An article published in the latest issue of Perspectives in Public Health illustrates public confusion about the microbes we live with, and whether they are good or bad for our health.

Misunderstanding has arisen because, on the one hand we are being told that we need exposure to microbes to build up the healthy bacteria in our gut and on our skin (our human microbiome). But we are also told we must not relax standards of hygiene – firstly because it keeps us healthy, and secondly because preventing infection is key to tackling the global problem of antimicrobial resistance, by reducing the need for antibiotic prescribing.

The article, based on polling commissioned by RSPH, reveals that 98% of the public acknowledged the importance of hygiene. One in two (50%) agreed that poor hygiene contributes to antibiotic resistance and three in four (74%) believed hygiene is important to reduce pressure on the NHS by preventing ill health.

However, further questioning revealed that people need clearer advice about what hygiene really means to them. For many, there appears to be a misconception that being hygienic is about removing dirt – which is often incorrectly regarded as the main source of harmful microbes. More than 70% said that it is very or fairly important to remove harmful microbes from floors, and a third (32%) believed not using an antibacterial to clean kitchen and bathroom floors was risky.

To address this confusion, the article sets out the nine “moments” at which it is vital to practise good hygiene in daily life – the times when harmful microbes are most likely to be spread:

1. During food handling;
2. Whilst eating with fingers;
3. Using the toilet and changing a nappy;
4. Coughing, sneezing and nose blowing;
5. Touching surfaces frequently touched by other people;
6. Handling and laundering ‘dirty’ clothing and household linens;
7. Caring for domestic animals;
8. Handling and disposing of refuse;
9. Caring for an infected family member.

These form the basis of an approach to home and everyday hygiene known as Targeted Hygiene, developed by the International Scientific Forum on Home Hygiene (IFH) and endorsed by RSPH in the 2019 report Too Clean or Not Too Clean.

Professor Sally Bloomfield of London School of Hygiene and Tropical Medicine, Chairman of the IFH and author of the article said: “The problem is that we are not sure what being hygienic means and don’t really understand the difference between hygiene and cleanliness. To achieve change we have to blow the myth about being too clean. This misbelief has persisted since the hygiene hypothesis – that cleanliness is linked to rising allergies in children – was first proposed in 1989. We now know that the exposure children need is not to infectious diseases, but microbes we share with friends and family in our natural environment.”

Professor Lisa Ackerley, RSPH Trustee and food hygiene expert commented: “An obvious example of targeted hygiene is when we are handling raw poultry. After preparation, the places which must be cleaned and disinfected are our hands and anything our hands or the chicken has touched, including the chopping board, knife and cleaning cloth.  If we clean immediately in a targeted manner at risk moments, the risk is contained and we have broken the journey of the germ.”