The 250-year-old history of hand hygiene in healthcare

Early days: between recognition and ridicule

Alexander Gordon documented the first systematic observation regarding hand hygiene more than 200 years ago in Aberdeen, Scotland. He recognized the contagiousness of the puerperal fever and the role of caretakers’ hands in cross-transmission leading to outbreaks and high fatality. Over the centuries, several pioneers suggested the hand hygiene as a preventive measure, with various degrees of professional recognition. Work of Ignaz Phillip Semmelweis, Hungarian obstetrician who demonstrated experimentally that appropriate hand hygiene significantly reduced risk of puerperal infections and maternal deaths, was rejected by peers. Similarly, Gordon’s theory was ridiculed and dismissed by the doctors, midwives and the public of Aberdeen. And even when Watson and Holmes received recognition for their medical achievements, they had to endure attacks on their theories of hygiene, often finding their recommendations disregarded.

Evidence base helps, yet attitude is key

After 1870, the germ-theory offered a strong support for earlier hygiene theories, established through discoveries of Pasteur, Koch, and Lister. Yet, even in 21st century compliance to hand hygiene remains low. Current work by Didier Pittet highlights the importance of a multimodal approach. Knowledge of the evidence base behind hygiene alone is not sufficient. Attitude is another important factor, among health care workers. And finally, the system must be designed to allow opportunity for applying hygienic practices. According to Pittet, strategies to improve hand hygiene compliance must include system change, staff education and motivation, the use of performance indicators, and hospital management support.

This poster presents the chronology of these milestones in hand hygiene. It was presented at the Semmelweis Conference in Budapest, 7-8 March 2017.

Authors: Rita Szabo, Andrea Kurcz, Arnold Bosman

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