Bygiene: The new paradigm of bidirectional hygiene

Gabriel A. Al-Ghalith, Dan Knights

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


The pervasive dogma surrounding the evolution of virulence namely, that a pathogen’s virulence de-creases 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.

Original languageEnglish (US)
Pages (from-to)359-365
Number of pages7
JournalYale Journal of Biology and Medicine
Issue number4
StatePublished - Dec 2015

Bibliographical note

Publisher Copyright:
© 2015.


  • Antibiotics
  • Drug resistance
  • Ecology
  • Microbiome
  • Pathogenicity
  • Virulence


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