Handwashing is one of the most overlooked yet powerful tools in preventing infectious diseases, including fecal-oral diseases. One common misconception is that if a person uses the washroom and doesn’t wash their hands, they are only putting themselves at risk. In reality, viral and bacterial diarrheal infections do not just affect the individual. They put entire communities in danger. These include: viral diarrheal infections like norovirus, hepatitis A, rotavirus, and bacterial infections such as E. coli and Shigella.
How Do Fecal-Oral Diseases Spread?
Fecal-oral diseases spread when microscopic particles of fecal matter—containing infectious pathogens—get onto hands, surfaces, or food and are then ingested by another person. If someone uses the washroom and fails to wash their hands properly, they may not immediately fall ill if they were already carrying the pathogens in their GI tract. However, as a vector for infection, they transmit these germs to others. Transmission may occur through shared surfaces, handshakes, food handling, or other close contact.
The Risk of a Vector: Spreading Illness to Others
While it’s possible that the original person won’t get sick from their own germs, if they are a vector, they pose a significant risk to everyone around them—family members, classmates, coworkers, and anyone who touches contaminated surfaces. Here’s how:
1. Shedding Pathogens Even After Symptoms Disappear
Many fecal-oral diseases, such as norovirus and hepatitis A, continue to shed in a person’s stool even after they start feeling better. This means that an individual who appears healthy may still be contagious for days or even weeks, unknowingly spreading infection.
2. Contaminating Surfaces and Food
Improper handwashing after bathroom use can transfer dangerous microbes onto door handles, light switches, shared touchscreens, and other everyday objects. Even more alarming, if an infected person prepares food without washing their hands thoroughly. As a result, they can introduce these harmful pathogens directly into meals, leading to outbreaks in households, schools, restaurants, workplaces and other.
3. Reinfecting Themselves and Prolonging Illness
In some cases, poor hygiene can lead to self-reinfection, as germs persist on the hands and find their way back into the body through food, drinks, or touching the face. This can prolong an illness, making recovery slower and increasing the chances of infecting others.
4. Silent Spreaders: The Danger of Asymptomatic Carriers
One of the most insidious aspects of fecal-oral diseases is that not everyone shows symptoms. Children, in particular, can carry and spread these infections without feeling sick themselves. Hepatitis A, for example, can be contagious weeks before symptoms appear—meaning someone could be unknowingly spreading the disease long before they ever feel unwell.
How Long Can Patients with Norovirus or Hepatitis A Remain Infectious?
Norovirus
- People with norovirus are most contagious from the moment they start feeling sick until a few days after recovery.
- The virus can still be shed in the stool for at least 2 weeks after symptoms go away, although shedding decreases over time.
- Even if someone feels better, they can still spread the virus if they don’t practice proper hand hygiene.
- Can they be chronic carriers? No, norovirus does not cause chronic infections. However, in immunocompromised individuals, the virus can persist for weeks or even months, leading to prolonged shedding.
Hepatitis A
- A person with hepatitis A is most contagious about 2 weeks before symptoms appear and during the first week of illness.
- The virus continues to be shed in stool for up to several weeks after symptoms resolve, with some cases shedding for up to 6 months, especially in infants or immunocompromised individuals.
- Can they be chronic carriers? No, hepatitis A does not cause chronic infections. Unlike hepatitis B and C, hepatitis A does not lead to chronic liver disease. Indeed: once a person recovers, they develop lifelong immunity.
Key Takeaway
Both norovirus and hepatitis A can be spread for weeks after a person recovers, even if they feel completely fine. This makes proper handwashing, surface disinfection, and food safety crucial to prevent outbreaks—especially in schools, healthcare settings, and food service environments.
The Importance of Handwashing: A Simple but Lifesaving Habit
Handwashing is not just a personal hygiene practice; it is a public health responsibility. Every time someone skips washing their hands after using the washroom, they are rolling the dice, not just with their own health, but with the health of everyone around them. In crowded environments like schools, workplaces, and public spaces, this can lead to widespread outbreaks of preventable illnesses.
Educators and Parents: The Frontline Defenders
Educators and parents play a critical role in reinforcing proper handwashing habits. Schools, in particular, are hotspots for the spread of fecal-oral diseases due to the close contact between children. Teachers, school staff, and parents must emphasize both the “why” and the “how” of effective hand hygiene, ensuring that children understand the importance of scrubbing all areas—including fingertips, fingernails, between fingers, and the backs of hands—with soap and clean running water.
A school-based handwashing program can make a tangible difference in reducing the spread of disease. Parents, too, can set an example by practicing good hand hygiene at home and ensuring that their children develop proper habits early.
As one of the parents who attended our Handwashing Training Session once put it, “My kids are germ factories! I would absolutely pay for an app that teaches them to wash their hands properly (beyond what I teach them). It is such an important and needed skill” Indeed, we developed such an up for K12 children: it is called a Bubble Beats Trainer.
A Call to Action: Protecting Ourselves and Our Communities
The reality is stark: one person’s failure to wash their hands can cause an outbreak that affects dozens, if not hundreds, of people.
But the solution is simple. A PROPER handwashing habit with soap and clean running water can drastically reduce the risk of transmitting fecal-oral diseases and keep families, schools, and entire communities safer.
So, the next time you — or your child—leave the washroom, make sure handwashing isn’t an afterthought. It’s not just about protecting yourself. It’s about protecting everyone.
Dr. Jasminka Vukanovic-Criley MD, FACP, FHM is a multiple award-winning physician, internist, hospitalist, healthcare & education innovator & Associate Clinical Professor of Medicine at UCLA. She is a career mentor & advisor to numerous undergraduate, graduate & postgraduate students & faculty. As a researcher, Dr. Criley received awards from the National Institutes of Health & the U.S. Department of Education Her work focuses on creating research-driven #edtech games & digital media to improve health, civics, science education & promote healthy habits. Dr Criley is also a founding Board member of Physician’s Weekly. She can be reached on X at @criley_md and at www.linkedin.com/in/jasminka-criley-md