One of our favourite childhood books was a delightfully illustrated Russian book called Wash ‘Em Clean. It was a funny poem about a little boy who would not wash and bathe, and how he was converted to cleanliness.
Instilling the habit of proper hand hygiene has been one of the great challenges through the ages.
On 15 October, in 2008, over 120 million children in more than 70 countries around the world washed their hands with soap. This marked the first Global Handwashing Day, founded by the Global Handwashing Partnership as a way to raise awareness about the importance of washing hands. Since then, this day is celebrated annually to reiterate the simplicity and value of clean hands. The theme for this year is Hand Hygiene For All.
Ironically, in just over a decade since then, a single Handwashing Day is not enough. Handwashing is making daily headlines across the world as, possibly, the most effective protection from Covid 19.
Interestingly this was the very message that was sought to be promoted as far back as 1847 by Dr. Ignaz Semmelweis, a German-Hungarian physician and scientist. Armed with a doctorate from the University of Vienna and a Master’s degree in midwifery, Semmelweis joined as Director of the maternity clinic at the Vienna General Hospital in Austria. At that time a mysterious infection known as ‘childbed fever’ was leading to high mortality rates in new mothers in maternity wards across Europe. Semmelweis was determined to understand what caused this rampant infection, and he began to closely observe the practices of the doctors on duty.
Until the late 1800s surgeons did not scrub up before and after surgery, or even wash their hands between patients; causing infections to be transferred from one patient to another. In fact, even after dissecting corpses, doctors and medical students went straight to the maternity wards to examine women who had recently delivered, without first washing their hands. Semmelwies deduced that it was the doctors who were transmitting infections to the patients. In maternity wards these infections led to the new mothers dying from puerperal fever or ‘childbed’ fever as it was called.
This was in the era before antibiotics (and before the recognition that germs are the agents of infectious disease).
Dr Semmelweis immediately instituted a strict regimen wherein all medical staff had to wash their hands between patient examinations. This seemingly simple step was the most difficult to implement. His peers were very sceptical, some were openly hostile; how could he dare to claim that the doctors were killing their patients? His own staff rose against him. He was labelled a madman because of his fanatic insistence on hand washing.
But the results of his ‘lunacy’ spoke for themselves–before hand washing was instituted in May 1847, his clinic’s mortality rate was 18.3%. By July, the rate had dropped to 1.2%, and it was zero the next year. But despite the clear link between cause and effect, most doctors did not change their practices.
Instead, in the face of opposition from a large part of the medical fraternity, the doctor was dismissed from his post, and he moved to Budapest. At the age of 47 he was committed to a mental asylum, and died there only 14 days later.
Semmelweis never published an explanation of the logic behind his theory. His experiments with hygienic practices were only validated some years later when Louis Pasteur expanded on the germ theory of disease. This was taken further by Joseph Lister a British surgeon. Based on his observations as a surgeon, Lister also deduced that a high number of post-operative deaths, which were attributed to ‘ward fever,’ were caused not by the surgery but by infections spread by germs from unwashed bed linen and surgical instruments, as well as lack of hand hygiene among doctors. Lister saw this as the cause, as well as the solution, to the problem. He started using carbolic acid to wash hands and to sterilize instruments, as well as to dress wounds. He experimented successfully with these techniques, and, unlike Semmelweis, went on to publish everything he discovered in a medical journal The Lancet in 1867. He became known as the father of antiseptic surgery.
That was a hundred and fifty years ago; but how much have things changed even now?
Here are some shocking facts.
Most patients and their families believe that a hospital is the safest place in terms of hygiene. But the Centers for Disease Control (CDCs) in America estimate that 1 in 25 patients pick up an infection while hospitalized. In 2011 there were more than 700,000 health care-related infections at intensive-care hospitals, and about 10 per cent of the infected patients died during their hospitalization. One of the major contributors to the spread was low hand-washing compliance among the attending doctors and nurses.
The well-known author and surgeon Dr Atul Gawande wrote an eye-opening essay in 2004. Titled On Washing Hands the essay endorsed that hand washing non-compliance was a major factor in spread of infection. But it also explained why this seemingly simple measure is, in practice, very complicated due to the sheer volume of interactions between a medical caregiver and a patient. For example, in a regular 12 hour shift a nurse would have up to 100 occasions on which hand washing is required. Given the tremendous pressure of time and patients, he accepts that the kind of hand washing that would be effective would mean that one-third of the medical staff’s time would be spent on washing. While this is not realistic, he urges that even a small increase in compliance would mean saving at least a few more lives that are lost to infection.
From Semmelweis to Gawande, the crusaders for hand washing have been spreading the message for almost 200 years. In this year of the Corona, never before has hand washing been more critical and more imperative. Handwashing is not just for doctors. Every one of us can save lives—especially our own, by becoming fanatical about hand washing.
Let’s put our hands together to applaud the super power of soap and water.