By Elizabeth Cohen
CNN Medical Correspondent

ATLANTA, Georgia (CNN) — This week while you’re traveling, if you happen to spot a man applying hand sanitizer as he gets off an escalator, there’s a good chance it’s Dr. Mark Gendreau, a senior staff physician at the Lahey Clinic in Burlington, Massachusetts.

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Travel season can be a germ fest. Make sure to keep your hands clean.

Gendreau studies germiness while traveling, and he knows just how infectious travel can be.

“The risk of contracting a contagious illness is heightened when we travel within any enclosed space, especially during the winter months, when most of the respiratory viruses thrive,” Gendreau said.

Studies show that germs can travel easily on an airplane, where people are packed together like sardines.

For example, a woman on a 1994 flight from Chicago to Honolulu transmitted drug-resistant tuberculosis to at least six of her fellow passengers, according to a New England Journal of Medicine study.

In 2003, 22 people came down with SARS, or severe acute respiratory syndrome, from a single fellow passenger who had SARS but didn’t have any symptoms, according to another New England journal study.

But the airplane isn’t the only place along your travel route where germs thrive. Here are five ways to avoid germs while traveling.

1. Sit toward the front of the airplane

“Pick a seat near the front, since ventilation systems on most commercial aircraft provide better air flow in the front of the aircraft,” Gendreau advised. If you can afford it, sit in first class, where people aren’t so squished together.

2. Don’t drink coffee or tea on an airplane

Monitoring by the Environmental Protection Agency shows that water in airplanes’ water tanks isn’t always clean — and coffee and tea are usually made from that water, not from bottled water, according to Victoria Day, a spokeswoman for the Air Transport Association.

The EPA advises anyone with a suppressed immune system or anyone who’s “concerned” about bacteria to refrain from drinking coffee or tea on an airplane.

“While boiling water for one minute will remove pathogens from drinking water, the water used to prepare coffee and tea aboard a plane is not generally brought to a sufficiently high temperature to guarantee that pathogens are killed,” according to the EPA’s Web site.

According to the EPA, out of 7,812 water samples taken from 2,316 aircraft, 2.8 percent were positive for coliform bacteria. Although that sounds like a small number, this means 222 samples contained coliform bacteria.

3. Sanitize your hands after leaving an airplane bathroom

A toilet on an airplane “is among the germiest that you will encounter almost anywhere,” said Charles Gerba, an environmental microbiologist at the University of Arizona who’s also known as “Dr. Germ.”

“You have 50 people per toilet, unless you are flying a discount airline; then it is 75,” Gerba said. “We always find E. coli on surfaces in airplane restrooms.”

You should wash your hands after using the restroom, but because the water itself might have harmful bacteria (see No. 2 above) and because the door handle on your way out has been touched by all those who went before you, Gendreau also advises sanitizing your hands when you return to your seat.

4. Wash or sanitize your hands after getting off an escalator

Gendreau says tests show that escalators in airports are full of germs.

To confirm these tests, here’s a fun activity while you wait for your flight this Thanksgiving: Look at your watch, and count how many people get on an escalator in a five-minute time period. Multiply that by 12, and you have how many people are on that escalator every hour.

High-volume handrails are why Gendreau sanitizes his hands as soon as he can after he exits an escalator.

5. Wash or sanitize your hands after using an ATM

Gendreau says ATMs, especially in busy places like airports, are full of germs. As with escalators, he sanitizes ASAP after using one.

Gendreau says that keeping healthy while traveling can be summed up in six words: “hand hygiene, hand hygiene, hand hygiene.”

Keeping your hands clean is crucial, he says, when you’re spending the day touching surfaces that have been touched by hundreds or thousands of people before you.

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Conquering the ‘ewww’ factor of the public potty

By Elizabeth Landau
CNN

ATLANTA, Georgia (CNN) — Most of us have them — the personal ritual to deal with the “ick” of a public bathroom: wiping the seat with toilet paper, using a paper seat cover or even rolling up several pieces of toilet paper to create a thicker barrier between the skin and … the unknown.

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Public bathrooms may be teeming with bacteria, but the toilet seat is probably safe for sitting.

But the toilet seat is actually the cleanest part of the bathroom, one expert says.

Charles Gerba, a microbiologist at the University of Arizona who has studied restrooms and other germ-infested environments for more than 20 years, says that because of the care people take when they’re about to sit, other parts of the bathroom are much more prone to delivering bacterial infections.

