Hand hygiene and anesthesiology.

Even though hand hygiene in hospitals is currently considered as the standard of clinical care, the history behind this practice is relatively recent. The practice of hand hygiene among health care workers was first proposed by Ignaz Philipp Semmelweis (1818-1865). He was an assistant professor of Medicine, at a time when puerperal fever was a common cause of maternal mortality. While working at a maternity clinic in Austria, he witnessed physicians and medical students moving between the anatomy laboratory and the labor ward. In 1847, Dr Semmelweis found that an intervention consisting of hand disinfection of the hands of medical staff with a chlorinated lime solution between performing autopsies and providing maternal care at the delivery suite decreased puerperal fever from 16% to 3%. Semmelweis’s discovery of the importance of hand disinfection was quite revolutionary for his time, but like many new ideas, not embraced by the medical “establishment.” His results were dismissed and disregarded by many of his peers. In his subsequent quest to change hand hygiene behaviors of physicians, he felt increasingly frustrated and ostracized. Eventually, his conduct deteriorated and the diagnosis of insanity was made. This chapter in the history of hand hygiene comes to a sad end. In 1865, Dr Semmelweis was committed to a mental institution, dying 14 days after being institutionalized. A sorrowful introduction, indeed, to the important subject of hand hygiene compliance among physicians and an example of just how difficult it is to change the culture of nonadherence to hand hygiene among hospital staff.