New Approach to Home Hygiene Needed to Control Disease and Reduce Costs, Says Report

Three key measures could help to reduce the burden of infectious disease in a sustainable way according to a Report published by the International Scientific Forum on Home Hygiene (IFH).

Infectious diseases continue to exact a heavy toll on the health and prosperity of the European community. Preventing infectious diseases must involve everyone.  It must be a shared responsibility. The Report warns however that we are in danger of putting environmental and other concerns – important though these are – before the need to prevent the emergence and spread of infectious diseases. What is needed is an approach which is both effective and also sustainable.

The measures proposed by the Report’s authors include:


1. Focusing greater effort on infection prevention through hygiene in the home and community. Hygiene offers a cost effective means to reduce the burden of infectious diseases and the associated healthcare and economic costs. Prevention is fundamentally more sustainable than treating infection. Better infection prevention through hygiene would also reduce the number of antibiotic courses which in turn can reduce the impact of antibiotic resistance


2. Adopting a ‘targeted’ approach to hygiene.   We need to adopt an approach to hygiene which focuses on “breaking the chain of infection transmission”. This means breaking the chain of infection at critical points such as hands, hand contact surfaces, and food preparation surfaces to eliminate germs and prevent them from spreading further.  This approach also provides a framework for sustainable hygiene because it ensures prudent and focused use of hygiene.


3. A family-centered approach. Whilst separate campaigns to promote the spread of  infection in a single area – such as food hygiene or respiratory hygiene – are important, they give the public a fragmented view of hygiene. We need to build a more integrated and sustained understanding which people can adapt to meet changing needs as new infectious disease threats arise. The EU-funded e-Bug project is already working to address this need by ensuring that all children leave school with a basic understanding of infectious diseases and hygiene.

The Report, ‘Preventing the spread of infectious diseases in the European Union – targeted hygiene as a framework for sustainable hygiene’ was released to Europeans, MPs and other stakeholders at an information and roundtable session on Tuesday 2nd March 2010.

One of the Report’s authors, Professor Sally Bloomfield, IFH Scientific Advisory Board and Honorary Professor at the London School of Hygiene and Tropical Medicine, says: “If we are to get people to share the responsibility for disease prevention, we need new approaches which meet the challenges of the 21st century. We need strategies that change people’s perceptions, which provide them with clearer codes of hygiene practice and crucially persuade them to change their behavior.  At the same time, however, these approaches must be sustainable.”

She adds: “The emergence and spread of new, or more antibiotic resistant, infections such as the avian and swine flu and the PVL toxin-producing MRSA infections have shown us that as soon as we begin to get one pathogen under control another  emerges. Improving healthcare now means [understanding] that people with reduced immunity to infection, such as the elderly, the sick and the very young, make up as much as 20% of the population. Increased homecare is one approach to reducing health spending, but any gains can be undermined by inadequate infection control at home”.

Commenting on the need for a more balanced view about environmental and hygiene concerns, Professor Exner, Director of the Hygiene Institute in Bonn and a co-author of the Report says: “IFH is concerned that environmental issues are now taking precedence over the very real need to prevent the spread of infectious diseases.   Much of the ever-increasing homecare of vulnerable groups is provided by family members. These people need access to appropriate hygiene advice and hygiene products.”

Talking about the e-Bug project Dr. Cliodna McNulty of the Health Protection Agency in England and lead scientist on the project says, “The aim of e-Bug is to reduce the burden of infections, antibiotic use and antibiotic resistance by increasing children’s awareness of hygiene, prudent antibiotic use and vaccines.  The project is disseminating a school antibiotic and hygiene education pack aimed at both primary and secondary school level across Europe, and currently involves a consortium of 18 partner EU countries. This exciting teaching resource for junior and senior schools teaches about microbes and their spread, through fun activities in the classroom and Web-based games”.   This pack can be downloaded at

The following notes expand upon each of the three steps noted.

1. Preventing Infections


Preventing infection through measures such as hygiene and vaccination programs is an intrinsically more sustainable approach than treatment. However, hygiene measures must themselves be sustainable, which means that impacts on the environment, concerns about antibiotic resistance, and the much publicized notion that “we have become too clean for our own good” need to be assessed and appropriately managed.     

As antibiotic resistance continues to reduce our ability to treat infections, infection prevention through effective hygiene becomes of even greater importance.   By reducing the number of infections through good hygiene, which in some cases requires the use of a biocidal hygiene product, the number of antibiotic courses prescribed can be lowered, which can in turn reduce the impact of antibiotic resistance.

