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You are better to wash at least from time to time.
Knox infection is purely chance based and isn't affected by how dirty you are.
At least if that's still how it is in B42.
Well.... it can make you sad and anxious, it can increase chance of infection when getting wounded, it can increase chance of getting sick when eating/preparing food. Seems to be very low... but it is there.
I wash once in a while.
It's a very common myth in the game that getting dirty and covered in blood changes Knox virus chances, because it would be logical after all. Being dirty does influence the risk of a REGULAR, I repeat, REGULAR infection. Not Knox virus. Not the zombie virus. Regular infection only slows down healing and can be ignored. The rates for Knox virus / zombification are as follows.
Scratch = 7 percent
Laceration = 25 percent
Bite = 100 percent.
That is all. No modifiers from anything, ever. Period.
Again all of this is for build 41. Build 42, I haven't heard about any changes and doubt there have been or people would be all over it.
Back to the topic, yeah, knox virus roll happen only on the wound creation. And I believe the devs fixed the bugs where even trees could infect you.
there are downsides to dirty bloody clothes, but its not the worst thing.
Dirt and blood don't affect cooking either. Unless that's changed now. Apparently you can open canned food with knives now, just like the mod that provides the same function. In that mod, you can die when you use bloodied knives to open the canned food. But no one has confirmed if that's a vanilla feature in b42 now.
Dirt and blood do nothing outside of causing wound infection in b41. And that doesn't necessarily remain the same now in b42.
As I said above, my character is always filthy as ♥♥♥♥, and I can say that I've never seen them sick from cooking while being dirty. Of course the caveat is that my cooking utensils are all clean. I haven't tried cooking with bloodied knives.