The History of Hand Hygiene in Health Care
Handwashing with soap and water has been considered a measure of personal hygiene for centuries now. In medicine, hand hygiene is a basic, important procedure that is second nature to all clinicians. It is almost impossible to picture a time in medicine without proper hand-cleaning technique.
However, such time exists, and it took a lot of effort to change that. One of the significant figures contributing to changing that is Ignaz Semmelweis. In the mid-1800s, studies by Semmelweis in Vienna, Austria, established that hospital-acquired diseases were transmitted via the hands of health care workers.
In 1847, Semmelweiss was appointed as a house officer in one of the two obstetric clinics at the University of Vienna Allgemeine Krankenhaus (General Hospital). He observed that maternal mortality rates, mostly attributable to puerperal fever, were substantially higher in one clinic compared with the other, with the clinic where labor is helped by doctors and medical students had a higher mortality rate (16%) than the one where labor was helped by midwives (7%).
Semmelweis also noted that doctors and medical students often went directly to the delivery suite after performing autopsies and had a disagreeable odor on their hands despite handwashing with soap and water before entering the clinic. “Germ theory” hadn’t been proposed at this time, so he hypothesized that “cadaverous particles” were transmitted via the hands of doctors and students from the autopsy room to the delivery theatre and caused the puerperal fever. As a consequence, Semmelweis recommended that hands be scrubbed in a chlorinated lime solution before every patient contact and particularly after leaving the autopsy room. Following the implementation of this measure, the mortality rate fell dramatically to 3% in the clinic most affected and remained low thereafter.
Unfortunately, Semmelweis failed to observe a sustained change in their colleagues’ behavior. In particular, Semmelweis experienced great difficulties in convincing his colleagues and administrators of the benefits of this procedure. Even though mortality rate dropped drastically, many of his colleagues refused to continue with the procedure. Some feeling as if they were to blame for the deaths that had previously occurred.
In the light of the principles of social marketing today, his major error was that he imposed a system change (the use of the chlorinated lime solution) without consulting the opinion of his collaborators. Semmelweis is considered not only the father of hand hygiene, but his intervention is also a model of epidemiologically driven strategies to prevent infection.
“Synergizing Diversity, Thriving in Unity”
World Health Organization. (2009). Historical Perspective on Hand Hygine in Health Care – WHO gudelines on hand hygiene in health care. http://whqlibdoc. who. int/publications/2009/9789241597906_eng. pdf.