Medical Credit Cards Can Come With Unpleasant Surprises – NYTimes.com

IF you are like most people, you have probably used a credit card to pay some of your medical bills. With rising health costs and gaps in insurance coverage, it’s almost unavoidable.

Patients pay about $45 billion worth of health care costs with plastic, according to a report from McKinsey & Company. By 2015, that number could more than triple to an estimated $150 billion. And big finance companies and medical providers have taken note.

Companies like GE Money, Citibank and JPMorgan Chase have issued medical credit cards or lines of credit intended to be used specifically for elective health care expenses not covered by insurance, including certain dental procedures, Lasik surgery, some cosmetic surgery and even veterinary care. The cards are not used for continuing medical care or emergency room visits.

The issuers market these cards not so much to consumers but to doctors, dentists and other health care providers, who in turn offer them to patients as a payment option. Patients like medical credit cards because payments for care can be spread out over many months and the cards can be used at multiple providers. The providers have embraced them as a way of offloading billing headaches and expenses.

But even as medical credit cards become increasingly popular, they are getting more scrutiny — not much of it flattering. Critics and patient advocates claim that aggressive and misleading marketing tactics can lead to serious headaches for consumers.

In extreme cases, medical providers and associations marketing the cards have been accused of receiving financial incentives for signing up patients or of falsifying financial information to make it easier for patients to qualify for cards.

More commonly, critics say, patients may be led to assume that their providers are simply offering payment plans, not a credit card with all the potential fees, interest rate increases and the impact on credit scores that can entail.

“Ironically, these cards may be best suited to people who already have financial resources,” said Mark Rukavina, executive director of the Access Project, a consumer advocacy group in Boston, and co-author of a study on medical debt. “But it’s usually people with limited resources who sign up.”

Consumer complaints concerning aggressive marketing tactics prompted the New York attorney general, Andrew M. Cuomo, to start an investigation into medical credit cards earlier this year. In Minnesota, the state attorney general, Lori Swanson, has filed lawsuits against two chiropractors whose staff is accused of signing up patients for medical credit cards without their knowledge.

A medical credit card is “one payment option among several a provider may offer and represents a very small component of health care financing for elective procedures,” said Stephen White, a spokesman for CareCredit, a medical credit card issued by GE Money. “Benefits to consumers include the ability to plan, budget and pay for certain elective health care procedures over time.”

Whether you view these cards as a convenient way to pay medical expenses or just another way for credit card companies to collect interest and fees, here are some things to consider if your provider approaches you.

ASK FOR ALTERNATIVES First, try to negotiate a lower fee with your provider; he may be more flexible than you think. Then ask about payment options. Your doctor may well offer a payment plan of his or her own, without the high interest rates often charged by a medical credit card company.

“I encourage people to negotiate with their provider, then get an extended payment plan directly from that office with a monthly payment and time period you are comfortable with,” said Mr. Rukavina. “I think most providers are willing to work for patients in this way.”

If you do opt for a payment plan, ask whether you will be paying the provider directly or a third party. If there’s a third party involved, you may well wind up with a medical credit card. If you choose to sign up for it, be sure you’ve read through the terms carefully and that you understand the interest rates and late payment fees.

If your income is low enough, be aware that you may qualify for a public assistance program, especially for dental costs.

DODGE THE HARD SELL “Some patients report feeling pressured by their clinics to use the card to pay for procedures or treatments they may not need or can’t afford,” Ms. Swanson said. That’s no surprise, since these cards are intended, at least in part, to drive more business to dentists, chiropractors, cosmetic and eye surgeons, weight loss programs, hearing aid dispensers and other providers.

But the intense marketing can lead to unethical behavior, according to Ms. Swanson.

One of the lawsuits filed by her office claims that staff members at a chiropractic office told patients they were not signing up for a credit card but rather just going through a credit check. Instead, Ms. Swanson charges, the staff members submitted applications in the patients’ names and falsified patient’s yearly income information to make sure they qualified.

If you sense you’re being pushed, that things are moving too quickly, remember that you don’t have to sign up for anything on the spot. Take a day or two to read through materials thoroughly and research your options.

BEWARE THOSE TEASER RATES Almost all medical credit cards claim zero percent financing. This is what makes them attractive: you can spread out your payments and pay no interest.

