Which United States President died due to poor hand-washing?

Holmes

Semmelweis

Pasteur

During the 19th century, women in childbirth were dying at alarming rates in Europe and the United States. Up to 25% of women who delivered their babies in hospitals died from childbed fever (puerperal sepsis), later found to be caused by Streptococcus pyogenes bacteria.

As early as 1843, Dr. Oliver Wendell Holmes (whose son became the well known US Supreme Court Justice) advocated hand-washing to prevent childbed fever. Holmes was horrified by the prevalence in American hospitals of the fever, which he believed to be an infectious disease passed to pregnant women by the hands of doctors. He recommended that a physician finding two cases of the disease in his practice within a short time should remove himself from obstetrical duty for a month. Holmes' ideas were greeted with disdain by many physicians of his time.

In the late 1840's, Dr. Ignaz Semmelweis was an assistant in the maternity wards of a Vienna hospital. There he observed that the mortality rate in a delivery room staffed by medical students was up to three times higher than in a second delivery room staffed by midwives. In fact, women were terrified of the room staffed by the medical students. Semmelweis observed that the students were coming straight from their lessons in the autopsy room to the delivery room. He postulated that the students might be carrying the infection from their dissections to birthing mothers. He ordered doctors and medical students to wash their hands with a chlorinated solution before examining women in labor. The mortality rate in his maternity wards eventually dropped to less than one percent.

Proper hand-washing was difficult to achieve in those days . The lack of indoor plumbing made it difficult to get water. In order to make the water comfortably warm, it would have to be heated over a fire. Given advancements in education, modern plumbing, and emerging challenges related to increasing antibiotic resistance, it is difficult to understand how physicians are resistant to the most fundamental infection control practice. 

In the 1870's in France, one hospital was called the House of Crime because of the alarming number of new mothers dying of childbed fever within its confines. In 1879, at a seminar at the Academy of Medicine in Paris, a noted speaker stood at the podium and cast doubt on the spread of disease through the hands. An outraged member of the audience felt compelled to protest. He shouted at the speaker: "The thing that kills women with [childbirth fever]...is you doctors that carry deadly microbes from sick women to healthy ones." That man was Louis Pasteur. Pasteur, of course, contributed to the germ theory of disease (and the developer of pasteurization). 

In 1910, Josephine Baker, M.D. started a program to teach hygiene to child care providers in New York. Thirty physicians sent a petition to the Mayor protesting that "it was ruining medical practice by...keeping babies well."

How Far Have We Come?

Yet, recent studies and reports indicate that lack of or improper hand-washing still contributes significantly to disease transmission. While we are all potentially at risk of contracting hand-transmitted illnesses, one-third of our population is especially vulnerable, including pregnant women, children, old people, and those with weakened immune systems.

It seems reasonable to assume that hospitals have come closest to responding to this problem. Modern surgery, after all, has long since solved many of the early problems of infection. However, fundamental problems of hygiene still exist. In 1992, The New England Journal of Medicine reported on a hand-washing study in an intensive-care unit. Despite special education and monitored observation, hand-washing rates were as low as 30% and never went above 48%!

Nosocomial infections are those acquired by patients while they are in the hospital, unrelated to the condition for which the patients were hospitalized. The Centers for Disease Control and Prevention estimates that over 2,000,000 hospital patients acquire some type of nosocomial infection each year in the US alone, at an annual cost of over $45 billion. 

Hospital personnel can also become infected. In 1993, 11 health-care workers became ill with hepatitis A because they didn't wash their hands after treating one of two patients with hepatitis A. The New England Journal of Medicine report reminds us, one of the most effective, simple, and cost saving solutions would be for all hospital personnel to wash their hands between every patient.

Yet, hospitals are not the only places in which hand-washing is important. A recent study in Infectious Diseases in Children states: "In spite of all the studies about the benefits of hand-washing, improper or infrequent hand-washing continues to be a major factor in the spread of disease in day-care." 

In the food-service industry, studies indicate that inadequate hand-washing and cross-contamination is responsible for as much as 40% of food-borne illnesses, including Salmonella, Hepatitis A, Shigellosis, Staphylococcus, Streptococcus, Listeria, Giardia, e. Coli, and many as yet unidentified but dangerous viral infections. It is estimated that there are over 80 million cases of food poisoning in the United States each year and 325,000 hospitalizations resulting in greatly increased health care costs, loss of job productivity, and as many as 9,000 deaths per year. 

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