How better home hygiene could curb antibiotic resistance

Pharmacologists and infectious disease specialists say there is an urgent need to promote good hygiene in the home and in community settings. They believe that this will be essential in reducing antibiotic use and preventing the spread of drug-resistant bacteria in the coming years.

Rates of resistance to commonly used antibiotics have already reached 40–60% in some countries outside the Organisation for Economic Co-operation and Development (OECD) and are set to continue rising fast.

In OECD countries, rates of resistance could reach nearly 1 in 5 (or 18%) by 2030 for eight different bacterium-antibiotic combinations.

By 2050, about 10 million people could die each year as a result of resistance to antimicrobial agents.

While policymakers usually focus on hygiene in healthcare settings, such as hospitals, a group of pharmacology and infectious disease experts believes that improved hygiene in homes and community settings is just as important.

The scientists have published a position paper in the American Journal of Infection Control on behalf of the Global Hygiene Council.

“Although global and national [antimicrobial resistance] action plans are in place,” they write, “infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed.”

They have also launched a manifesto that calls on health policymakers to recognize the importance of this topic.

‘More urgent than ever’

Simple hygiene measures, such as hand washing, can help reduce infections and antibiotic use, the authors argue. In turn, this will minimize the development of resistance.

“In light of the current COVID-19 pandemic and evidence presented in this paper, it is more urgent than ever for policymakers to recognize the role of community hygiene to minimize the spread of infections, which, in turn, will help in reducing the consumption of antibiotics and help the fight against [antimicrobial resistance],” says lead author Prof. Jean-Yves Maillard from the School of Pharmacy and Pharmaceutical Sciences at Cardiff University in the United Kingdom.

The World Health Organization (WHO) estimate that 35% of common infections are already resistant to currently available medicines, with this figure rising to 80–90% in some low and middle income countries.

Overuse of the drugs accelerates the development of resistance. In the United States, for example, the Centers for Disease Control and Prevention (CDC) estimate that of the 80–90% of antibiotic use that occurs outside hospitals, about half is inappropriate or unnecessary.

The authors point out that while the majority of bacteria that are multidrug-resistant (resistant to at least one agent in three or more antimicrobial classes) get picked up in hospitals, some have become prevalent in the community.

Patients leaving the hospital can carry methicillin-resistant Staphylococcus aureus (MRSA) on their skin, for example, or resistant strains of enterobacteria in their gut. Resistant bacteria can then pass to other family members.

The authors write:

“Although the precise impact of hygiene on transmission of infection between community and healthcare settings needs further investigation, it is important to recognize that reducing the need for antibiotic prescribing and the circulation of [antimicrobial-resistant] strains in healthcare settings cannot be achieved without also reducing circulation of infections and [resistant] strains in the community. We cannot allow hygiene in home and everyday life settings to become the weak link in the chain.”

Hand washing is a crucial measure

They argue that better hand hygiene would prevent many infections in the home and in community settings, such as schools, nurseries, and workplaces.

Only about 19% of people wash their hands after using the toilet, according to a review of research that the paper cites. The same review found that hand washing reduces the risk of diarrhea by nearly one-quarter (23%) in studies with good methodological design.

Educating people to wash their hands with ordinary soap is one of the best ways to reduce infections, according to experts. Overall, research has shown that improvements in hand hygiene lead to a 21% reduction in respiratory illnesses and a 31% reduction in gastrointestinal illnesses.

In addition, the position paper highlights the problem of foodborne pathogens, including Salmonella, Campylobacter, and Escherichia coli. These affect millions of people globally every year, causing diarrhea and other debilitating symptoms.

A 2014 study in Mexico found Salmonella in almost all cleaning cloths. Soaking these dish clothes in a 2% solution of bleach twice a day reduced the bacteria by 98%.

Key risks and strategies

The authors identify key risk moments for transmitting infections in the home. These are:

• food handling, including contaminated chopping boards and kitchen sponges
• using the toilet
• changing a baby’s diaper
• coughing, sneezing, and nose blowing
• touching surfaces that others frequently touch
• handling and laundering clothing and household linen
• caring for domestic animals
• disposing of refuse
• caring for an infected family member

As key strategies to combat infection in the home, they recommend:

• soap or detergent-based cleaning together with adequate rinsing
• alcohol-based hand sanitizer
• inactivation or eradication using a disinfectant on hard surfaces
• mechanical removal using dry wiping
• heating to at least 60°C (140°F)
• UV treatment
• a combination of the above

However, they note that further research is necessary to evaluate the extent to which these practices might contribute to preventing the transmission of antimicrobial-resistant bacteria.

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