With cases of the highly infectious Delta variant rising rapidly across the nation, focus is increasing on the importance of handwashing.1 Today, it is well known that hand hygiene is the most effective way to prevent the spread of disease, yet physicians in both Europe and the US only adopted this practice in the mid-19th century.1

Numerous industries including medicine and the food industry now use handwashing to ensure safety and good hygiene for both employees and clients. For example, the food industry recommends handwashing to employees to prevent food contamination after using the restroom, switching from raw to cooked food, and after touching bare body parts.2 Historically, the medical community was slow to accept such guidelines, and attributed the spread of diseases such as childbed fever or maternal sepsis to maternal embarrassment or the surrounding atmosphere, making new mothers more prone to illness.3,4

Early birth of handwashing

Enter Ignaz Semmelweis who was an obstetrician born in Hungary in 1818. He was considered "the savior of mothers" due to his discovery that nearly all cases of childbed fever, or puerperal fever, occurred in women giving birth in hospitals with obstetricians. Mothers with midwife deliveries or at-home deliveries were much less likely to contract the disease since they did not have contact with physicians during labor. At that time, physicians and students also routinely examined cadavers and then patients without gloves, washing only with soap and water in between exams. Semmelweis proposed the deadly disease occurred because of infection introduced into the birth canal from an outside source and that vigorous handwashing between patients could reduce and/or prevent infection or death. In Vienna, where Semmelweis worked, the first (physician) division had an average mortality rate of 9% (with a high of 18%), which was three times higher than that of the second (midwife) division. Puerperal fever had a mortality up to 10% throughout Europe.3,5

In 1847, after trying several solutions, Semmelweis obtained permission from his chief (supervisor) and introduced an intervention requiring everyone to scrub their hands with a chlorinated lime solution when going from autopsies to the delivery room.3 The results were dramatic; mortality decreased significantly, and the death rates between the two divisions soon became comparable. He continued his efforts as the chief of obstetrics and later professor of midwifery in Budapest, further reducing infections. Based on growing evidence, he eventually recommended handwashing between contact with any patients. Although his results were impressive, his recommendations were not embraced by the medical community at the time, and he died before these were fully accepted and instituted throughout the world. His ideas contributed the germ theory of disease, which identified specific causes for contagion and the spread of infections.3 Louis Pasteur launched this theory in 1865, followed by Joseph Lister in 1867, ushering in a new era in medicine and biology demonstrating the relationship between specific germs and infectious diseases.6 His theories derived, in part, from experiments with silkworms that fed on diseased mulberry leaves, nearly destroying the silkworm industry in France. He challenged the notion that diseases were the result of miasmas, influenced by weather and the planets. Ultimately, his work was substantiated by scientists such as Lister, who believed infected wounds and gangrene resulted from contamination and bacteria.6 The germ theory sparked the hunt for pathogens responsible for the most infectious diseases, leading to improved hygiene, vaccines, and pasteurization. These diseases included cholera, bubonic plague, tuberculosis, and diphtheria.6

Public health strategies

Handwashing has contributed to preventing millions of deaths worldwide as well as reducing maternal morbidity and mortality.7 Formed in 1872, the American Public Health Association stressed preventive hygiene especially in urban areas. Public health and monitoring disease are ongoing responsibilities of health organizations such as this, even today. Disparities existed then and continue to exist today as access to proper maternity care is lacking in rural and impoverished areas.7 Semmelweis' discovery still has a lasting impact on mothers around the world, and his theories can be embraced by all.

Since the COVID-19 outbreak, experts at the CDC and the World Health Organization (WHO) recommend common-sense public health strategies like handwashing and masking, in addition to getting vaccinated, among the best ways to prevent the spread of this virus. The spread of diseases can be prevented in both community and healthcare settings, thus avoiding more serious infections and sepsis.4 Guidelines can be found at http://cdc.gov/handwashing and http://who.int, including WHO's "5 Moments for Hand Hygiene" campaign, which aims to prevent sepsis in healthcare settings.4 Healthcare professionals from all disciplines can educate others about this simple practice that ultimately saves lives.

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