In findings published Tuesday in The Lancet Infectious Diseases, researchers in the United Kingdom established that poor hygiene by humans, specifically insufficient hand washing after defecation, is especially responsible for the spread of antibiotic-resistant — superbug — strains of Escerichia coli (E. coli) bacteria.
"We wanted to find out how these superbugs are spread — and whether there is a cross-over from the food chain to humans" said lead author Professor David Livermore of the University of East Anglia's medical school. 
There are many strains of E. coli, and a large number are either harmless to humans or cause only mild health problems.  Infection with a pathogenic strain, however, can cause blood poisoning or other serious conditions.
In this work, scientists assessed the strains of E. coli from infected humans and looked for the same strains in sewage, dairy farm slurry, human faeces, and contaminated foods including beef, pork, chicken, salad and fruit from different parts of Great Britain.
"[T]he strains of resistant E. coli [found in food], were almost entirely different from the types found in human faeces, sewage and bloodstream infections", said Dr. Livermore. "[...] Rather — and unpalatably — the likeliest route of transmission for ESBL-E. coli is directly from human to human, with faecal particles from one person reaching the mouth of another.  We need to carry on cooking chicken well and never to alternately handle raw meat and salad. There are plenty of important food-poisoning bacteria, including other strains of E. coli, that do go down the food chain. But here — in the case of ESBL-E. coli — it's much more important to wash your hands after going to the toilet."
According to a survey published in 2017 by the Royal Pharmaceutical Society, 84% of surveyed Britons did not wash their hands well enough from a hygiene perspective — at least twenty seconds with soap and water.  Society President Ash Soni told the public, "If we can reduce the number of illnesses where antibiotics are needed [...] we can reduce antibiotic resistance by saving these important medicines for when they are really required."

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Wash your hands or else spread superbug E. coli, say scientists