Against disease: the impact of hygiene and cleanliness on health

This supplement, written as a set of 4 papers is written to support healthcare professionals and others who are asked to provide information to the community about the role of hygiene in the prevention of infection.The historical facts outlined in the first paper describe the endless struggle with devastating epidemics and unsanitary conditions leading to disease, particularly infant mortality and the early death of young adults. The ‘‘health revolution’’, as described in papers 2 and 3, in the late 18th and early 19th centuries brought about a fundamental upset of the status quo in these two regions and the dawning of an era in which disease and early death is no longer inevitable. A variety of medical, environmental, technical, and political innovations that were introduced as far back as 1850 interacted to gradually eliminate the sources or transmission routes of the ‘‘big killers.’’ A substantial but overlooked component of the health revolution was a sociocultural transformation in personal hygiene and cleanliness. The quarter century 1890 to 1915, in particular, was the beginning of a mass change in bathing, laundering, and domestic hygiene practice in the United States and England. A basic hypothesis is that personal hygiene and domestic cleanliness—including bathing, showering, laundering, dishwashing, and housecleaning— played an essential but subtle and generally ignored role in the revolution. To support this hypothesis, paper 2 examines records of soap production and consumption, bathing and hygiene habits, epidemiological data, and morbidity and mortality data from various areas of the world. Today, as described in the third paper, the health revolution continues in the form of personal hygiene and household cleanliness—two important disease-prevention strategies. This supplement includes an examination of the effectiveness of handwashing as well as household cleaning and disinfecting practices today in removing and killing microbes. The authors conclude that the current status of cleanliness and the resulting health benefits in developed countries shouldn’t be taken for granted. They are only of relatively recent origin, are confined geographically, and require continuous nurturing. American Journal of Infection Control 2008; 36 (suppl 3):S109-166