About 48 million Americans get sick from food-borne pathogens each year, according to the Centers for Disease Control and Prevention. But while many of cases are tied to restaurants and household food sources, millions of cases can actually be traced back to grocery stores, experts say.

Many surprising sources or germs – including dirty shopping cart handles, unrefrigerated prepared foods, and bacteria-laden reusable grocery bags – have all been linked to illnesses.

But there are steps you can take to reduce your risk, notes Dr. Adam Barkin, emergency department director at HCA Healthcare's Sky Ridge Medical Center in Denver.

Barkin tells Newsmax Health that there are certain actions you should take when grocery shopping to reduce your risk of germs. Among them: carrying a bottle of hand sanitizer with you and using it before you enter the store and after you leave.

Here are 10 additional ways to reduce germs when grocery shopping.

Wipe down the cart: When you first get your grocery cart, wipe down the handle and sides. According to Food Protection Trends, E. coli bacteria is lurking on 50 percent of shopping carts. That’s a 50/50 chance that you’re coming into contact with the bacteria if you don’t wipe down your cart.

“Most stores have sanitizer wipes at the front entrance, so use them to wipe down the handlebars and child seat on your grocery cart. This is an important first step to avoiding grocery store germs,” Barkin tells Newsmax Health.

One study found that traditional store carts typically harbor 361 times more bacteria per square inch than a bathroom doorknob.

Shopping order: Temperature-sensitive grocery foods – including prepared ready-to-eat items that should remain cold or hot – can cause food-borne illnesses, if they are purchased and kept in shopping carts or your car’s trunk for too long. To limit your risk, first shop for foods that have a long shelf-life – such as canned and dry goods. Next, move to the frozen section and get your fresh meats and seafood last because they are sensitive to temperature.

Shake it off: Fresh produce, like leafy green vegetables, is often bathed in a mist of water to keep it fresh, but that’s something you don’t need once you’re home. It’s a good idea to shake the water off while you’re in the grocery store. The added water can actually lead to the produce spoiling, as well as fungal or bacterial growth, if you don’t shake it off.

Wash produce well: Fresh fruits and vegetables are staples of a well-balanced diet, but they can be covered in germs. Think about the shoppers who touch and squeeze produce to test for freshness who may not have washed their hands.

When buying fruit, look for cotton-like fuzz that could indicate spiders have been on them. Bruises and tears on fruit and vegetable skin can also allow bacteria to enter the produce. Carefully check your items before putting them in your shopping cart. Always wash your produce before eating, even if it says it was prewashed.

Secondary containment: When you’re purchasing raw fish or meat, consider secondary containment. That means a second bag that acts as a second layer protecting the fish or meat from any contaminants that may be around and providing a safeguard against cross contamination.

“Make sure you keep chicken and meats separate from your other groceries, particularly produce,” Barkin says.

You should also grab a bag of ice to keep the fish or meat as cold as possible from the grocery store to your refrigerator. According to the U.S. Department of Agriculture, bacteria grow most rapidly at temperatures between 40 degrees and 140 degrees Fahrenheit. Consider an insulated bag to keep your food cool on the ride home.

Beware reusable bags: If you reuse the same bags multiple times, bacteria and contaminants can build up inside them. To prevent bacterial growth, wash them and let them dry before reusing.

Beware the checkout: According to the Journal of Food Protection, microorganisms like bacteria, yeast, and mold are commonly found on grocery store conveyor belts. Bagging foods before you place them on the belt can help make sure your food is still fresh by the time you make it home.

Skip the samples: Deli samples of meat, dips, and cheese may look tempting but they could be harboring bacteria. In 2010, an E. coli outbreak was linked to cheese samples at Costco. Avoid free samples if the food looks old, it's on a communal tray, or there's no staff person manning the sample station. If there's no one managing the samples, you won't know how long the food has been sitting out or how it was handled.

Watch where your child sits: The seat compartment of shopping carts can be a breeding ground for germs because children often sit there. A 2006 CDC study found that riding in shopping carts next to meat was a risk factor for salmonella infections in infants.

Check the dates: It should go without saying that you should check the date of any item you're purchasing – especially meat and dairy. Look for the "best if used by" date or the "use-by" date to know when the product will be at its peak quality.

Barkin says your vigilance and food-safety precautions should continue after you leave the grocery store.

“Wash your hands and produce thoroughly when you return home,” he advises.