An Australian infectious disease expert says airport operators should introduce hand hygiene pumps to fight the health threat of antibiotic resistance.
A new study has reaffirmed fears airports silently transport drug resistant bacteria between destinations.
And many of these nasties can be found on toilet door handles.
With airports visited by millions of people every day, it has always been plausible international travellers could pick up antimicrobial-resistant bacteria from airport surfaces and introduce them into their homes.
A group of researchers led by Frieder Schaumburg from the University Hospital Munster, Germany, say they have now found drug-resistant bacteria on the handles of toilet doors at various international airports.
Each time a member of their research group travelled internationally and passed through an airport, they swabbed the surface of an internal toilet door and preserved it to study further when they returned to the lab.
In total, 400 door handles in 136 airports in 59 countries were sampled. More than 80 per cent of the swabs were taken from arrivals terminals. Sixty per cent came from men's rooms and 40 per cent women's.
The results, published in the journal Clinical Microbiology and Infection, show bacteria Staphylococcus aureus was present in 5.5 per cent of the samples.
Staphylococcus maltophilia was found in two per cent and bacteria of the Acinetobacter baumannii complex were found in 1.3 per cent of the samples.
A quarter of the S. maltophillia bacteria samples were found to be resistant to trimethoprim, used mainly in the treatment of bladder infections and sulfamethoxazole, used to treat urinary tract and middle ear infections and bronchitis.
Two-fifths of the A. baumannii complex were resistant to trimethoprim and sulfamethoxazole but all were susceptible to antibiotic medication that uses quinolones and gentamicin.
The S. aureus bacteria found on a toilet door in a Paris airport showed multiple resistance to antibiotics.
According to the World Health Organisation, antibiotic resistance is one of the greatest threats to human health in the 21st century and will cause a projected 10 million deaths annually by 2050.
Professor Jonathan Iredell, an infectious diseases physician and clinical microbiologist from the University of Sydney, says the findings are not surprising because humans pass bacteria on every time they open a door or share a drink.
But he does say the study highlights that there is a lot of silent transmission of bacteria going on as a result of globalisation and that we must act.
Prof Iredell says airports could seriously think about making hand hygiene gel readily available.
"These pumps have made a huge impact on the transmission of antimicrobial resistance in patients in hospitals and there is little doubt these would work quite well in that context," he said.