Table 1 History and hand hygiene

Interest in hand hygiene dates to the middle of the nineteenth century. Oliver Wendell Holmes, in Boston, and Ignaz Philipp Semmelweis, in Vienna, both noticed the contagious nature of puerperal fever, which affects women shortly after childbirth [5, 129]. Publishing their findings nearly concurrently, but on different continents, they both argued that physicians with unwashed hands spread the disease to birthing women. Semmelweis’s work went one step further; he made the connection that medical students often went straight from the autopsy theater to the birthing room and concluded that they must be transmitting “cadaverous particles” from the corpses to the patients. To combat this spread, he instituted a policy of scrubbing the hands in chloride of lime (calcium hypochlorite) for anyone moving between the autopsy theater and the maternity wards; mortality rates were quickly reduced [6].

Both physicians were ridiculed for their beliefs at the time, but they laid the foundations for thought about hygiene and the spread of infection in the medical establishment. Semmelweis turned to alcohol as his calls for reform were consistently ignored and refused, and was eventually tricked into entering an insane asylum. When he tried to escape, he was severely beaten, and died 2 weeks later from a gangrenous wound, probably a result of the beating [5]. Around this time, in France, Louis Pasteur was working on germ theory and fermentation, formally publishing the pasteurization method in 1865 (the year of Semmelweis’s death), followed by the initial publication on germ theory in silkworms in 1870, just 9 years after Semmelweis’s research on puerperal fever [130]. Pasteur was also working on puerperal fever; in 1880, he published microbiological observation and recommendations concerning the disease [7], which were more readily accepted by the medical establishment than Semmelweis’s recommendations.