Preventive washing for infection control

Denise Gibson, assistant director, infection prevention and control, Barnsley Hospital NHS Foundation Trust, provides an insight into preventive washing and its contribution to the prevention of healthcare-associated infection. 

In 1847, Ignaz Semmelweis, a Viennese physician, noted that maternal mortality rates were substantially higher in one obstetric clinic than another (16% versus 7%). Semmelweis traced the difference to doctors and students transferring ‘cadaverous particles’ on their hands as they moved between the autopsy room and the delivery theatre. The ‘particles’ survived washing in soap and water. So, Semmelweis recommended preventive washing among the doctors by scrubbing hands in a chlorinated lime solution before every patient contact and after leaving the autopsy room. Mortality fell to 3% in the most affected clinic. Yet Semmelweis experienced considerable difficulties convincing his colleagues and administrators of the benefits of the procedure.1

Almost 170 years later, healthcare professionals proposing preventive washing as part of universal decolonisation against Multi Drug Resistant Organisms (MDROs) may face similar challenges. Improved hygeine could prevent many nosocominal infections, especially those caused by antibiotic resistant microorganisms, that threaten patient safety.2 For example, targeted decolonisation3, 4 with chlorhexidine and mupirocin reduces surgical site S. aureus infections by about 60%. It has been estimated that the S. aureus strain colonising patients at the time of surgery caused 80% of MDRO surgical site infections.5