Citation
Larson, Elaine L. & Aiello, Allison E. (2001). Hygiene and Health: An Epidemiologic Link?. American Journal of Infection Control, 29(4), 232-238.Abstract
One of the great achievements of the public health enterprise in the 20th century has been the control of infection. In 1900, one third of all deaths were caused by 3 infectious diseases (pneumonia, tuberculosis, and diarrhea); 40% of these deaths occurred in children younger than 5 years. By 1997, more than half of all deaths were caused by 2 chronic diseases, heart disease and cancer.1 This statistic indicates a profound improvement in infectious disease control that has been attributed to a variety of factors, including vaccination programs, improved public utilities (such as water chlorination and waste disposal), and general improvements in health related to nutrition and personal hygiene.Despite these major health care advances, the economic and social consequences of infectious diseases continue to be serious, even in the “developed” world. For example, in the United States approximately one fourth of visits to primary care providers are associated with infections, and the economic burden has been estimated to be more than $120 billion per year.2 and 3 Between 1980 and 1992 a 58% increase in death from infections occurred in the United States, only half of which was attributed to AIDS.4 Infections acquired in the community are important causes of hospital admissions, particularly for children. Respiratory infections (32%) and gastroenteritis (38%) were the principal causes for admission of 1599 children in one British hospital.5 Each year, nearly 90,000 US children are hospitalized just for respiratory syncytial virus infections.6 Rotavirus causes more than 3 million cases of diarrhea, 50,000 hospitalizations, and up to 40 deaths each year in the United States.7 and 8 In addition, more than 80% of the world's population lives in tropical developing countries in Asia, Africa, and Latin America. In these areas, more than 35 new infectious diseases have been identified in the past 2 decades, and up to 1 out of 4 children still die of diarrhea and dehydration before the age of 5 years.4
Because many factors associated with the control of infections (eg, better nutrition, safe drinking water, vaccination, and improved personal hygiene) have been temporally related to each other, occurring simultaneously or very close in time, measuring the specific impact of any single intervention is difficult, particularly with regard to cleanliness and personal hygiene within the home and community. On one hand, a burgeoning of availability and use of a variety of antibacterial products in homes for bathing, washing clothes and dishes, and general cleaning has occurred. Although the public's renewed interest in issues of cleanliness is evidenced by the demand for such products, a paucity of evidence exists regarding the impact of such products on disease incidence or transmission. On the other hand, in recent years the programmatic emphasis within the formal public health structure has moved away from personal hygiene and the home environment, focusing more on secondary and tertiary prevention and community-wide interventions.3 Hence, the home environment has received little attention from public health professionals in the past few decades, and the question remains: What is the contribution of household hygiene and personal cleanliness practices to the risk of infectious disease transmission? The purpose of this article is to summarize the recent health care literature and to examine the epidemiologic link between personal and household hygiene and risk of infection.
URL
http://dx.doi.org/10.1067/mic.2001.115679Reference Type
Journal ArticleYear Published
2001Journal Title
American Journal of Infection ControlAuthor(s)
Larson, Elaine L.Aiello, Allison E.