The infection potential in the home and the role of hygiene: historical and current perspectives.

The control of infection through hygiene has a long erratic history. Personal hygiene and handwashing was less appreciated in the past, since it was not known that invisible organisms could spread from apparently clean hands and surfaces. The role of a hygienic home environment received little attention until the 19th century. Since then, the modern tradition of hygiene has served us well, with improved water and drainage developing alongside vaccination, antibiotics, water purification, improved food production and hygienic food preparation and storage. Two major epidemiological trends are relevant to hygiene perspectives: the decline in the morbidity and mortality from infection, and the transition towards higher levels of chronic or debilitating disease. While mortality from some infections has decreased, communicable disease is no less prevalent. Infectious intestinal disease is still unacceptably high in both developed and developing countries. The control of infection within the home needs to take account of changing epidemiological trends, emphasis on evidence-based approaches and loss of public awareness of the role of hygiene. In earlier eras lack of research on the home environment prevented sufficient attention to infection transmission in the domestic setting. Recent research has demonstrated how microbial contamination can be transmitted by activities in the home. Application of this knowledge could significantly reduce the continuing impact of infectious diseases in our communities.