2. Targeted Hygiene

IFH has developed a new approach which has come to be known as ‘targeted hygiene’. This recognizes that harmful bacteria and viruses come mainly from people, contaminated raw food and domestic animals. These organisms are constantly circulating around our homes, offices, schools and so on, so that, when circumstances combine, people become infected.  Preventing exposure to infection means breaking this “chain of infection” at critical points like the hands, hand contact and food preparation surfaces before the germs can spread further.  In some situations, this can be done with cleaning products such as hand soap and detergent products, but sometimes this is not enough. Washing our hands with soap and rinsing them thoroughly under running water will get rid of the germs, but wiping a surface with a soapy cloth just spreads the germs onto the cloth, onto our hands and onto other surfaces.   In these situations we need to use an effective “germ kill” product such as a disinfectant or antibacterial product, or an alcohol hand gel to break the chain of infection.

Says Professor Bloomfield, “We still do not know whether use of certain types of antibacterial products might be contributing to the development of antibiotic resistance. The potential is there but there is still no evidence that it actually does. We increasingly think that exposure to microbes, particularly in early childhood may be important in protecting against allergic diseases such as asthma and hay fever but we really do not know what sort of exposure. It now seems unlikely that we need to suffer ‘infections’ to achieve this.  There is now evidence that frequent respiratory infections in early childhood can actually increase the risk of asthma in later life.”

Whilst targeted hygiene was originally developed by IFH as an effective approach to hygiene practice in the home and community, it also provides an excellent framework for building sustainability into hygiene.  Through targeted hygiene practice involving prudent and focused use of hygiene products and processes, it intrinsically minimizes their life-cycle impacts, maximizes safety margins against any hazards and minimizes any risks of encouraging the development of antibiotic resistance through low level biocide exposure.  It also seeks, as far as possible to sustain “normal” levels of exposure to the microbial flora of our environment to the extent that is important to build a balanced immune system.

3. Co-ordinating current public health practice

Changing people’s attitudes to hygiene and changing their behavior represents a significant challenge. IFH concludes that one problem which hinders progress is that public health within Europe is structured in such a way that the separate aspects of home hygiene – food hygiene, hand washing, pandemic flu preparedness, etc – are dealt with by separate agencies. If hygiene promotion is to be successful in changing behavior, the various agencies need to work together to develop an integrated family-centered approach to hygiene and hygiene promotion.

Interviewee and Authors


Professor Sally Bloomfield is the Chairman of the International Scientific Forum for Home Hygiene. She is also a member of the London School of Hygiene & Tropical Medicine’s Hygiene Center.

To interview Professor Bloomfield, or for more information, please contact the London School of Hygiene & Tropical Medicine Press Office on +44 (0) 207 927 2073/2802 or email [email protected] or [email protected]


Access the full report:


The authors of the report are the members of the Scientific Advisory Board of The International Scientific Forum on Home Hygiene:

•    Professor Sally F. Bloomfield, London School of Hygiene and Tropical Medicine, London, UK
•    Professor Martin Exner, Institute of Hygiene and Public Health, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
•    Professor Kumar Jyoti Nath, Sulabh International Social Service Organization, Calcutta, India
•    Mr John Pickup, Consultant in Scientific Issues, Bridgnorth, Shropshire, UK.
•    Professor Elizabeth A Scott, Department of Biology, Simmons College, Boston, MA USA
•    Professor Carlo Signorelli, Department of Public Health, University of Parma, Italy.

The London School of Hygiene & Tropical Medicine is Britain’s national school of public health and a leading postgraduate institution in Europe for public health and tropical medicine. Part of the University of London, the London School is an internationally recognized center of excellence in public health, international health and tropical medicine with a remarkable depth and breadth of expertise. It is one of the highest-rated research institutions in the UK. The Hygiene Center at the London School of Hygiene & Tropical Medicine can be found at

For further information about the e-Bug project go to or contact Dr Cliodna McNulty ([email protected]) or Dr Donna Lecky ([email protected]) at the Health Protection Agency Primary Care Unit, Microbiology Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN UK.

The International Scientific Forum on Home Hygiene ( is a registered charity with the mission to provide practical advice and guidance on the promotion of health and well-being through improved hygiene. Its main activities include reviewing, interpreting, making accessible and communicating the scientific data relevant to preventing infectious disease transmission in the home.