But it is important to read the fine print. As with most credit cards marketed this way, the zero percent rate lasts only for an initial promotional period, usually from six to 24 months. Once that time is up, you will start to pay interest — sometimes high interest.

For GE’s CareCredit, for instance, rates jump to 26.99 percent. (The company does offer a fixed rate of 14.9 percent for extended periods up to 60 months.)

High interest isn’t your only concern. Be sure to check your minimum payment, advised Ms. Swanson. If you pay only the minimum, your payments may extend beyond the zero percent financing period, and you’ll end up with the higher rate.

What’s more, if you make just one late payment or go over the initial promotion period, some cards will charge you a high interest rate retroactively on the original balance, Ms. Swanson noted. That can suddenly add hundreds of dollars to your bill.

PAY AS YOU GO Some providers will charge your medical card for an entire multivisit procedure, like a dental implant, all at once. If you change providers midway through, or do not go through the entire procedure for some other reason, it can be difficult and time-consuming to get a refund, warned Mr. Rukavina.

If you are entering into a treatment or procedure that will take more than one visit, make sure your provider is billing you by the visit, not in a lump sum.

You can find more background on medical credit cards from the Minnesota attorney general’s office at www.ag.state.mn.us/Consumer/Publications/HealthCareCreditCards.asp.

Medical Credit Cards Can Come With Unpleasant Surprises – NYTimes.com.

The fight against AIDS: HIV’s slow retreat | The Economist

THE timing of the pope’s much-discussed change of position on the use of condoms to prevent the spread of HIV (he will now allow prostitutes to use them without fear of hellfire) was surely no coincidence. He made it on November 21st—ten days before World AIDS Day and two before UNAIDS, the United Nations body charged with combating the epidemic, released its latest report on the state of the battle.

That report carries good news. Though some 33m people are infected, the rate of new infections is falling—down from 3.1m a year a decade ago to 2.6m in 2009. Moreover, as the map shows, the figure is falling fastest in many of the most heavily infected countries, especially those of sub-Saharan Africa and South and South-East Asia.

The reason is a combination of behavioural change (people are losing their virginity later, are being less promiscuous and are using condoms more), a big reduction in mother-to-child transmission at birth and during breast-feeding, and the roll-out of drug treatment for those already infected.

Related topics 

• Sub-Saharan Africa
• Africa
• Asia
• South-East Asia
• United Nations

Besides prolonging life, anti-HIV drugs make those taking them less likely to pass the virus on. More than 5m people in poor and middle-income countries are now on such drugs, though Michel Sidibe, the head of UNAIDS, says another 10m could benefit. (The remainder of those infected are not yet ill enough for drugs to do them good.) The problem, as always, is money. Dr Sidibe reckons the fight needs about $25 billion a year to be fully effective. At the moment, the sum spent is around $17 billion. Not a bad fraction of the desideratum, but one that will be hard to sustain in the face of the world’s economic difficulties.

The fight against AIDS: HIV’s slow retreat | The Economist.

Related Articles

• HIV infections and Aids deaths fall worldwide (guardian.co.uk)

Patient Safety Is Not Improving in Hospitals, Study Finds – NYTimes.com

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

“It is unlikely that other regions of the country have fared better,” said Dr. Christopher P. Landrigan, the lead author of the study and an assistant professor at Harvard Medical School. The study is being published on Thursday in The New England Journal of Medicine.

It is one of the most rigorous efforts to collect data about patient safety since a landmark report in 1999 found that medical mistakes caused as many as 98,000 deaths and more than one million injuries a year in the United States. That report, by the Institute of Medicine, an independent group that advises the government on health matters, led to a national movement to reduce errors and make hospital stays less hazardous to patients’ health.

Among the preventable problems that Dr. Landrigan’s team identified were severe bleeding during an operation, serious breathing trouble caused by a procedure that was performed incorrectly, a fall that dislocated a patient’s hip and damaged a nerve, and vaginal cuts caused by a vacuum device used to help deliver a baby.

Dr. Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.

But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.

The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.

“Until there is a more coordinated effort to implement those strategies proven beneficial, I think that progress in patient safety will be very slow,” he said.

