Germ Theory and Hand Hygiene

October 13, 2017

 

So let's start, and let's start with the basics - I love to ask this question at meetings; what the number one way to prevent the spread of infections? Hand hygiene, but let me ask, have you ever had a smug doctor question the significance of hand hygiene or ask for some research to back up the need to wash their hands? I have, can you believe it? Yes, crazy, scary, but yes. So, if you ever get this question, you will be able to give the history behind the discovery. I know in nursing school, I was never taught about doctor Semmelweis; it wasn’t until I was actually in my first infection prevention role. Did the infection prevention director actually speak about Semmelweis and explained who he was? I had no idea and I don’t think a lot of people know, so if you don’t remember and truthfully I didn't remember all these details. But I was able to find a wonderful article on doctor Semmelweis at Explorable.com and I'm going to share the highlights from that article at Explorable.com.

Doctor Ignaz Philipp Semmelweis was born on July 1, in 1818 in Taban, which is Budapest in Hungary, which is pretty amazing, because I'm half Hungarian and I thought that was actually pretty cool. Dr. Semmelweis actually discovered the ''germ theory’’; he saw a connection between puerperal fever and the disinfection of hands of the hospital staff. He was actually looking at puerperal fever which is also known as ''childbed fever''. He was looking at the connection between the high incidence of puerperal sepsis or the childbed fever, which was largely caused by transfer of infection due to the lack of indoor plumbing and hygiene facilities in hospitals. But, thanks to Dr. Semmelweis, he discovered the connection and the importance of hand washing. So Dr. Semmelweis looked at the practices of hands of infection in the obstetric clinic. He first observed the medical staff that went from doing autopsies and then delivering babies. So, he looked at the difference between the physician practice of doing autopsies or surgeries and then going and delivering babies to the midwives who didn’t do surgeries and who didn't work with cadavers and the difference in puerperal fever between the two groups of women.

And he observed -  the death rate for their mothers who were treated by the physicians was 13.10%. Death rate by the mothers that were cared for by the midwives to be 2.03%, a huge difference and the connection hit Semmelweis when he was actually doing an autopsy on a friend who had died because of a fatal dissection wound. Semmelweis saw this similarity between the symptoms of his friend and the childbed fever. It prompted him to connect cadaveric contamination with puerperal fever, so thus he recognized that the physicians were actually carrying the infection on their hands after they dissected the cadavers to the laboring moms. And then he took one step further and he realized that the instruments being used for surgeries weren’t being cleaned appropriately.

So once he saw this, he insisted on the use of chlorinated lime solutions for hand washing by the physicians before they treated the obstetrical patients. So when they did this, they began to see a decrease in fatal puerperal fever in that group. While in some months, there were actually no deaths from childbed fever and the patients treated by the physicians. The application of this chlorinated lime solution for hand washing instantaneously reduced the cases of puerperal fever from 12.24% to 2.38%, and some month there were no deaths at all of childbed fever. So besides washing the hands, he initiated using preventative washing for all instruments making contact with patients, which literally removed puerperal fever from the hospital and this was the beginning of the aseptic era.

So let's think about this, in 1847 people didn't wash their hands, they went from working with cadavers and then surgery, using dirty instruments and then going to the obstetric clinic and caring for the moms and newborns and all the disease they carried. And then he told them hey, wash your hands, use the solution and wash your hands and then they started to save lives. And then after they realized oh my goodness this is actually working and let’s clean those instruments that are used in surgery, let's get rid of this mode of transmission ''amazing''. So you can tell the physician or whomever else that Dr. Semmelweis; yes we do have research. Obviously, and it goes back to 1847; washing your hands, cleaning equipment between patients makes a difference, it saves lives. So everyone, wash your hands, do the appropriate hand hygiene, use the wipes, clean the equipment, sterilize, disinfect, do what you need to do to keep the patients safe. It’s in your hands, you are responsible and you can make such a difference.

So now you have some concrete knowledge of an 1847 Dr. Semmelweis introduced germ theory. He figured out physicians needed to wash their hands and the instruments used on cadavers and then surgery needed to be cleaned before used on patients. This was huge and poor Dr. Semmelweis, he was in an uphill battle, he didn't get the great recognition he should have gotten, but we now thank him.

 

We thank him here today in 2017, because we know because of what he figured out, it helps our patients. When you say gel in and gel out, there is a reason; we're not doing the transmission from patient to patient, from staff to patient, from equipment to patient. We are keeping the environment safe, the patient safe, our staff safe and we're doing the right thing and this is an amazing place to be in 2017 infection prevention, it is exploding. We know through all the focus from CMS, CDC and NHSN, leapfrog, the Department of Health in your area, everyone’s looking, everyone wants to keep our patient safe and they want to make sure that the facilities are doing what they need to do, so this will pay-for-performance.

If you're giving patients healthcare associated infections, you are not getting your full payment in many cases through Medicare and possibly through some other third-party payers, and money is one thing and patient lives are another. So thank you so much and I hope you enjoyed learning about Dr. Semmelweis and now you can actually tell whomever that's just giving you a hard time about gelling in and gelling out hand hygiene and why they actually need to do proper sterilization and disinfection etc. and wiping down equipment. It's important, it saves lives, this stuff is not made up, and it’s real.

 

It’s called Germ Theory, Dr. Semmelweis, in 1847 he figured it out, so thanks Dr. Semmelweis and thanks to all of you, all the infection preventionists, all you folks that are in charge of keeping your patients safe. Thank you for all you do, you're amazing, I'm still glad that you are my peers and I’m so glad to be on this journey with you. So take care, thanks so much.

 

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