“One of the cleanest things in the bathrooms we find are the toilet seats,” Gerba said. “I’d put my fanny on it any time — unless it’s wet; then you’d want to wipe it first.”

The Internet has come through for people who just want a clean place to go. New tools like MizPee (nationwide) and Diaroogle (New York only) will point you to the nearest public restroom and display extensive comments about those facilities from users, even delivering the information to your mobile phone. (Warning: CNN makes no promises about the cleanliness of the language in these bathroom locators.)

MizPee launched a year ago for people in San Francisco, California, after co-founder Peter Olfe saw that the city’s public library bathroom was “so disgusting,” said Dhana Pawar, vice president and co-founder of Yojo Mobile, which created MizPee. “Unfortunately, [MizPee] was inspired by that trip.”

Fueled by demand, MizPee has expanded to more than 22 cities in America and six in Europe, and has had more than 300,000 unique visitors. Users rate toilets on a scale from one to five toilet paper rolls and nominate the best and worst toilets for the Flush of the Year award. The site also gives users information on deals at restaurants, shops and services nearby, in addition to toilet trivia called “looisms.”

Women tend to have higher standards for bathroom cleanliness than men, often rating any given unisex bathroom lower than men, Pawar said. In general, many more women than men use the site, but male bikers and older men, especially colitis patients, also come to MizPee.

Women are also particularly concerned about finding clean bathrooms with changing stations, Pawar said. “You’d be surprised how few there are.”

Pawar said she herself is “really paranoid” when it comes to the restroom.

“I’m one of those really anal people who have to have a clean bathroom,” she said.

For many people, public bathrooms generate feelings of anxiety, fear and disgust.

“Basically, everybody is fearful of public restrooms,” said Dr. Lisa Bernstein, assistant professor at Emory University School of Medicine, who admitted that her mother always told her that she should never make direct contact with a toilet seat.

Research indicates that fear of the commode itself may be misdirected.

Public bathrooms may contain several kinds of harmful bacteria, including E. coli, salmonella, coliform, rotavirus, cold virus and the potentially deadly form of staph known as MRSA, experts say. But people are more likely to pick up these nasty bugs through touching things in the bathroom with their hands, not their behinds.

“I don’t think anyone would voluntarily sit on a seat with urine, but, in reality, urine touching intact skin on the tush won’t do anything,” Bernstein said.

More concerning, however, is a child who steadies himself or herself on a toilet seat by holding onto it and then leaving without washing hands, she said. Those germs could lead to an infection once the child’s hands touch the nose, mouth or eyes.

And don’t forget that unwashed hands have handled everything from the door knob to the lock to the flusher. Again, if you touch one of these objects and then rub your eye, nose or mouth, you’re apt to transmit that bacteria.

But there is hope. Here are hygiene helpers:

Wash your hands

Yes, it’s basic. But, in general, washing your hands is the most effective action you can take to prevent bacterial infections from a public bathroom, experts say.

“You can remove all gastrointestinal and respiratory infection bacteria by washing hands,” said Judy Daly, clinical microbiologist at the University of Utah and spokesperson for the Clean Hands Campaign. “Seventeen seconds of a little bit of friction, water and soap will really mediate bacteria.”

The American Society for Microbiology, which sponsors the Clean Hands Campaign, found in a study last year that about 77 percent of men and women washed their hands in public restrooms, down 6 percent from 2005. The observational study also found that women washed their hands more than men.

“It’s such an easy intervention,” Daly said. “If you get it to be a habit for a 30-day period, it’s something you do automatically.”

Use automatic devices

Recent bathroom additions like automatic hands-free faucets and paper towel dispensers diminish contact between your hands and bathroom items that may bear bacteria, Bernstein said.

Don’t let your belongings touch the floor

Gerba’s research found that the highest concentration of germs in a public bathroom are on the floor, the outside of the sanitary napkin disposal and the sink and water taps.

When Gerba looked at women’s purses, he found that one-third of them had fecal bacteria on the bottom. Make sure you hang your shoulder bag on a hook. If none is available, some people swear by hanging the strap around their necks.

Use the first stall

The middle stall of a public restroom usually has the most bacteria because people use it the most. “I guess people like company,” Gerba said. The first stall will probably be cleaner.

Recognize the best and the worst

As a rule, the cleanest toilets are usually in hospitals, because they use disinfectants heavily, but the worst are in airports and airplanes, Gerba said. The small size of airplane bathrooms, including the sinks themselves, make it hard for people to wash their hands — in fact, Gerba’s study found a thin layer of E. coli in an airplane bathroom.

