Why Hand Washing?

Allen Weiss, M.D. Allen Weiss, MD, MBA, FACP, FACR
President, NCH Healthcare System
March 8, 2006 - With a very simple technique, Dr. Ignaz Semmilweiss, a Viennese obstetrician in the mid-1850s, may have saved more lives, indirectly, than many of modern medicine’s incredible innovations All of us, whether in healthcare or not, can share this simple procedure to assist those around us, as well as ourselves.

Hand washing saves lives; no question about it! Dr. Semmilweiss’ observations and suggestions took 37 years to become accepted by the medical profession. Pregnant women intuitively realized there was a difference between two obstetrical wards in the same Viennese hospital. One ward was staffed by nurse midwives and had a 2% mortality rate from childbed fever, a potentially fatal infection in the uterus. Physicians and medical students who, in addition to delivering babies, performed autopsies, staffed the other obstetrics ward. This unfortunate ward had a 20% mortality rate from childbed fever. The physicians and medical students were not washing their hands after leaving the autopsy room and before delivering babies— thus tragically spreading infection. Dr. Semmilweiss urged the use of diluted chlorine to wash hands, which, unfortunately, was resisted for years as taking too long and being ineffective.

There are many better products today for hand washing than dilute chlorine. Nevertheless, spread of infection by human contact still plagues us. USA Today reported recently on an American Society of Microbiology paper that stated only 82% of people leaving a public restroom washed their hands. This number has increased from 78% in 2003. Traditionally, Naples experiences cold and flu “season” this month but we can all avoid infections by being careful. Hand hygiene, along with covering one’s nose and mouth when sneezing or coughing sounds like common sense, yet many people fail to do so. We all need to be diligent and vigilant in avoiding the unnecessary spread of germs.

Our daily activities include shaking hands, brushing cheeks with “air kisses” and light hugs, which are all opportunities to spread infection. A person who is feeling ill and may be contagious has the responsibility to avoid such activities in social engagements. The infected person can still participate in congregate activities but just has to identify him or herself as not feeling well and not wanting to share a potential infection. Human touch is so important for connecting but one can be careful to hand wash before eating or touching one’s face or mouth.

Even understanding these suggestions, the common cold is the most frequent reason to seek medical care. The Centers for Disease Control states that in a typical year kids will miss an aggregate total of 22 million school days because of common colds. This represents a huge disruption in learning, as well as upsetting the entire family’s rhythm. Parents miss time from work caring for a sick child, siblings subsequently get sick, and everyone suffers. Prevention of the spread of infection by good hand washing hygiene would -- and does -- make a difference.

Frequent hand washing with soap for about twenty seconds is effective. If sinks are not available then instant hand sanitizers work well and may be more convenient in many situations. The problem remains that many public restrooms necessitate touching potentially dirty surfaces such as faucet handles, paper towel dispensers and doors, after hands have been washed. Just being careful, without being too obsessive, can avoid most of these problems. Modern, state-of-the-art restrooms, such as those at the new Southwest Florida International Airport have electric sensors and physical layouts that facilitate avoidance of post hand washing contact.

I have been told by audiences with whom I’ve recently shared this information that many cruise ships have large stations positioned strategically at entrances to dining areas encouraging all about to dine to hand wash with waterless hand sanitizer. The ship’s captain when greeting, clasps the forearm of his guest rather than the hand in an effort to avoid hand contact spread of germs. Many supermarkets are now installing dispensers with sanitized wipes at entrances, so shoppers can wipe off the shopping cart handle before putting their hands on it also.

Prevention is always so much more effective than any treatment. Individuals should be responsible, thereby making a difference for others whom they are close enough to touch. We help ourselves by hand washing frequently and by keeping our hands away from our faces. Without each other’s cooperation, infection spreads. Together we can improve.

Dr. Semmilweiss would be pleased to know his recommendations have now been proven; he would be disappointed, however, to know that not everyone follows these good practices. We know what to do—we just have to wash our hands.

Dr. Allen Weiss is President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.