebMD Public Information from the CDC: "Viral Gastroenteritis." CDC web site.