As for the airports themselves, “In the men’s room at Chicago O’Hare, I don’t think the toilet seat ever gets cold,” Gerba said.

Don’t hold back

It’s fine for a woman to hover over the toilet seat if she doesn’t want to sit down, but if she doesn’t empty her bladder completely, she’s at risk for a urinary infection, Bernstein said.

“You may be doing yourself more harm than good,” she said.

Along the same lines, you can develop urinary infections from “holding it in” too long just because you don’t want to use a particular facility. Better in a public stall than not at all.

Put it in perspective

Although the bathroom seems like a nasty place, the possible infections from the dreaded stall are no different from the ones you can get anywhere else in public.

“They’re the same bugs we transmit shaking hands,” Bernstein said. “People are more freaked out about restrooms, but the same thing applies anywhere in public.”

After all that research — he’s had the cops called on him while prowling around bathroom floors — Gerba has no problem with sitting down on public toilets. But Bernstein still uses one or two seat covers, “because of what my mother taught me,” she said.

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WebMD Talks Turkey With Light Leftover Recipes

Our ‘Recipe Doctor’ offers tips on how to use up the rest of that bird

By Elaine Magee, MPH, RD
WebMD Feature

Reviewed by Kathleen M. Zelman, MPH, RD, LD

One of the best parts about the Thanksgiving and Christmas holidays actually comes the day after — leftovers! What’s your favorite: the leftover stuffing, the mashed potatoes, or a slice of pumpkin pie?

In honor of the season, and the leftover turkey we all hope to have sitting in our refrigerator after the hordes of dinner guests have departed, Here are a few favorite leftover turkey tips and recipes.

10 Light & Tasty Ways to Enjoy Leftover Turkey

10) Make a turkey salad sandwich by mixing a little light mayonnaise with just as much fat-free sour cream and stir in diced turkey along with some chopped celery, a pinch of Dijon mustard, and a sprinkle of toasted pecans or walnuts. Serve on whole-grain bread or a whole-grain roll.

(Check out my Turkey and Cranberry Sandwich recipe below.)

9) Add diced turkey to whatever soup, stew, or chowder you enjoy. You can even buy low-fat canned soup (like chicken noodle, minestrone, etc.) and stir some diced turkey into the saucepan when you are heating it up.

8) Use shredded turkey in place of chicken in your favorite Mexican recipes, such as enchiladas, quesadillas, tamales, etc.

7) Add shredded turkey to your favorite pasta dish, such as light fettuccine Alfredo (see recipe below), lasagna, pesto and pasta, even chilled pasta salad.

6) Add shredded turkey to your favorite rice dish, such as a rice casserole, a saffron or savory rice dish, or even a cold rice salad.

5) Make an individual serving of stuffing casserole. Stir about 1/3 cup of shredded turkey meat (and 1/3 cup of some vegetables if desired) into a small microwave-safe bowl, along with about 1 cup of leftover stuffing. Top with a spoon of gravy or grated reduced-fat cheese, if desired. Cover and reheat mixture in the microwave about 2 minutes on HIGH.

(Or try out my Irish Shepherd’s Pie recipe below!)

4) Turkey chili will heat things up the day after Thanksgiving. Make your favorite light chili recipe but instead of adding in browned ground beef or beef chunks, stir in some diced or shredded turkey.

3) Enjoy a light turkey Caesar salad the next day. Mix up a quick Caesar salad using Romaine lettuce, tomato wedges, and fat-free or low-fat Caesar salad croutons (available in most supermarkets). Top the salad with plenty of shredded turkey and drizzle bottled light Caesar salad dressing over the top. If you can’t find light Caesar dressing in your market, make up your own by blending 1/2 cup of regular Caesar dressing with 1/2 cup of apple juice.

2) Don’t wait until lunch to enjoy your leftover turkey. Add some shredded turkey to your breakfast omelet or frittata. Turkey goes well with the fixings we normally add to our omelets and frittatas — green onions, avocado, vegetables, reduced-fat cheese, fat-free sour cream, etc.

1) Transform leftover turkey into an elegant turkey divan by topping a turkey and broccoli casserole with melted reduced-fat cheese and a light crumb topping.

Turkey and Cranberry Sandwich

I know you are all going to want to make turkey sandwiches the day after Thanksgiving. To give you yet another sandwich to enjoy, other than the standard turkey sandwich, here’s a sandwich that uses the leftover cranberry sauce as well!