An expert on hospital safety who was not associated with the study said the findings were a warning for the patient-safety movement. “We need to do more, and to do it more quickly,” said the expert, Dr. Robert M. Wachter, the chief of hospital medicine at the University of California, San Francisco.

A recent government report found similar results, saying that in October 2008, 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays. The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year. And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths. That report, issued this month by the inspector general of the Department of Health and Human Services, was based on a sample of Medicare records from patients discharged from hospitals.

Dr. Landrigan’s study reviewed the records of 2,341 patients admitted to 10 hospitals — in both urban and rural areas and involving large and small medical centers. (The hospitals were not named.) The researchers used a “trigger tool,” a list of 54 red flags that indicated something could have gone wrong. They included drugs used only to reverse an overdose, the presence of bedsores or the patient’s readmission to the hospital within 30 days.

The researchers found 588 instances in which a patient was harmed by medical care, or 25.1 injuries per 100 admissions.

Not all the problems were serious. Most were temporary and treatable, like a bout with severe low blood sugar from receiving too much insulin or a urinary infection caused by a catheter. But 42.7 percent of them required extra time in the hospital for treatment of problems like an infected surgical incision.

In 2.9 percent of the cases, patients suffered a permanent injury — brain damage from a stroke that could have been prevented after an operation, for example. A little more than 8 percent of the problems were life-threatening, like severe bleeding during surgery. And 2.4 percent of them caused or contributed to a patient’s death — like bleeding and organ failure after surgery.

Medication errors caused problems in 162 cases. Computerized systems for ordering drugs can cut such mistakes by up to 80 percent, Dr. Landrigan said. But only 17 percent of hospitals have such systems.

For the most part, the reporting of medical errors or harm to patients is voluntary, and that “vastly underestimates the frequency of errors and injuries that occur,” Dr. Landrigan said.

“We need a monitoring system that is mandatory,” he said. “There has to be some mechanism for federal-level reporting, where hospitals across the country are held to it.”

Dr. Mark R. Chassin, president of the Joint Commission, which accredits hospitals, cautioned that the study was limited by its list of “triggers.” If a hospital had performed a completely unnecessary operation, but had done it well, the study would not have uncovered it, he said. Similarly, he said, the study would not have found areas where many hospitals have made progress, such as in making sure that patients who had heart attacks or heart failure were sent home with the right medicines.

The bottom line, he said, “is that preventable complications are way too frequent in American health care, and “it’s not a problem we’re going to get rid of in six months or a year.”

Dr. Wachter said the study made clear the difficulty in improving patients’ safety.

“Process changes, like a new computer system or the use of a checklist, may help a bit,” he said, “but if they are not embedded in a system in which the providers are engaged in safety efforts, educated about how to identify safety hazards and fix them, and have a culture of strong communication and teamwork, progress may be painfully slow.”

Leah Binder, the chief executive officer of the Leapfrog Group, a patient safety organization whose members include large employers trying to improve health care, said it was essential that hospitals be more open about reporting problems.

“What we know works in a general sense is a competitive open market where consumers can compare providers and services,” she said. “Right now you ought to be able to know the infection rate of every hospital in your community.”

For hospitals with poor scores, there should be consequences, Ms. Binder said: “And the consequences need to be the feet of the American public.”

Patient Safety Is Not Improving in Hospitals, Study Finds – NYTimes.com.

Planning for Home Care After the Hospital Stay – NYTimes.com

Annie Brumbaugh has become a bit of an expert on recuperating at home. Over the last two years, the 65-year-old wardrobe consultant has had two serious operations on her foot, plus a bone graft, each of which left her homebound for weeks at a time. “This is not easy,” said Ms. Brumbaugh, who lives alone in Manhattan. “Most people have no idea what they are in for.”

Even straightforward procedures, like C-sections and hip replacements, can involve longer-than- expected recuperations. Preparing for these requires more than stocking up on novels, DVDs and plenty of frozen entrees (though such supplies certainly are useful). After a hospitalization, you will need help doing things that you’re unable to do for yourself — even with performing basic tasks like cleaning and dressing. You may need a nurse to change the bandage on a wound or to administer intravenous drugs. You may need equipment, too: a walker, a bath seat or a commode to ensure you don’t injure yourself during recovery.

