Clean Hands: The Oldest New Idea

Floyd Press / Road Less Traveled for November 1, 2007

Ignaz Semmelweis is hardly a house-hold name, but trust me: the practice that he recommended for hospital maternity wards more than a hundred and fifty years ago we have recently rediscovered as the single best way to prevent the spread of infectious disease: simple hand washing.

Semmelweis, a Hungarian obstetrician practicing in Vienna in the 1840s, made some critical discoveries that pointed toward the cause for the alarmingly high rate of maternal death caused by a mysterious “childbed (or puerperal) fever”.

His first observation in 1844 was that, between the two wards in the same hospital where he lectured, one (staffed only by midwives) had a childbirth maternal date rate of just 2% while the other, staffed by medical students-who also performed autopsies-was 16%.

The hospital situation was so bad that the incidence of childbed fever symptoms was actually lower for women who had their babies unassisted on the streets of the city than for those whose children were born in the maternity wards of Vienna’s prestigious hospital centers of medical research and education!

Things were so bad that just a year earlier, physician and author Oliver Wendell Holmes Sr. had said that “in my own family, I had rather that those I esteemed the most should be delivered unaided, in a stable, by the mangerside, than that they should receive the best help, in the fairest apartment, but exposed to the vapors of this pitiless disease.”

This blame on malignant vapors must be forgiven, as it was some decades yet before Louis Pasteur would demonstrate conclusively that there are indeed invisible agents of infection we now know as bacteria. (Viruses would be discovered only much later.)

Simmelweis’ claimed to his colleagues that he had proven a connection between childbed fever and the spread of “cadaverous particles”. He further stated that doctors were the primary carriers of these particles from victim to victim, and that hand washing was the solution. As you might expect, this outrageous idea was ridiculed by pompous medical contemporaries. “Doctors are gentlemen, and gentlemen’s hands are clean.” Yeah, right.

I was thinking about all this a few weeks back as we made our way toward our next departure at the Chicago airport.  I lifted my hand reflexively from the rail of (Caution! You are about to reach the end of the) moving walkway-a hand that by then had touched the touch of hands from across the country and around the world. Money, doorknobs, bathroom fixtures; runny noses, taxi cab seats, and handrails: my hand shared in the common contact and accumulated invisible microbial veneer left behind by a thousand strangers.

We settled into seats and I got lost in my USA Today as our boarding time approached. I stopped myself at the last instant before I absentmindedly moistened my unwashed thumb with my mouth to turn the dry pages. Now there’s a habit that would have Dr. Simmelweis screaming “cadaverous particles!”

So here we are in our modern, enlightened times on the other side of the age of the “overworked miracle” of antibiotics. We give these wee flightless, legless hitch-hikers (not only bacteria but also viruses, prions, fungi and protozoans) transportation around the world in a day, carry them far from the forests soils and remote mountain jungles where they evolved and where they did little harm outside their primate or mammalian or avian hosts.

Then too, we’ve saturated our cattle, chickens and children with penicillin and all its temporarily effective successors. By agricultural and medical overuse, we’ve managed to eliminate the susceptible bacterial strains and left to survive those variants that have managed to persist-even thrive-paradoxically and especially in hospitals where antibiotic use is the highest.

I emerged from the Travel Section of my newspaper for a last visit to the mens’ room as our flight was called to board. There were no doors with handles to touch; soap and water and toilet-flushes happened without hands. And this time, I found something new: a quick, jet-powered dryer that you stick both hands into without touching.

But even today, men are especially likely to neglect washing their hands in public restrooms. And many folks mistakenly think that the alcohol-based dry washes or towelettes are as effective as a hand washing, or that the antibacterial soaps are a great advance over plain old soap and water. They aren’t, and they may actually do harm: the use of antibacterials “may cause some bacteria to become resistant to commonly used drugs such as amoxicillin, the researchers say.”

Even if you wash as frequently as you should, almost nobody washes for long enough. The Center for Communicable Disease recommends that you wash for at least 20 seconds. So how long is that? They suggest you wash your hands while you imagine singing all the way through Happy Birthday to a friend, twice.

Now that little performance ought to get you some extra elbow room at the airport restroom sink, don’t you think?

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