2 slices whole-grain bread or 1 whole-grain roll
1 to 2 tablespoons light cream cheese
1 to 2 tablespoons cranberry sauce
A couple of carved slices of turkey (about the size of the palm of your hand)
Lettuce, tomato, sliced onion, alfalfa sprouts (as desired)

# Spread the cream cheese over one of the slices of bread or roll. Spread cranberry sauce over the top of that.
# Add the slices of turkey and top with lettuce, tomato, sliced onion or alfalfa sprouts as desired. Enjoy!

Makes 1 sandwich.

Per sandwich: 339 calories, 33 g protein, 36 g carbohydrates, 6.5 g fat (3.2 g saturated fat, 0.9 g monounsaturated fat, 0.7 g polyunsaturated fat), 81 mg cholesterol, 4 g fiber, 419 mg sodium. Calories from fat: 17%.

The Day After Irish Shepherd’s Pie

This is a wonderful way to enjoy the leftover mashed potatoes, green vegetables, and gravy, too!

Canola cooking spray
2/3 cup chopped mild or sweet onion
2 cups diced roasted turkey
2 cups leftover gravy
1/2 to 1 teaspoon Worcestershire sauce (optional)
1-2 cups assorted leftover vegetables (optional)
2 cups mashed potatoes
1 tablespoon butter or no/low-trans fat margarine
Freshly ground black pepper (optional)

# Preheat the oven to 400 degrees Farenheit. Coat the inside of a deep-dish pie plate with canola cooking spray.
# Coat a large, nonstick skillet with canola cooking spray, add the onion, and cook until the onion is lightly browned. With the spatula, stir in the diced turkey, gravy, Worcestershire sauce, and leftover vegetables, if desired.
# Spread the turkey mixture evenly in the prepared pie plate. Spread the mashed potatoes evenly over the meat. With the fork, make a design in the mashed potatoes. Set aside.
# In a microwave-safe cup, melt the butter in the microwave (or melt it in saucepan over low heat on the stove). With a pastry brush, brush the top of the potatoes with the melted butter. Sprinkle black pepper over the top if desired.
# Place pie dish in the oven and cook until heated through and golden on top (about 25 minutes).

Makes 6 servings.

Per serving (using a store-bought gravy): 234 calories, 18 g protein, 24 g carbohydrate, 7.3 g fat (2.2 g saturated fat, 2.8 g monounsaturated fat, 2.2 g polyunsaturated fat), 42 mg cholesterol, 2.5 g fiber, 500-700 mg sodium (depending on the gravy). Calories from fat: 28%.

Turkey Fettuccini Alfredo

You will love this totally creamy and comforting dish.

2 to 2 1/2 cups roasted turkey breast, cut into strips (skinless)
1/4 cup light cream cheese
1 1/2 cups fat-free half-and-half or whole milk, divided
1 tablespoon Wondra quick-mixing flour
1 tablespoon butter (or no/low-trans fat margarine)
3 cups hot cooked and drained spaghetti or fettuccine noodles
Salt and freshly grated pepper to taste
Pinch or two of nutmeg (add more to taste if desired)
1/4 cup shredded Parmesan cheese (add more at the table if desired)

# Boil fettuccine noodles.
# Combine cream cheese, 1/4-cup fat-free half-and-half, and flour in a small mixing bowl or food processor. Beat or pulse until well blended. Slowly pour in remaining half-and-half or milk and beat until smooth.
# Melt 1 tablespoon butter in large, nonstick frying pan or saucepan over medium heat. Add the milk mixture and continue to heat, stirring constantly, until the sauce is just the right thickness (about 3-4 minutes). Turn the heat to low and add the hot noodles and turkey strips. Toss to coat noodles and turkey well with sauce. Add salt, pepper, and nutmeg to taste if desired. Stir in grated Parmesan and serve.

Makes 4 servings.

Per serving: 419 calories, 37 g protein, 44 g carbohydrate, 9 g fat (3.8 g saturated fat, 2.8 g monounsaturated fat, 1.6 g polyunsaturated fat), 79 mg cholesterol, 2 g fiber, 332 mg sodium. Calories from fat: 23%.

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WebMD Green Bean Casserole

A Thanksgiving classic gets a healthy makeover.

Green bean casserole has a pedigree: invented by Campbell Soup Company in 1955 to prompt happy housewives to buy more cream of mushroom soup, it’s a piece of American marketing history. A culinary icon, but one, like many from its era, that falls squarely in our makeover sweet-spot. Traditionally made with butter, canned soup and canned French-fried onions, this classic is high in calories, sodium and saturated fat. We get an equally delicious result by using fresh mushrooms, low-fat milk and lightly pan-fried sweet onions coated with garlic-seasoned flour. When you taste our version, we’re sure you’ll agree this is one culinary icon that was ready for a re-invention.

