Few of us paused July 17, 2019, to recognize a significant birth laying a substantial helping in controlling the COVID-19 virus. That event was the birth of an individual who’s seminal heritage appeared in children’s chalk on sidewalks, store windows, flags, billboards, etc. All became embedded in many of us. That date and recognition ceremonies around the world celebrated a birth that occurred 200 years ago: the birth of Ignaz Semmelweis, later as young man adding the suffix MD.
Statues or images of the man rarely cross our visual, written or oral world. Yet his dominant influence in the 1800s deserves our deepest human gratitude for three simple words: “Wash your hands.”
It is difficult to imagine that such a simple hygienic action was during Semmeleweis’ early days at a leading Vienna University.
Take a moment for a positive reflective comment and a nod to him, his difficulties in getting medical acceptance for his proposition, and our improvement and support for his seminal analysis. Oliver Wendell Homes, Senior, had similar thoughts in the 1800s. That story for another time.
I begin with a definition of Puerperal (childbed fever) fever. In labor and after childbirth, giving birth was a hazardous event for mother and child. Its cause and often death of the mother, and child, was unknown, other than an infection of the uterus. Childbirth mortality rates were about 25-30%. Seeking the causes for the high mortality rate became his lifetime study.
That interest intensified in the early 1840s after his appointment as obstetric assistant at a clinic in Vienna. There two divisions of the hospital taught obstetrics: The first to medical students and the second to midwives. His tentative conclusion, after observing the mortality rate between the two child-birth areas had an exception: less deaths occurred in the area taught to midwives whereas a higher mortality rate occurred in areas involving the senior doctors and medical students. A second inference was his feeling that the doctors may have been bringing something with them when attending mothers-to-be.
Opposition to Semmelweis thesis
Today, about 200 years later, we cringe when reading descriptions of the birthing room. For no rational reason there was intense opposition to his simple recommendation: Hygienically wash your hands before tending a mother-to-be and thereafter.
How did Semmelweis come to that conclusion?
- Students and doctors would complete an examination barehanded when examining a patient.
- Students and doctors would come directly from e.g. ,an autopsy with unwashed hands directly to another patient, even a woman in labor.
- Students and doctors would come directly from a dissection into a maternity ward with unwashed hands.
- And other negatives.
In short. Today it is uncomfortable to read the above, or write about early unhygienic procedures that today would be abhorrent. It is sufficient to say that numerous elder medical doctors of the day simply did not believe that they could be carriers of infection. Youthful doctors were more supportive, but opposition to his simple solution took years to be accepted.
Hand hygiene today
Erase the idea that medical personnel for an early period quickly accepted Semmmelweis’ correlation between hygienic handwashing affected a birth-mother’s life or death. Fortunately, today worldwide support is evident in healthcare workers, regardless of specialty. Yet compliance in the medical profession still has a gap between conviction and action.
My above generalization relies on generalized comments found in many articles. Nonetheless, while different measurement methods and healthcare groups were tabulated, groups in hygienic handwashing compliance tended to fall below 50%. Overall median compliance rate lies between 35-40%.
In other words, the health profession is not 100% in adhering to guidelines for hand washing. While many studies for the above incomplete data pertains more to the hospital setting, one can guess that handwashing in senior residential facilities would be less. And as mentioned, hygenic handwashing for homebound elders is probably smaller. As a yearly reminder, the World Health Organization (WHO) sets aside 5 May for the world to consider SAVE LIVES: Clean Your Hands.
I end this casual, hopefully positive, statement during these torturous days with applause for two significant contributions for hygienic handwashing. First, the significant “WHO World Study: WHO Guidelines on Hand Hygiene in Health Care: a Summary:” https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf;jsessionid=18D5E81D4CDEFDEB4CCE4C19B2EFE4E7?sequence=1
This superior 250+-page analysis of issues relating to hygienic handwashing in the healthcare area begins with “Review of scientific data related to hand hygiene” and ends with “Comparison of national and sub-national Guidelines for Hand Hygiene.” An extended piece for non-slumber reading.
And second are showers of human and semantic hyperbole for Dr. Semmelweis. As he staggered beneath appalling childbed statistics — as we do today under COVID-19 — it is incomprehensible that educated persons during an earlier period resisted an almost innate desire to have clean hands. Semmmelweis’ zeal of confidence for an easy action, regardless of negations from colleagues, is a legacy revered today. He, inestimably, is revered to a simplistic and hygienic “invention.” He should receive our unending recognition for a legacy left with healthcare givers and we as individuals facing similar human crises.
Two main sources as basis for above statements. WHO, (2009). Guidelines on Hand Hygiene in Health Care: a Summary. Geneva, Switzerland. WHO, (2014; 2020, 17 January; 2020, March). Infection Prevention and Control of Epidemic-and Pandemic-prone Acute Respiratory Infections in Health Care. WHO. Geneva, Switzerland.
Herb Hildebrandt Ph.D, Hl.D., is a founder and current resident of Glacier Hills, Ann Arbor, MI., Trinity Health’s Glacier Hill’s senior living facility.