Equipment and support services will help speed up your recovery, but they also can put a dent in your savings. That’s because most insurers pay for home health care by skilled professionals only during the first, acute part of your recovery. Insurers do not pay for care provided by home care aides, often needed for both short and long recuperations.

The gap often comes as a shock to patients and their families. “There’s a big misconception about what home health care is and what services are covered by insurance,” said Heather McKenzie, senior director of clinical education and quality initiatives for the Visiting Nurse Associations of America. “Most people think all home services will be covered on a long-term basis.”

Every recovery is different, of course, but the more you know and the better prepared you are, the easier it will be to make cost-effective decisions. Whether you are entering the hospital for a planned surgery or just want to be better prepared for an emergency, a few strategies can help guide your way.

PLAN AHEAD Many patients wind up in the hospital as a result of an emergency. For them, lining up home care is likely to be a haphazard process. But a surprising number know in advance that they will be convalescing, yet fail to consider the need for help once they return home.

If you plan to go to the hospital for, say, elective surgery, have a frank talk with your doctor about how long your recovery may be and what you will and will not be able to do. Then call your insurer, whether it’s Medicare or a private carrier, and ask about your policy’s home care benefits.

The insurer can give you a general sense of the services you are entitled to. Be sure to check out your long-term care policy, if you have one; it should cover temporary home care. If you’re covered by Medicare, you can find information on covered home health care services on its Web site.

Elderly patients in assisted living may need skilled aides, as well. While the staff can most likely help with showers and dressing, they probably cannot perform medical tasks, like emptying surgical drains. Don’t leave it up to the hospital to figure out what the facility can provide.

“Hospitals often make false assumptions about what assisted living facilities can and cannot do,” said Maribeth Bersani, senior vice president of public policy at the Assisted Living Federation of America. Check with the assisted living facility directly.

APPROACH HOSPITAL STAFF Let’s imagine you land in the hospital as a result of a sudden emergency. The moment you are able, begin talking to the discharge manager or the social worker about what comes after the hospitalization. Better yet, designate a family member to speak on your behalf, someone who can get the ball rolling even if you’re not up to it.

Whoever does the talking should detail the situation at home for the hospital discharge manager or social worker, including who lives with you and how much help can be provided.

“Health professionals frequently assume there is more support at home than there is,” Ms. McKenzie said. It’s important to make clear that there may not be full-time support. The hospital will have to authorize skilled nursing care for your insurer to pay; discharge planners may consider someone living alone to be more qualified for services than someone living with a spouse.

If you feel you are being hustled out the door too quickly, or that more time is needed to make arrangements, say so. If the discharge planner balks, ask to speak to the supervisor or the hospital’s patient advocate.

“Discharge managers are under the gun to get people out when an individual’s insurance company indicates denial of further coverage and may overlook aspects of your case,” said Vanessa R. Bishop, founder of Elder Care Consultants Inc. in Reston, Va.

Ask, too, if the hospital can order equipment, like a walker or commode, so it is there when you arrive home.

DETERMINE YOUR NEEDS There are two basic levels of home care: skilled and unskilled. Most insurers will pay only for skilled care, but even then you must be homebound and require only temporary care. The hospital should have arranged for short-term nursing care, if needed, before you were discharged. But typically a nurse will also come to your home and evaluate your continuing needs.

Private insurers almost never pay for unskilled help, like a home health aide. If you decide you need more help than your insurer will authorize, first consider whether you need a nurse (who may charge $50 or so an hour) or whether a home health aide will suffice (more like $10 to $38, depending on where you live).

If you do want a skilled nurse, you must get a prescription from your doctor ordering the services, even if insurance is paying.

How do you find a home health aide? It’s usually less expensive to find someone on your own than to go through an agency, so start by asking friends and family for referrals. If you do opt to use an agency, call a few and ask for price quotes. Ask, too, whether they do background checks on their workers. (They should, of course.)

A good place to start is the local visiting nurse agency. These agencies are nonprofit and privately operated, so each one offers slightly different services, but some can provide the services of both nurses and home health aides. For tips on selecting health care agencies, go to the V.N.A.A. Web site at vnaa.org.

HIRE A MANAGER If you don’t have the time or stamina to figure out an ideal home health care plan for yourself or a loved one, turn to a health care advocate or, in the case of elderly patients, a geriatric care manager.

