By Barry C. Fox, M.D., University of Wisconsin
In order to do justice to the concept of hand washing, we have to take ourselves back more than a century to Vienna in 1847 and understand a true, yet tragic story of women giving birth and that of Dr. Ignaz Semmelweis. Who was Dr. Semmelweis? What did he say about maintaining hand hygiene in hospitals?
Dr. Semmelweis worked in a maternity clinic in Vienna in 1847. He was instrumental in saving the lives of many mothers and is known as the father of hand washing.
There were many infections in his maternity wards during this time due to an illness known as puerperal fever, also called childbed fever. It affected women within three days after giving birth. It wasn’t known at the time that this infection was actually caused by contaminated hands of doctors and unsterile instruments after the hospital started an anatomy lab two decades earlier.
Over a period of months, Dr. Semmelweis noted that the mothers who were tended to by medical doctors, all men, had more than three times the rate of death than those tended by midwives. He also made a comparison with a hospital in Dublin, Ireland without an anatomy lab.
This is a transcript from the video series An Introduction to Infectious Diseases. Watch it now, on Wondrium.
Hand Hygiene Explanation of Semmelweis
Semmelweis noted that pregnant mothers who did not have internal pelvic exams survived, and hence he began to suspect a contagious agent. When one of his male medical colleagues died a few days after pricking his finger during an autopsy on a young mother, he observed the colleague’s body at autopsy and it had the same type of damage that was seen with childbed fever.
Dr. Semmelweis now recognized the connection: he observed that doctors often went from touching infected corpses in the cadaver dissection lab, to the maternity ward, where they examined women and delivered babies without hand washing.
Semmelweis directed the doctors at the hospital to use a chlorinated lime solution on their hands prior to and after touching the women. When this procedure was followed, the maternal mortality rate went from a high of 13 percent down to 1 percent over the next two years.
Learn more about the microbes that are all around us.
The Tragic End of Semmelweis
Unfortunately, hundreds of women had died before hand washing became standard practice, and Semmelweis, rather than being appreciated, suffered attacks by the medical profession for his ideas, just as Hippocrates had.
Semmelweis died a sad and tragic death after being tricked into going to an insane asylum, where he was beaten, put in a straitjacket, and confined to a dark cell. He died two weeks later at the age of 47, never having received credit for his extremely important work.
Today, however, Semmelweis is recognized as the pioneer of antiseptic theory, and he is known for his book Etiology, Concept and Prophylaxis of Childbed Fever. Today, there is a metaphor called the Semmelweis reflex for certain human behavior—mainly rejecting new knowledge because it goes against beliefs that are so heavily entrenched in society.
Hand Hygiene Compliance
After hearing this story, which is taught to all medical students, one would think that 100 percent of physicians and other medical personnel would automatically wash their hands between contact with patients. Well, that’s not the reality. The fact that hand washing compliance is not 100 percent gives rise to two interesting questions:
First, are physicians or nursing staff better at hand washing compliance? Secondly, what is the true percentage of hand washing when medical care providers are observed in the hospital? Hand hygiene compliance is at best around 90 percent, but more typically in the 70th to 80th percentile. Also, nurses, perhaps not unexpectedly, are more judicious about hand washing than physicians, as they are more directly involved with the day-to-day patient care management.
Learn more about the body’s immune system.
Infection Control Measures
There are basic infection control principles that healthcare providers must follow to protect both you as a patient and themselves from transmittable pathogens. These are known as standard or universal precautions, and can be used both to protect healthcare providers and for preventing transmission to patients.
The standard measures include hand washing, implementing isolation restrictions, and protecting against blood borne pathogens with personal protective equipment like gloves, gowns, and face shields.
Guidelines on Hand Hygiene
The Centers for Disease Control and Prevention, or CDC, recently published Guidelines for Hand Hygiene that had two major new recommendations. The first involved the use of hand sanitizers for routine hand disinfection and only washing with soap and water when hands were visibly dirty.
Secondly, establishing monitoring programs for hand hygiene compliance. Using alcohol-based hand sanitizers has enabled hygiene to become more convenient and less time-consuming.
The Joint Hospital Commission, another healthcare governing agency, made hand washing compliance a national patient-safety goal. It requires hospitals that are seeking accreditation to develop both compliance monitoring and improvement programs.
Common Questions about Contribution of Dr. Semmelweis in Maintaining Hand Hygiene
The metaphor Semmelweis reflex stands for a certain human behavior that rejects new knowledge because it goes against beliefs that are so heavily entrenched in society.
Semmelweis died a sad and tragic death at the age of 47 after being tricked into going to an insane asylum, where he was beaten, put in a straitjacket, and confined to a dark cell.
The healthcare providers should follow certain standard measures, which include hand washing, implementing isolation restrictions, and protecting against blood borne pathogens with personal protective equipment like gloves, gowns, and face shields.
