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180The number of people who are aware of the existing of germs all around the places has been increased as compared to the past. Most of the people understand the importance of home hygiene and personal hygiene. Hence, they wash and cook the food before they eat. Hand washing is a must whenever they think that they are dirty or after they touch something dirty. However, the increase in knowledge about germs causes germs to become an obsession with some people. Over obsession of people with germs can be labeled as phobia. Germophobia which is also known as mysophobia is defined as "an anxiety disorder characterised by an overreaction to the slightest uncleanliness or an irrational fear of dirt, contamination, or defilement" (Mosby's Dictionary of Medicine, Nursing & Health Professions, 2009). The modern life style and development in science and technology cause human beings to stop exposing to some bacteria and worms as we no longer walk barefoot and will refrigerate our food. (Real Food Forager, 2012) When people are trying to keep themselves as clean as possible, the introduction of hygiene hypothesis causes people to wonder are they getting 'too clean'?
Discovery of Germs
178The improvement made in microscopic optics allowed us to observe tiny living organisms better. (Pommerville, 2010)The germ theory of disease which was introduced by Louis Pasteur, a great chemist and biologist, causes great impact for us. The theory stated that microscopic organisms such as bacteria or germs could cause serious diseases. People started to know that germs might appear in everywhere and could be spread easily. Germs can be found in dirt, food and beverages, pets, garbage and can be spread through dirty hands and flies. (Levenstein, 2012) The discovery of germs and the realization about disease causing germs led to germ revolution. The knowledge regarding germs enabled people to try to reduce the disease transmission by improving hygiene and sanitation. Health care professionals also aware of this and therefore tried to make themselves and the environment free of germs while taking care of patients. The health care system improved a lot after realizing the harmfulness of germs. Safe surgery and large-scale vaccination programs were carried out after the discovery of germs. This discovery also led to the development of antibiotics. (Waller, 2003)
Negative Consequences of Germophobia
117It is true that as we improve our hygiene and sanitation practices through vaccinations, pasteurization of dairy products, hand washing, and drinking treated water, we are free from diseases which killed many people in the past. A lot of lives are saved from chronic diseases and death. However, there are also negative consequences due to obsession with germs. The American Academy of Dermatologists claimed that hand washing practice can cause dermatitis. From a study at University Hospital's Case Medical Centre in Cleveland, among 60 health care workers who washed hands 10 times daily, 63 per cent developed hand dermatitis. (Yeates, 2008) Dermatitis is the irritation of skin due to overexposure of water and overuse of soaps and cleaning agents. (Dermatology Consultants, [no date])
163In order to destroy disease-causing microorganisms, chlorine has been added to treat drinking water. (Chlorine Chemistry Division of the American Chemistry Council, 2010) Antimicrobial agent triclosan reacts readily with chlorine in drinking water to form chloroform. Besides, dioxin can be formed under presence of sunlight. (Rule et. al, 2005) Although exposure to low level of chloroform is not carcinogenic, high doses of it can cause cancer for laboratory animals. (Chlorine Chemistry Division of the American Chemistry Council, 2010) Therefore, it is not safe for human to expose to chloroform though it has not been proved that it is harmful towards human. Many people use antibacterial sanitizers or soaps while washing hands in order to make sure that they are free of germs but the safety of triclosan which is a main ingredient in toothpaste, antibacterial soaps and body washes has been argued. It is sure that triclosan in toothpaste can prevent gingivitis as reviewed by FDA in 1997 but the recent animal testing proved that triclosan can alter hormone regulation. Other studies also showed that triclosan may be one of the causes for antibiotic resistance. (FDA, 2012)
125Antibiotics have been regarded as miraculous compound especially when penicillin, the first antibiotic, was introduced to combat infection. However, the effectiveness of antibiotics is reduced due to overuse. The number of bacteria resistant towards antibiotics increases as the number of antibiotics used increases. (Salyers and Whitt, 2005) The irrational use of antimicrobials leads to the emergence of multidrug resistant 'superbugs' such as methicillin resistant Staphylococcus aureus (MRSA) and New Delhi metallo-ß-lactamase 1 (NDM-1). (Thomas and Nandave, 2011) Antibiotic resistance becomes problem all over the world. At the 8th International Symposium on Antimicrobial Agents and Resistance held in Korea in April 2011, the problem in Asia was highlighted to gain concern all over the world. (Deresinski, 2011) In a recent report of the World Health Organisation, the lack of available treatments for superbugs has been emphasized. (Pharmawatch, 2007)