These consultants charge an hourly fee of $90 to $160, which is not reimbursed by insurers. But a one-hour consultation could potentially save you hours of precious time.

A nurse advocate or geriatric care manager can explain how insurance and Medicare work and the services you may be entitled to, and they can speak to doctors on your behalf. If you’re interested in hiring a geriatric care manager, contact the National Association of Professional Geriatric Care Managers. If you want to find an advocate, you’ll have to ask around for referrals, as there is no central resource.

Planning for Home Care After the Hospital Stay – NYTimes.com.

Related Articles

• Well: The Cost of Recuperating at Home (well.blogs.nytimes.com)

Nothings too good for our soldiers (not)!

Tough story in the Clarksville, Tenn., Leaf-Chronicle this morning about a soldier with PTSD who says he went AWOL, instead of returning to Afghanistan, because of the lack of mental-health services at Fort Campbell, Kentucky. “All I wanted was to be treated,” Specialist Jeff Hanks, who also served in Iraq in 2008, said outside the fort’s gate Thursday as he turned himself in. “Hopefully they’ll listen to me and treat me.” Hanks said he went absent without leave nearly a month ago after his post-traumatic stress disorder and the collapse of his family convinced him he couldn’t get the help he needed in a war zone:

Hanks said he reached out to his commanders while home on leave, but he was met with resistance and delay. He said he was told he would immediately have to go back to Afghanistan.

We wrote about this sad state of affairs at Fort Campbell in the August 16 issue of Time:

The Army has spent $7 million building at Fort Campbell what it calls its first behavioral-health campus (soldiers call it “the mental-health mall”) with a half-dozen new clinics filled with the latest technology for diagnosing and treating posttraumatic stress disorder (PTSD) and traumatic brain injury. The fort’s mental-health staff has grown from 31 in January 2008 to 95 today…But the trend at the base remains clear; the workload per mental-health worker has nearly doubled from 2008 to 2010, jumping from 19 to 32 visits per week.

Additional reporting for that story revealed:

The focus on Fort Campbell’s mental health has been driven, in part, by a 2008 probe that tried to figure out why its 2007 suicide rate was 50 percent higher than the overall Army’s. Outside Army experts found that even as Fort Campbell’s mental-health visits increased fivefold from 2005 to 2007, the staff shrunk from 28 to 18. That led to longer waits between visits and individual troops being seen in clinics beset by “frequent staff turnover,” forcing the soldier to “start over” with a new therapist each visit. The mental-health workload led to poor care and morale, as well as “compassion fatigue,” among counselors. The first recommendation to curb suicides: “address critical behavioral-health shortages.”

The Army’s didn’t care for the attention garnered by the young soldier. “It seems a shame to focus attention on this particular young man on Veterans Day,” a post spokeswoman said in a statement, “when we have 15,000 men and women from the 101st Airborne Division bravely supporting the fight and placing themselves in harm’s way in Afghanistan and Iraq.”

Read more: http://swampland.blogs.time.com/2010/11/12/as-we-were-saying/#ixzz155meVToJ

As We Were Saying… – Swampland – TIME.com.

Related Articles

• AWOL soldier returns on Veterans Day (seattletimes.nwsource.com)

Colds and flu? Not you! – CNN.com

(Health.com) — It’s that time again: Everywhere you go, people are sniffling, sneezing, and coughing. Think you’re next to get sick? Not necessarily.

“There are no guarantees, but you can seriously lower your odds of illness by taking simple precautions to avoid germs and keep your immune system humming,” says Dr. Sandra Fryhofer, M.D., clinical associate professor of medicine at Emory University School of Medicine.

Use this checklist to stay healthy through cold-and-flu season and beyond.

Say yes to the flu shot

The big news this year is that the Centers for Disease Control and Prevention is now recommending that everyone 6 months and older get the influenza vaccine — before, only those at highest risk of flu complications were urged to get it.

“There’s a greater realization that we all interact with each other, so the best way to reduce the spread of flu is to vaccinate everyone,” says Dr. Susan Rehm, M.D., medical director of the National Foundation for Infectious Diseases.

Health.com: Is it a cold, flu, or something else?

