Significance of biocide usage and antimicrobial resistance in domiciliary environments.

Recent events have raised awareness of the need for effective hygiene in the home. Not least is the requirement to reduce antibiotic resistance by reducing the need for antibiotic prescribing. Current evidence suggests that improved hygiene in the domestic setting could have a significant impact. Recently, it has been suggested that widespread biocide usage, particularly in consumer products, may be a contributory factor in antibiotic resistance. In developing home hygiene policies, however, it is important that biocide use as an integral part of good hygiene practice is not discouraged in situations where there is real benefit. Although laboratory data indicate possible links, it is necessary to assess whether and to what extent biocide exposure could contribute to antibiotic resistance in clinical practice. The extent to which reduced susceptibility to biocides resulting from biocide exposure could compromise their 'in-use' effectiveness must also be considered. Equally, it is important that changes in susceptibility induced by biocide exposure are assessed relative to those induced by antibiotic exposure or the phenotypic changes induced by 'normal' environmental 'stresses'. It is proposed that to be effective, home hygiene policy should be based on the concept of risk assessment and risk prevention. Using this approach, critical risk situations are identified and appropriate hygiene procedures applied to reduce risks. This may involve either soap and water cleaning, or cleaning combined with a disinfection process. A 'targeted' hygiene approach not only provides the most effective means of preventing infectious disease, it also offers a means of addressing concerns about 'too much hygiene' and 'too many antibacterials' amongst a public who have lost confidence regarding appropriate hygiene for their home environment.