Bygiene: The New Paradigm of Bidirectional Hygiene

Abstract

The pervasive dogma surrounding the evolution of virulence - -namely, that a pathogen's virulence decreases over time to prevent threatening its host -- is an archaic assertion that is more appropriately cast as an optimization of virulence cost and benefit. However, the prevailing attitudes underlying practices of medical hygiene and sanitization remain entrenched in these passé ideas. This is true despite the emergence of evidence linking those practices to mounting virulence and antimicrobial resistance in the hospital. It is, therefore, our position that just as the microbe has sought an optimized balance in virulence, so should we seek such an optimized balance in vigilance, complementing warfare with restoration. We call this approach "bygiene," or bidirectional hygiene.

Keywords: antibiotics; drug resistance; ecology; microbiome; pathogenicity; virulence.

Figure 1

The continuum of modern hygiene. Hygienic practices in the outer circles are typically practiced along with those in the inner circles. An ideal scenario would involve practicing baseline and extended hygienic practices while eliminating super-sanitization.