When Mom said, “Wash your hands before supper,” she probably didn’t realize she was giving sound medical advice based on mid-19th century work by obstetrician and infection control pioneer Ignaz Semmelweis of the Vienna Lying-in Hospital in Austria.

In the United States and at about the same time, Harvard-trained obstetrician and author Oliver Wendell Holmes was doing similar work to convince the medical world that handwashing could help contain the spread of disease. Both men were targets for the disdain of the medical community at the time, largely because they had the temerity to challenge current obstetrical practice, which they found to be spreading infection among a large percentage of women in childbirth. But their data demonstrated women’s lives were saved when physicians washed their hands before examining their patients.

To MUSC pediatric surgeon H. Biemann Othersen, M.D., Semmelweis and Holmes are among the heroes of modern medicine. And for good reason. “Of all the things you can do for your patient in the hospital, handwashing is most important. Yet studies have shown that only 30 percent take the time to wash their hands between each patient contact,” Othersen said.

“No one has come up with a good way to make people wash their hands,” Othersen said. “And they should wash their hands even when wearing gloves. Germs will grow under the gloves, creating their own colonies.” He said that handwashing is a matter of personal conscience, and should be done out of concern for the health and welfare of the patient. Othersen said that it was well known in mid-19th century Vienna that women had a far better chance of surviving childbirth under the care of a nurse midwife than a doctor. Typically, in a hospital obstetrics ward, a doctor would examine one woman after another without washing his hands. Infection spread, and the mortality rate was high. Once Semmelweis instituted thorough handwashing on his ward, including scrubbing fingernails and use of chlorine water and later chloride of lime, the death rate in his ward lowered to 1.27 percent.

An incident in another ward, where 11 of 13 women died after being examined by a group of physicians, underscored the importance of handwashing and demonstrated how infection can spread if precautions aren’t taken. The first woman to be examined had gangrenous carcinoma of the cervix, which spread to the others. Thorough handwashing is a good habit to bring home from work, Othersen said. “Touch your nose after shaking hands with someone who has a runny nose and touched his nose, and you’ve got it,” he said. Frequent handwashing breaks the cycle and prevents spread of disease. Listing the diseases that can be spread by careless physical contact, Othersen cited diarrhea or gastroenteritis, vomiting, respiratory infections and wound infections.

Disease prevention key to infection control

by Beth Rhoton, RN, MS, CIC

Infection control practitioners encourage consumers to ensure their own wellness by taking specific steps to prevent the spread of disease. Some of these preventive practices, such as handwashing, may seem rather simple and obvious, yet their importance and indisputable effectiveness cannot be overstated. The everyday germs that are present on our hands can cause illnesses such as diarrhea, colds and other more serious diseases, such as hepatitis and E. coli infection. According to APIC (Association for Professionals in Infection Control and Epidemiology) and the Centers for Disease Control and Prevention, handwashing is one of the most important means of preventing the spread of infection.

With the incidence of foodborne illness on the rise, it is also important to ensure proper preparation, cooking and storage of foods to prevent transmission of E. coli and salmonella bacteria—this includes proper cleaning of surfaces and careful handwashing, particularly after exposure to uncooked meat, poultry, seafood and eggs. Examples of other preventive measures that can help ensure good health include practicing safe sex and obtaining proper child and adult immunizations.

Anyone interested in planning or carrying out an activity targeted at increasing awareness of infection control practices among their personnel can work with their unit or department ICRN/P or contact one of the infection control practitioners for assistance.

The Medical Center Infection Control Department is comprised of: Dr. Bruce Ribner, hospital epidemiologist; Betty Webster, ICP; Pam Fogle, ICP; Beth Rhoton, ICP; manager of the Quality/Utilization Department, Jodell Johnson; and Annette DeVeaux, ASB.

The members of the Infection Control Department are committed to improving patient care, preventing adverse outcomes and to minimizing occupational exposure to biohazards associated with the delivery of health care.

Handwashing, 'Yankee Doodle' and medical ethics

During the recent Joint Commission inspection, Medical Center employees were treated to an H. Biemann Othersen, M.D., rendition of "Yankee Doodle," which lasts just about long enough to give the hands a good thorough washing. Here it is: Handwashing is of critical importance, and although the public is recently more aware of how important it is, you are usually the only one who will know if you washed your hands and washed them appropriately. Therefore, it becomes an ethical issue—a matter of conscience. Your sense of ethical commitment to your patients’ well being must be your guide. Education about the importance of handwashing and how to do it, and the availability of sinks are only part of the answer. A simple handwash may be the difference between a successful recovery and joining the 80,000 patients each year who die of nosocomial (hospital) infections.

Yankee Doodle went to town a-riding on a pony. He stuck a feather in his hat and called it Macaroni. (Not pasta. “Macaroni” was a particular class of Revolutionary War soldier from Maryland known for their fancy uniforms, complete with feathered hats.) Yankee Doodle keep it up, Yankee Doodle dandy. Mind the music and the step, And with the girls (or optional “boys”) be handy.

Chain of Infection

Infectious Agent: a biological entity capable of causing disease

• number of organisms, virulence (or ability to produce disease), ability to enter and survive in the host, susceptibility of the host to the agent

Reservoir: where an infectious agent can survive but may or may not multiply

• man, animals, environmental/fomites

Portal of Exit: the path by which an infectious agent leaves the reservoir

• skin and mucous membranes, respiratory tract, urinary tract, gastrointestinal tract, blood

Mode of Transmission: the mechanism for transfer of an infectious agent from a reservoir to a susceptible host

• contact: direct, indirect, droplet spread, air: droplet nuclei, dust, vehicles: contaminated items, vectors: insects, animals

Portal of Entry: the path by which an infectious agent enters the susceptible host

• skin and mucous membranes
• respiratory tract
• gastrointestinal tract
• reproductive tract q parenteral tract (percutaneous, via blood)

Susceptible Host: a person or animal lacking effective resistance to a particular pathogenic agent

• age, sex, ethnicity, socioeconomic status, disease history/underlying disease, lifestyle, heredity, nutritional status, occupation, immunization status, diagnostic/therapeutic procedure, medications, pregnancy, trauma