Hand Washing Saves Patients’ Lives

Rodney Warner
Rodney Warner

Medical Professionals Have Known for Over 150 Years Hand Washing Saves Patients’ Lives: Why are Unwashed Hands Still Killing Thousands of American Hospital Patients Every Year?

It was 1846 and a Hungarian born doctor, Ignaz Semmelweis, achieved one of the great “Eureka!” moments in the history of medicine. He figured out that hospital patients were dying of infections because doctors weren’t washing their hands before treating them, according to an NPR article. What have we learned since then? Not nearly enough.

An estimated 721,800 infections occurred in American hospitals in 2011, with about 75,000 dying as a result, according to statistics from the federal Centers for Disease Control and Prevention, cited in a CNN article. That year about one in every 25 patients became infected at hospitals. As bad as this sounds, it’s actually a big improvement from the past. In 2002, there were an estimated 1.7 million health care related infections and 155,668 infected-patient deaths.

Dr. Semmelweiss practiced medicine at the maternity clinic at a hospital in Vienna, Austria. At the time many women who came to the hospital to give birth didn’t leave the hospital alive because of “puerperal fever” or childbed fever. There were two maternity wards at the hospital, one staffed by doctors and the other by mid wives. Women being attended to by doctors were dying of infections at a rate five times higher than those helped by mid wives.

At this time it was much more common for doctors to perform autopsies and learn more about anatomy, causes of death and how to prevent them, which was a good thing. The bad thing was that they weren’t washing their hands, or not washing them well enough, then moving on to treat patients, like those giving birth. Unlike the doctors, the mid wives weren’t performing autopsies. Semmelweis determined it was cadaverous particles causing the deadly fevers (germs were not known at the time).

Semmelweis ordered his medical staff to clean their hands and instruments with a chlorine solution. Chlorine is about the best disinfectant available. He chose it because he thought it would get rid of any smell from any lingering bits of corpse. As a result the rate of childbed fever fell dramatically.

Fellow doctors had a hard time accepting they were causing the problem. The hand washing eventually stopped. Semmelweis was not a tactful man and publicly berated his critics, made enemies, was fired, reportedly went insane and died 19 years later at the age of 47.

One modern and deadly hospital acquired infection is from clostridium difficile, or C. diff. For about 14,000 American hospital patients this year this drug resistant bug will give them a terminal case of diarrhea, according to an article in Scientific American. The number of hospital patients with a C. diff. infection in 1993 was less than 100,000. By 2009 that number climbed to 336,600.

According to the Scientific American article:

A recent survey from the Association for Professionals in Infection Control and Epidemiology (APIC) of 1,087 hospitals revealed inadequate implementation of cleaning strategies known to prevent hospital-acquired C. diff infections, such as…washing hands with soap and water…Alcohol gels and foams don’t remove the spores so are an inadequate defense against spreading the germ. Only soap and water can rinse spores away. “If everybody washed their hands like they’re supposed to, there would be hardly any transmission of this stuff,” says Deverick Anderson, associate professor of medicine and chair of antibiotic stewardship at Duke University. However, only 77 percent of survey respondents had a policy of promoting soap-and-water hand washing when caring for C. diff–infected patients, and only 10 percent had policies requiring sick patients to wash their hands with soap and water.

There are some hospitals that “get it” and have taken the radical step of requiring those treating patients to wash their hands, despite it’s awesome expense (I imagine a hospital can buy soap in bulk, so the cost would be far less than what you see at the grocery store) and that it’s terrifically time consuming (about a minute). One such hospital is MetroHealth Medical Center in Cleveland which instituted a program requiring health care professionals to wash their hands, according to an article in the Cleveland Plain Dealer.

“People were good at coming up with excuses why they didn’t need to wash hands,” (Dr. Al) Connors (the hospital’s chief medical officer) said of the mindset at the start of the hand-washing campaign. “But when you walk into a patient’s room, you never know what’s going to happen.”

Today, the hospital’s compliance rate in its various clinical units is over 97.6 percent.

How that stacks up against other hospitals is anyone’s guess, since no method exists for collecting individual hospitals’ hand hygiene compliance data and compiling a national report.

To get to that near-perfect number, MetroHealth hired four hand washing monitors, complete with white coats and a clipboard. Their duty: To monitor everyone’s comings and goings, and to see who washed their hands — and who didn’t — after walking in and out of patient rooms.

Those observances provided Connors with accurate data on the rate of hand washing on every floor and any improvements over time.

“It was very effective,” he said. “Everyone wanted to do a good job.”

The hand-washing improvements have lowered central line-associated bloodstream infections (down 35 percent since 2010), ventilator-associated pneumonia (down 71 percent since 2010) and surgical site infections (down 64 percent since 2010). Overall, (healthcare associated infections) at MetroHealth as a whole have dropped 38 percent since 2010.

If he could come back from the dead, I’m sure Dr. Semmelweiss would be amazed at how far the state of medical knowledge and treatment has come. He might also be shocked and disappointed that despite all the medical progress 169 years since he first told doctors to wash their hands, thousands of American hospital patients still die each year due to the dirty hands of health care professionals.

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