Developing resilience against the threat of infectious diseases and anti-microbial resistance: Putting targeted hygiene into practice in home and everyday lives.

Objectives: COVID-19 has highlighted the importance of hygiene in home and everyday life (HEDL) to build population resilience against ongoing infectious disease threats. Despite having high awareness of hygiene, people have relatively poor understanding of hygiene risk which compromises their ability to follow advice. This paper combines new insights into hygiene science and hygiene behaviour to propose a framework for achieving more effective behavior. It is aimed at supporting government initiatives to build hygiene resilience within the UK population. Study design: Non-systematic narrative review. Methods: The review is based on findings of recent consensus reviews, prepared by acknowledged hygiene experts. It also draws on studies of hygiene understanding, drivers for behaviour change and behaviour change models. Results: To build hygiene resilience, HEDL hygiene requires a risk management approach where practices combine to reduce infection risk in community populations to an acceptable level. Using this we construct a framework showing when, where and how to practice hygiene. Based on visualization, it gives clear practical guidance and develops better hygiene understanding. Promoting this approach using health belief models ensures behaviours that are embedded are fit for purpose. Conclusions: A risk management approach to hygiene, promoted through behaviour change models, provides a framework for developing effective resilient hygiene behaviour. To achieve this, however, the separate aspects of HEDL hygiene (food, healthcare, pandemic preparedness) must be combined and communicated in a user-centric manner. Leadership teams must also be established with sole responsibility for HEDL hygiene, and the power to drive change.