181Hygiene hypothesis was first introduced by David P. Strachan. This theory suggested that immune-related health problems such as allergies could be caused by lack of early exposure to germs and stimuli which people used to have. (Smith, 2010) The young children now are nurtured in environment which is "too clean" that prevent their immune system to be stimulated effectively and mature. This causes the children's immune system cannot react properly when they encounter germs after growing up. (Davis, 2012) According to epidemiological studies, children of farmers have lower risk of getting asthma as their blood cells express higher amount of CD14 as compared to children of non-farmers. (Lauener et al, 2002) Moreover, children with elder siblings at home have less chance to develop asthma as their siblings expose germs to them and cause them to develop stronger immune system. The occurrence of asthma increases nowadays as the family sizes decrease. (Mutius, 2001)
Number of Older Siblings
Number of Children
Percentage of Children with Asthma (%)
Table 1. Percentage of Children with Asthma According to the Number of Older Siblings and the Age at Entry into Day Care. (Ball et al, 2000)
The research has been done among 1035 children. The results showed that the percentage of children with asthma decreased as the number of older siblings increased. Children with more exposure to other children had lower risk of developing asthma. (Ball et al, 2000)
"Old Friends" Hypothesis
240Even though it has been discussed for a long time that being too clean may cause immune-related diseases after the introduction of hygiene hypothesis, there is no evidence which can prove that cleanliness increases risk of getting those diseases. Hence, "Old Friends" hypothesis was proposed by Rook in 2003 as hygiene hypothesis cannot explain the correct ideas and it is misleading. This hypothesis stated that we should expose to microbes which evolved long time ago during the development of human immune system for immune regulation but not microbes which cause infection diseases. (Bloomfield et al, 2012) Hygiene, sanitation and usage of antibiotics protect us from infectious diseases but at the same time these cause us to lost touch with "old friends". It is not right that cleaning habits or "sterile" homes can cause diseases as even the cleanest looking home has microbes. After thorough cleaning, microbes still can be replaced soon through dust, air, human bodies, pets and food. (News-Medical.Net, 2012) The truth is that the modern houses now in urban areas have different and less diversity of microbes as compared to the past when people stayed in rural surroundings. The diets, lifestyles and outside environment now are very different compared to the past. All of these lead us to less exposure towards microbes which we co-evolved. Besides allergies, deficiency in exposure to microbes can cause chronic inflammatory diseases (CIDs) such as type 1 diabetes and multiple sclerosis, inflammatory bowel disease (IBD), some cancers and depression. (Bloomfield et al, 2012)
Useful microbes unsure
The Right Ways
193Starting from the fear and panic after the discovery of germs until the recent proposes about the importance of certain microbes, humans are always in a dilemma on whether we should be clean or not. In facts, we need to be clean so that we can keep ourselves away from infectious diseases such as gastrointestinal and respiratory illnesses. Personal hygiene and home hygiene should not be abandoned as they are vital in combating diseases which spread and kill many lives. Many people are wondering about the usage of antimicrobial products.
Table 2. Rates of at Least One Infectious Disease Symptom for Each Household-Month by Group. (Larson et al, 2004)
From the research that was conducted in 2004, there was no significant difference between antibacterial and non-antibacterial group on infectious disease symptoms. Plain soap is as effective as antibacterial soaps. (Lanson et al, 2004) This shows that antibacterial soaps and sanitizers are not necessary during hand washing. Since the antimicrobial products and disinfectants do not really show the effectiveness in reducing illnesses, the usage should be reduced as they may contain chemicals that are harmful. In order to increase the exposure towards beneficial microbes, people should be encouraged to carry out more activities at rural areas where diversity of microbes is similar to the past.
121The myths about autoimmune diseases are caused by 'sterile homes' or being 'too clean' should be dismantled. We are not being 'too clean' as there is no places we stay that are completely free from germs. "Old Friends" hypothesis has been introduced to prevent people from relaxing cleanliness and allow dangerous pathogens to cause severe illnesses. The importance of hygiene should not be underrated as it is the main way to prevent transmission of diseases. Good hygiene practices should be carried out to prevent negative consequences of overdoing. The concern now is that studies should be carried out to determine ways to allow people to expose to the right kinds of microbes which are essential for the development of immune system.