At times, disease prevention advocates must focus on a single message with a clear directive, such as: Get vaccinated against H1N1 or Wash your hands to prevent transmitting hepatitis A. Circumstances generally dictate the nature and content of the prevention message or messages. Yet all health educators know that preventing the majority of infections requires numerous methods of disease prevention.

Heath educators need a simple, multi-message campaign for their arsenal of prevention communications to improve the overall health of the public. Orange Nose Day, a celebration of the top five steps to good health, does just that.


Step 1: Wash Hands

Handwashing is on the uptick in the U.S., but we still have room for improvement to stop the spread of infection. In 2010, 85% of adults washed their hands in public restrooms, compared with 77% in 2007. Yet, only 39% of American adults say they always wash their hands after coughing or sneezing1. When it comes to children, only 58% of female and 48% of male middle- and high-school students washed their hands after using the bathroom. Of these, only 33% of the females and 8% of the males used soap2.

Healthcare workers also lag in hand hygiene compliance. Only 34.3% of healthcare workers are compliant during routine clinical practice3.

These missteps in hand hygiene have devastating and expensive outcomes. Each year, an estimated 2.5 million patients in the U.S. develop healthcare-associated infections that result in 90,000 deaths and cost the healthcare system an estimated $4.5 to $5.7 billion4. Poor hand hygiene contributes to these totals.

With education, people perform adequate hand hygiene and the community as a whole sees a difference. For instance:

My Healthy Arkansas Initiative, a multi-faceted hand hygiene education program in Jonesboro, AR – At the conclusion of the study, researchers confirmed a 25% reduction in the incidence of skin and skin structure infections presenting to the hospital emergency department compared to the beginning of the study. The most common isolate from the wound cultures was methicillin-resistant Staphylococcus aureus5.


Step 2: Get Immunized

Adult vaccination rates are dismally low:

  • Influenza (without high-risk conditions): 19–49 years, 19.7%; 50–64 years, 34.2%; healthcare workers, 52.9%6
  • Tdap: 20.7%7
  • Hepatitis A: For adults ages 19–49 years, rate is low overall (9.8%) but slightly higher (15.0% versus 7.1%) among travelers outside of the U.S. to countries other than Europe, Japan, Australia, New Zealand, or Canada since 1995.
  • Hepatitis B: Hepatitis B vaccination coverage in 2009 was similar between non-Hispanic whites (43.2%) and non-Hispanic blacks (43.6%). The estimate for Hispanics was 36.7%.

Adolescent vaccination rates are better, but nowhere near creating the “herd immunity” we need to stop the spread of vaccine-preventable diseases:8

  • Tdap – 56%
  • Meningococcal conjugate vaccine – 54%
  • All three doses of human papillomavirus (HPV) vaccine – 27%

We need higher vaccination rates to keep these and other diseases at bay:

  • Influenza: Approximately 250,000–500,000 new cases of influenza occur each year in the U.S. Influenza viruses cause 20,000 deaths and 200,000 hospitalizations each year in the U.S..9
  • Pertussis: In 2010, more than 21,000 cases of pertussis (whooping cough) were reported in the U.S10. Many more go undiagnosed and unreported. In California, from January 1–June 30, 2010, a total of 1,337 cases were reported, a 418% increase from the 258 cases reported during the same period in 200911.
  • Hepatitis A: In 2007, 2,979 acute symptomatic cases of hepatitis A were reported. After adjusting for asymptomatic infection and underreporting, the estimated number of new infections was 25,00012.
  • Hepatitis B: In 2007, there were an estimated 43,000 new hepatitis B virus infections in the United States. However, the official number of reported hepatitis B cases is much lower. Many people don’t know they are infected or may not have symptoms and therefore never seek the attention of medical or public health officials13.


Step 3: Eat Colorful Foods

The science of medicine helps keep infections controlled, but individuals can take many steps on their own to bolster their immunity to disease. Including colorful foods in the diet can increase the body’s natural defense against infection.

The CDC reported in 2009 that most adults are not meeting the Healthy People 2010 goals for fruit and vegetable consumption14. Yet, the importance of these foods in our diet is irrefutable.

Good sources: These foods contain 10 to 19% of the Daily Value per reference amount.
Excellent sources: These foods contain 20% or more of the Daily Value per reference amount.

The CDC also notes that: “Compared with people who consume a diet with only small amounts of fruits and vegetables, those who eat more generous amounts as part of a healthful diet are likely to have reduced risk of chronic diseases, including stroke and perhaps other cardiovascular diseases, and certain cancers.15

Introducing colorful foods such as fruit and vegetables into the diet goes a long way toward improving and maintaining an individual’s health.

