1 EUROSURVEILLANCE Vol. 13 · Issues 4–6 · Apr–Jun 2008 · www.eurosurveillance.orgPerspectivesP r e v e n t i o n o f t h e s P r e a d o f i n f e c t i o n – t h e n e e d f o r a f a m i l y - c e n t r e d a P P r o a c h t o h y g i e n e P r o m o t i o nS Bloomfield ([email protected])1,2, M Exner1,3, G M Fara1,4, E A Scott1,51. International Scientific Forum on Home Hygiene, Cheshire, United Kingdom2. London School of Hygiene and Tropical Medicine, London, United Kingdom3. Institute for Hygiene and Public Health, University of Bonn, Bonn, Germany4. Department of Public Health Sciences, G. Sanarelli Città Universitaria, Rome, Italy5. Simmons College, Boston, United StatesInfectious diseases circulating in the home and community are a continuing and significant burden on the health and prosperity of the European community. They could, however, be significantly reduced by better standards of hygiene. Across Europe, public health is currently structured such that the separate aspects of hygiene in different settings (food hygiene, personal hygiene, handwashing, pandemic flu preparedness, patient empowerment etc.) are dealt with by separate agencies. If efforts to promote hygiene at community level are to be successful in changing behaviour, we need a concerted family-centred approach to ensure that a basic understanding of infectious disease agents and their mechanisms of spread, together with an understanding of a risk-based approach to hygiene, are promoted as part of the school curriculum and as part of public health campaigns. Alongside this, we also need unambiguous communication with the public on issues such as the hygiene hypothesis and environmental issues.IntroductionThe last two decades have seen infectious diseases moving steadily back up the health agenda, prompting new emphasis on strategies for prevention and control. Increasingly, this includes strategies to reduce the spread of infection within the family at home, and in their social and work lives outside the home. In the event of a flu pandemic, it is likely that hygiene will be a first line of defence during the early critical period before mass vaccination becomes available. ‘Global Preparedness’ means that respiratory hygiene needs to become part of our daily lives already before such an event; the evidence suggests that not just protection from coughs and sneezes, but also hand and surface hygiene play a part in reducing the spread of respiratory infections such as colds and also influenza [1,2]. Whereas at one time there was a feeling that it was only a matter of time before we could ‘close the book’ on infectious diseases, experience now shows that, as soon as we begin to get one pathogen under control, another emerges. Indications are that poor hygiene is a contributory factor in the spread of pathogens such as norovirus, Helicobacter pylori, Legionella and Campylobacter, pathogens which were largely unheard of before the 1980s. Across Europe, healthcare-associated infections (HCAIs) are no longer seen as a nuisance, but as a major barrier to delivering health. In addition, there is acceptance that controlling infections such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile and norovirus is a community as well as a hospital problem [3]. Hospital managers now realise that managing HCAI is hampered by people (new patients, visitors and healthcare workers) walking into their facilities who are silent carriers of these organisms, and that one of the key aims is containing these infections at the source in the community. Hygiene is also recognised as key to tackling antibiotic resistance. Good hygiene means fewer infections, fewer patients demanding antibiotics from their general practitioner, and thus fewer resistant strains developing and circulating in the community. Reducing the reservoir of carriers in the community reduces the risk of these strains being carried into healthcare facilities by new patients.Across Europe, governments are under pressure to fund the level of healthcare that people expect. Although shorter hospital stays mean reduced hospital costs, the gains are likely to be undermined by inadequate infection control associated with care at home. Across Europe, up to one in five people living at home have impaired immunity to infection and need special care [1]. Those at risk include the growing elderly population, patients discharged earlier from hospital as a result of shorter hospital stays, and patients undergoing outpatient treatments such as chemotherapy, or patients with indwelling catheters. The 1990s saw rapid increases in the incidence of food poisoning, and finally a call to action to reverse this trend. Although this has been achieved in many European countries, levels of food-borne disease remain unacceptably high. ‘The Zoonoses Report’, published by the European Food Safety Authority (EFSA) and the European Centre for Disease Control and Prevention (ECDC) in 2007, estimated that one third of populations in developed countries are affected by food-borne diseases every year [4]. The 2003 World Health Organization (WHO) report concluded that about 40% of reported food-borne outbreaks in the WHO European Region occur in private homes [5]. The potential for food poisoning at home is indicated by the prevalence of food-related pathogens in products purchased from retail premises. The ECDC review estimated that campylobacter were most commonly detected in fresh poultry meat, with an average of 35% positive samples. Salmonella was most commonly found in fresh poultry and pork meat, with 5.6% and 1.0% positive samples. Chapman et al. showed that 0.4-0.8% of meat products purchased from butchers in the United Kingdom (UK) were positive for Escherichia coli O157 [6].EUROSURVEILLANCE Vol. 13 · Issues 4–6 · Apr–Jun 2008 · www.eurosurveillance.org 2Obtaining a true picture of the burden of gastrointestinal infections circulating in the community is difficult. Surveillance systems mostly focus on food-borne disease, the data coming mainly from large outbreaks in restaurants, hospitals etc, whilst sporadic cases, particularly milder infections in the home go largely unreported. Community-based studies carried out in the UK [7]
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