The ideal time to get vaccinated is before the onset of flu season (which is usually sometime in November or December), but it’s never too late. You can opt for an injection or (if you’re healthy and not pregnant) the FluMist nasal spray.

Get a new flu shot every year because you lose immunity over time and because the viruses targeted by the vaccine usually change from year to year. This year’s formulation will also protect against H1N1 (a.k.a. swine flu), so there’s no need for a separate shot.

Eat to beat illness

“Diet is the fuel that runs the complex human machine and all of its parts, including the immune system,” says Dr. David Katz, M.D., director of the Yale Prevention Research Center.

Essential power players include high-quality protein, such as fish, lean meats, and beans, needed to help build white blood cells (the body’s defenders); brightly colored fruits and veggies, which provide immune-boosting antioxidants; and omega-3 fatty acids (good sources include fatty fish, walnuts, and flaxseed) to keep the immune system balanced.

Health.com: Immune-boosting vitamins and superfoods

Keep moving

Exercise can keep you from getting sick by stimulating the immune cells that target cold infections, Fryhofer explains. A University of South Carolina study found that people who walked or did other moderate activity for 30 minutes most days averaged one cold per year, while less-active folks reported more than four colds per year.

Just don’t overdo it: Heavy exertion — like marathon training — may increase your risk of catching seasonal bugs, perhaps because it can stress the body’s systems, allowing viruses to gain a foothold.

Health.com: Cold or flu? How to tell if you’re too sick to work out

Hydrate inside and out

Lower humidity and temperatures help the flu virus spread, which may explain why flu outbreaks peak in winter.

Humidity, on the other hand, kills the virus, so keep air at home warm and moist. Use a humidifier to maintain around 50 percent humidity and set room temperatures to at least 69 degrees F. If you’re going to be in a superdry environment like an airplane cabin, protect yourself by using a saline nasal spray to moisten the membranes in your nose.

“When nasal passages are hydrated, the cilia, hair-like structures lining the nose, do a better job of keeping bacteria and viruses out,” Fryhofer says.

Drink plenty of water, too: Your body needs H2O to execute many key immune functions, Katz says.

Health.com: 15 big benefits of water

Befriend bacteria

The good kind, that is. Probiotics are friendly microbes that may strengthen the immune system by crowding out bad germs that make us sick. A German study found that healthy men and women who took probiotics daily for three months shortened bouts of the common cold by almost two days and reported reduced severity of symptoms, such as headaches, coughing, and sneezing.

Aim for three servings a day of probiotic-rich foods — yogurt with live bacteria, aged cheese, kefir, or other fermented foods (like sauerkraut or kimchi), says Gary Huffnagle, Ph.D., a professor of internal medicine at the University of Michigan Medical School and author of “The Probiotics Revolution.” If you prefer a supplement, Huffnagle recommends choosing one with 3 billion to 5 billion CFU (colony-forming units).

Health.com: 7 natural cold remedies: do they work?

Sleep on it

Logging less than seven hours sleep in the weeks before being exposed to a cold virus can make you three times more likely to develop a respiratory illness than if you got eight or more hours, according to a study published in 2009 in the Archives of Internal Medicine. That’s because even minor sleep deprivation suppresses immune function.

Health.com: 7 tips for the best sleep ever

Give germs the slip

Your biggest defense against lurking cold and flu bugs: old-fashioned hand-washing. Soap up long enough to sing “Happy Birthday” twice through (about 20 seconds); if you can’t wash, use an alcohol-based hand sanitizer.

Be sure to scrub or sanitize after touching the germiest surfaces — doorknobs, fridge handles, TV remotes, bathroom faucets, and money — and after shaking hands. Keep your mitts off your face, to avoid giving germs a free ride into your eyes, nose, or mouth.

Health.com: The germiest places in America

Germ-filled droplets can fly through the air, too, so if someone within 6 feet of you is coughing or sneezing, turn your head away for about 10 seconds while the air clears, Fryhofer advises, and (if you’re in public, like in a café or on a bus or train) change seats as soon as you can.

And do your part to prevent the spread of germs: If you do get sick, sneeze into your sleeve, toss tissues immediately, and — if possible — stay home until you’re better.

Colds and flu? Not you! – CNN.com.

Related Articles

• Guest column: Vaccination is key to slowing flu scourge (commercialappeal.com)