WebMD’s Green Bean Casserole

Makes 6 servings, about 3/4 cup each

TOTAL TIME: 45 minutes

ACTIVE TIME: 30 minutes

EASE OF PREPARATION: Easy

This healthy revision of green bean casserole skips the canned soup and all the fat and sodium that come with it. Our white sauce with sliced fresh mushrooms, sweet onions and low-fat milk makes a creamy, rich casserole.

3 tablespoons canola oil, divided
1 medium sweet onion (half diced, half thinly sliced), divided
8 ounces mushrooms, chopped
1 tablespoon onion powder
1 1/4 teaspoons salt, divided
1/2 teaspoon dried thyme
1/2 teaspoon freshly ground pepper
2/3 cup all-purpose flour, divided
1 cup low-fat milk
3 tablespoons dry sherry (see Ingredient Note)
1 pound frozen French-cut green beans (about 4 cups)
1/3 cup reduced-fat sour cream
3 tablespoons buttermilk powder (see Ingredient Note)
1 teaspoon paprika
1/2 teaspoon garlic powder

1. Preheat oven to 400°F. Coat a 2 1/2-quart baking dish with cooking spray.
2. Heat 1 tablespoon oil in a large saucepan over medium heat. Add diced onion and cook, stirring often, until softened and slightly translucent, about 4 minutes. Stir in mushrooms, onion powder, 1 teaspoon salt, thyme and pepper. Cook, stirring often, until the mushroom juices are almost evaporated, 3 to 5 minutes. Sprinkle 1/3 cup flour over the vegetables; stir to coat. Add milk and sherry and bring to a simmer, stirring often. Stir in green beans and return to a simmer. Cook, stirring, until heated through, about 1 minute. Stir in sour cream and buttermilk powder. Transfer to the prepared baking dish.
3. Whisk the remaining 1/3 cup flour, paprika, garlic powder and the remaining 1/4 teaspoon salt in a shallow dish. Add sliced onion; toss to coat. Heat the remaining 2 tablespoons oil in a large nonstick skillet over medium-high heat. Add the onion along with any remaining flour mixture and cook, turning once or twice, until golden and crispy, 4 to 5 minutes. Spread the onion topping over the casserole.
4. Bake the casserole until bubbling, about 15 minutes. Let cool for 5 minutes before serving.

Tips: Don’t use the high-sodium “cooking sherry” sold in many supermarkets. Instead, purchase dry sherry sold with other fortified wines.

Look for buttermilk powder, such as Saco Buttermilk Blend, in the baking section or with the powdered milk in most supermarkets.

Per serving: 212 calories; 10 g fat (2 g saturated fat, 5g mono unsaturated fat); 10 mg cholesterol; 23 g carbohydrates; 7 g protein; 3 g fiber; 533 mg sodium; 259 mg potassium. 1 1/2 Carbohydrate Servings. Exchanges: 1/2 starch, 1 vegetable, 2 fat

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Lightened Kraft Cheesy Brunch/Lunch/Supper Casserole

Ingredients:

12 cups of 1/2-inch cubes of whole wheat bread (whole wheat sourdough works well), (or substitute rice or left-over rice, to your taste, adjust according to number of servings)

1/2 cup chopped red pepper, divided use

12 ounces Kraft shredded, reduced-fat sharp cheddar cheese, divided use

3 cups small fresh broccoli florets

4 large eggs (use a higher omega-3 brand if available)

1 cup egg substitute

1/2 cup fat-free sour cream

2 1/2 cups fat-free half-and-half (or substitute low-fat milk)

Preparation:

1. Preheat oven to 350 degrees. Coat a 13 x 9-inch baking dish with canola cooking spray.
2. Layer half of the bread cubes, half the chopped red pepper and half the shredded cheese in the prepared baking dish. Sprinkle all the broccoli florets over the top then repeat the previous layers with the remaining bread cubes, red pepper and cheese.
3. In large mixing bowl, beat eggs, egg substitute, and sour cream until blended. Pour in the half-and-half and beat until blended. Pour egg mixture evenly over ingredients in baking dish. Bake for 50 minutes to 1 hour, or until golden brown on top and the center of the casserole is nicely set (not runny). Let stand 10 minutes before cutting and serving.

Yield: Makes 12 servings

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