Table: Nutrient Information from the CDC16


Fiber: Diets rich in dietary fiber can have a number of beneficial effects, including decreased risk of coronary artery disease. Excellent vegetable sources:
navy beans, kidney beans, black beans, pinto beans, lima beans, white beans, soybeans, split peas, chick peas, black-eyed peas, lentils, artichokes
Folate: Healthful diets with adequate folate may reduce a woman’s risk of having a child with a brain or spinal cord defect. Excellent vegetable sources:
black-eyed peas, cooked spinach, great northern beans, asparagus
Potassium: Diets rich in potassium may help to maintain a healthy blood pressure. Good fruit and vegetable sources:
sweet potatoes, tomato paste, tomato puree, beet greens, white potatoes, white beans, lima beans, cooked greens, carrot juice, prune juice
Vitamin A: Vitamin A keeps eyes and skin healthy and helps to protect against infections. Excellent fruit and vegetable sources:
sweet potatoes, pumpkin, carrots, spinach, turnip greens, mustard greens, kale, collard greens, winter squash, cantaloupe, red peppers, Chinese cabbage
Vitamin C: Vitamin C helps heal cuts and wounds and keep teeth and gums healthy. Excellent fruit and vegetable sources:
red and green peppers, kiwi, strawberries, sweet potatoes, kale, cantaloupe, broccoli, pineapple, Brussels sprouts, oranges, mangoes, tomato juice, cauliflower


Step 4: Exercise

Exercise is an inseparable companion to the other methods of disease prevention.

As reported in the Wall Street Journal,
“. . . a growing body of research is showing that regular exercise—as simple as a brisk 30- to 45-minute walk five times a week—can boost the body’s immune system, increasing the circulation of natural killer cells that fight off viruses and bacteria. And exercise has been shown to improve the body’s response to the influenza vaccine, making it more effective at keeping the virus at bay.17

Although these and other benefits attributed to regular exercise are unquestioned, sedentary Americans need encouragement from many different fronts to become adherent. The Wall Street Journal article goes on to state, “A survey by the ACSM, whose members include physicians and exercise-science professionals, found that only four out of 10 doctors talk to their patients about the importance of exercise, and they don’t always offer suggestions on the best ways to be physically active.”

On an average day, about 16% of Americans play sports or exercise, compared to around 80% who watch television18.

Exercise should be part of every conversation healthcare professionals have with their patients.


Step 5: Avoid Body Fluids

Disease prevention is a way of thinking as well as a set of actions to take to stay healthy. Practicing standard precautions outside of a clinical care setting is important to health.

For practical purposes in daily living, “standard precautions” means assuming that everyone is infected with something. People of all colors, rich and poor, fat and thin, old and young can be chronically infected with HCV, HBV, HIV, and other diseases. Forty to 90 percent of these individuals don’t know they’re infected19 and are not aware of the risk they may pose to others.

A key component of a disease prevention program is remembering that anyone may be capable of transmitting disease and acting accordingly by putting a barrier between oneself and another’s blood or body fluid.

Through education, the public can learn about simple and effective ways to prevent the spread of diseases through contact with bodily fluids.

1 “Public Handwashing Takes a Hike.” September 13, 2010.
2 Guinan ME, McGuckin-Guinan M, Sevareid A. Who washes hands after using the bathroom? American Journal of
Infection Control. 1997;24(5):424-425.
3 Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice
4 “Hand Hygiene in Hospitals Not Up to Par” May 31, 2010.
5 “Citywide Hand Hygiene Intervention Triggers 25 Percent Drop in Community Infection Rate” 12/13/10.

6 2009 Adult Vaccination Coverage, NHIS. November 17, 2010.

7 Vaccination Coverage Among Adults. CDC.

8 Teen Vaccination Rates Increasing Across the US. CDC. August 19, 2010.
9 Influenza. eMedicine from WebMD.
10 “21,000 had whooping cough last year, CDC says,” published February 24, 2011, Associated Press, accessed
February 24, 2011,
11 “Notes from the Field: Pertussis,” published July 9, 2010, Centers for Disease Control and Prevention, accessed
on February 24, 2011
12 Hepatitis A. CDC.
13 Hepatitis B, CDC
14 Most Americans Still Not Eating Enough Fruits, Veggies

16 Fruit & Vegetable Benefits, CDC
17 The Hidden Benefits of Exercise,
19 Standard precautions. PKIDs.