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RSPH calls for clean-up of public attitudes to hygiene

The Royal Society for Public Health have published a report entitled  Too clean or not too clean - the case for targeted hygiene in home and everyday life which calls for an end to the myth that people are being too hygienic for their own good.  The report can be found at: https://www.rsph.org.uk/our-work/policy/infection-control/too-clean-or-not-too-clean.html.

The RSPH call to action is in line with government health policy which increasingly recognises that getting the public to practice good hygiene is vital for safeguarding public health and reducing antibiotic prescribing. The #overlay=node/add/latest-from-ifh">2019 UK Antimicrobial Resistance Action Plan https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/784894/UK_AMR_5_year_national_action_plan.pdfsays “Health providers can only do so much; when it comes to preventing infections in the community, the public have a huge part to play”.  Policy-makers faced with ever-increasing costs, recognize that sustaining the quality of state-funded healthcare requires getting the public to take greater responsibility for their own health  https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf and are investing in strategies to promote hygiene behaviour change.

Set against this, the RSPH paper also addresses growing evidence that exposure to “good” microbes through contact with our human, animal and natural environment is also essential for health. These microbes allow us to build a diverse microbiome in our gut, respiratory tract, skin etc.  Failure to maintain a diverse microbiota on and in our body is being linked to increasing range of diseases including allergic (asthma, eczema, hay fever, food allergies) and autoimmune diseases (such as multiple sclerosis, type 1 diabetes and inflammatory bowel disease) which have risen dramatically, particularly in the last 50 years. It is also being linked to other disorders such as depression and obesity.

The bottom line for public health policy is that in future we are going to have to view our microbial world very differently - adopting lifestyles which sustain exposure to the right sort of microbes, whilst at the same time protecting against those that cause disease   

Indications are that lifestyle changes that can promote exposures to essential microbes include spending more time outdoors and interacting with friends, family and pets. Since early exposure to good microbes appears to be important, opting for natural childbirth and breast feeding are also being seen as important, whilst avoiding unnecessary use of antibiotics and adopting a healthy diet are important for sustaining a healthy diverse microbiome.

Since 1997 IFH has been developing an approach to infection prevention in home and everyday life which has come to be known as Targeted Hygiene. Targeted Hygiene means focusing hygiene practices at the times and places that matter to break the chain of infection.  The times when infections are most likely to spread are during food preparation, using the toilet, coughing, sneezing and nose blowing, caring for pets etc whilst the surfaces most likely to spread harmful microbes in these situations are hands, hand contact surfaces and cleaning cloths and utensils. Targeted hygiene is set out in more detail here.

Targeted hygiene is key because it offers a lifestyle choice which maximises protection at times when we most risk exposure to harmful microbes, but at the same time maximizes ongoing interaction with microbial friends from human, animal and natural environments. In their report RSPH call for widespread adoption of Targeted Hygiene as the most effective way of breaking the chain of infection.

By including the results of a national telephone survey looking at public understanding and practice of hygiene, the RSPH report reveals that while the value of hygiene is broadly understood, there are key misconceptions and gaps in understanding of hygiene. The questionnaire shows that the public have become confused about what hygiene is, and how it differs from cleanliness in a way that represents a challenging barrier to change. For example

  • Whereas cleaning means removing dirt and microbes, hygiene means cleaning in the places and times that matter - in the right way - to break the chain of infection whilst preparing food, using the toilet, caring for pets etc.
  • One in four (23%) of the public still have a view hygiene in the home is not important, thinking children need to be exposed to harmful germs to build their immune system. This is despite the fact that the link between childhood infections and allergies is no longer supported.
  • When asked “Which of the following factors do you believe is preventing children coming into contact with enough good bacteria?”, although 56 and 59% responded that taking too many antibiotics and spending less time outdoors were critical factors, almost as many, 55 and 52%, said that “Keeping our homes too clean” and “Using too many antibacterial cleaners” were important.

In addition to calling for adoption of Targeted Hygiene as the most effective way of breaking the chain of infection, RSPH  is also calling for action to change public understanding of hygiene - what it is and how it works  They say “Schools, the media, and manufacturers of hygiene products all have a responsibility to advocate for clear messages about Targeted Hygiene which includes understanding the difference between cleanliness and hygiene, and dispelling the myth that disease likes allergies are caused by “too much” household cleanliness”.

This RSPH report has been prompted by recent publication of a white paper commissioned by the International Scientific Forum on Home Hygiene (IFH).which calls for an integrated strategy for developing and promoting hygiene behaviour change in home and everyday life” The IFH white paper can be found here.

Author: Royal Society for Public Health

Published: 25/06/2019

Publication Type: Review, Public Leaflet