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A 21st century view of infection control in everyday settings: the Microbial Theory of Health

Due to significant advances in microbiome science over the past two decades, we are at the brink of a paradigm shift regarding the role of microbes in disease and health which necessitates a fundamental change in the approaches used to prevent transmission of infection. In particular, protection against disease will need to be balanced against need for exposure to naturally diverse microbial communities.

In a new “state of Science” review in the American Journal of Infection Control, Professor Elizabeth Scott (Simmons University, Boston) and colleagues discuss how we need to revise hygiene policy to address this paradigm shift. As they point out, this shift is happening in a world where, contrary to optimistic predictions during the mid-20th century, infectious diseases have not been eradicated. Rather, new infectious agents continue to emerge and/or re-emerge globally including emerging antibiotic-resistant pathogens. This is set against a background where community-based respiratory, gastrointestinal, and skin infections continue to exert a heavy toll on human health and the problem is exacerbated by the aging of the population and the associated increase in percentage (now ~20%) of immunocompromised individuals living in the community. This is without knowing what impact the coronavirus pandemic might have on global health agency and public attitudes to hygiene.

The paper proposes a Microbial Theory of Health which encompasses our total relationship with our microbial world including protection against infection and the need for microbial exposure. The Microbial Theory of Health centres around the risk management approach to hygiene, known as Targeted Hygiene. This is an evidence-based hygiene policy that is employed to prevent transmission of pathogens and the transmission of infectious diseases through targeting only sites, surfaces, and practices that are considered high risk for pathogen transmission.  Targeted Hygiene also discourages indiscriminate use of broad-spectrum microbicides for lower-risk activities and surfaces. 

The authors conclude that “The Microbial Theory of Health including age-appropriate and health-appropriate hygiene practices for home and everyday life, should usher in a new era in which pathogen reduction can be accomplished without indiscriminate elimination of potentially beneficial microbes from the human and environmental microbiomes”.


Author: Scott EA, Nims RW, Rubino JR, IJaz MK.

Published: 08/08/2020

Publication Type: Review