You're careful about using toilet seat covers and wouldn't even dream of touching the door handle of a public restroom without a paper towel. But then there's the tricky question of how to dry your hands after you wash them. Is this step the weak link in your anti-germ crusade?

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Gone (or empty) are the paper towel dispensers in my public bathrooms. They've been replaced by electric air dryers. Ah, progress! But at what cost? 

In one study, researchers coated volunteers' hands with organisms to mimic hands that had been contaminated and poorly washed. Then they then had the people dry their hands using either a high-speed air dryer, a warm air dryer or paper towels. Next the researchers evaluated how contaminated the surrounding air was after each drying method. The bacterial count was more than four times higher for the high-speed air dryer than the warm air dryer, and 27 times higher than when participants used a paper towel. The study was published in 2014 edition of the Journal of Hospital Infection.

In another study, published in 2012 in the same journal, researchers combined the results of 12 published studies that looked at electric hand dryers versus paper towels. Again, paper towels were deemed superior because they worked well to dry hands, remove bacteria and decrease contamination of the bathroom air.

It's not surprising air dryers spew more bacteria, says Aaron Glatt, MD, a spokesperson for the Infectious Diseases Society of America. However, he says, the germs occupy a limited area, and the findings may not have much practical importance. In other words, the air won't necessarily make you sick.

That difference in bacterial spread among the different hand drying methods might be a concern, he says, in a hospital intensive care unit, but it's probably much less so in a public bathroom. While research clearly favors paper towels, he says, an electric dryer is fine if that's the only choice you have. "I would not hesitate to use them if there were no paper towels. I think you need to be practical. You can't go through life without touching germs.''

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More important is how you wash — and whether you dry 

Whatever the hand drying options in a public bathroom, ''the critical focus should be on washing your hands properly," Glatt says. And that job includes the often-overlooked step of drying them correctly. If you don't dry your hands well, you not only risk having more bacteria on them, but developing dry, cracked skin.

This is the right way to wash and dry your hands when using a public bathroom, Glatt says:

  • Using whatever soap is available, wash your hands in warm water. Vigorously rub your hands together for about 30 seconds (which he says most people do not do).
  • Rinse your hands in warm water.
  • Dry your hands thoroughly using whatever method is available.

More restroom germ control

Other ways to reduce bacterial spread during your bathroom break:

  • Close the toilet lid, if there is one, before flushing. Researchers compared the amount of the bacterium C. difficile in the area above toilets that had lids and those that did not. The bacteria were much fewer when the lids were closed before flushing, according to a 2012 report in the Journal of Hospital Infection.
  • Avoid the germy bathroom door handle, which could carry the bugs of the not-so-fastidious person who just left the bathroom without washing up. Some public bathrooms now have the so-called touchless exit door handle, built in a J-shape with an antimicrobial finish and designed to be opened by hooking your arm through the handle. About 10,000 are in operation, says Matt Fulkerson, owner of the company selling SanitGrasp. However, if the bathroom you're visiting doesn't have it, experts suggest grabbing a paper towel and using that to cover the handle and open the door. You'll likely find a wastebasket nearby, proving you're not the only one who’s germ-conscious.

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Kathleen Doheny is a Los Angeles journalist specializing in health, behavior and fitness topics.