Hygiene in the home: What can we learn from the Covid-19 pandemic?

In the past, hygiene in the home and everyday life (HEDL) has often been considered less important than infection prevention and control in health facilities. However, the Covid-19 pandemic has proved otherwise. Public hygiene and the cleanliness of our homes has a major, yet under-recognised, role to play in driving down infection rates and preventing the spread of infectious diseases. This is something that needs to be better recognised by politicians, policymakers, healthcare professionals and others and given a more equal allocation of resources and education to the public.

Improving public hygiene can have a significant impact on society at large - alleviating some of the pressure the NHS is currently under and reducing the cost to businesses lessening the number of sick days people take. But most importantly, it will help to reduce antimicrobial resistance. 

Antimicrobial resistance

Antimicrobial resistance is becoming an increasingly large issue and is considered one of the biggest threats to global health, food security and development today. It’s estimated that 25,000 people already die every year in Europe because of infections resistant to antibiotics, and that figure is rising year on year. The rapid emergence of resistant bacteria is occurring worldwide, threatening the efficacy of antibiotics and antimicrobial treatments, which we have previously relied on to save millions of lives. This has been attributed to the overuse and misuse of these medications, but public hygiene is also a contributing factor.

But according to the IFH, the reduction of antibiotic consumption is not sufficient to control antimicrobial resistance - instead, measures to improve sanitation and public hygiene are needed to tackle the resistance on a global scale. Bacterial infections, which are largely treated with antibiotics, are largely transmitted in the home - a 2016 study of the most contaminated objects in the home found over 340 different bacteria on 30 different objects. Bacteria divide every 20 minutes at the right temperature and with the right nutrients.

Any microbes we pick up on a day to day basis will be brought back into the home, where they continue to divide and spread from person to person. Households also appear to be the highest risk setting for transmission of COVID-19.

Targeted hygiene

The International Scientific Forum (IFH) have developed an approach to hygiene in the home called Targeted Hygiene - aimed at increasing public health through increased cleanliness in our homes. Targeted Hygiene means focusing on hygiene practices at the times (moments) and in the places that matter most. This provides a basis for prompting action when and where needed, thereby building behaviour change in the future.

The IFH have identified a ‘ranking of surfaces’ for people to follow a targeted hygiene routine, focusing on these 4 key areas in order. This includes...

• Surfaces with the highest risk, i.e. hand contact surfaces, food contact surfaces and cleaning utensils (including kitchen cloths, sponges, washing up brushes etc).
• Clothing (particularly clothing in contact with the human body), bed linens, hand and bath towels and face cloths etc.
• Toilets and sink, bath, washbasin and shower surfaces
• Floors, walls, furniture and other surfaces (i.e. not hand or food contact surfaces). Although they may look visibly dirty and have high levels of microbes, they are considered low risk partly because harmful microbes are unlikely to be present and partly because we do not have frequent exposure to them. This means the daily/weekly routine of keeping floors, furniture, etc visibly clean contributes little to preventing microbial exposure, compared with practices carried out at critical moments.