1 July 2018 will mark the 200th anniversary of Ignaz Semmelweis' birth. Today (Thursday), MedUni Vienna, Vienna General Hospital and the Vienna-based Semmelweis Foundation are holding a specialist symposium in honour of the Viennese surgeon and obstetrician, founder of evidence-based medicine and "inventor" of hand hygiene. At a press conference held in advance of the symposium at the restored Semmelweis monument on Vienna General Hospital Medical University Campus, experts emphasised the huge importance of this medical hygiene pioneer – who went unacknowledged during his lifetime – for the advancement of medicine. "Hand hygiene saves many human lives every day," pointed out the experts from MedUni Vienna, Vienna General Hospital and the Semmelweis Foundation.
"Today we are using this excellent opportunity to honour an icon of modern medicine. Ignaz Semmelweis was one of the most important doctors of his time and a champion of medical progress. Many patients have much to thank him for, as does medicine itself. If he were alive today, he would certainly be up for a Nobel prize. Sadly his immense achievements were only recognised after his death at the tender age of 47," said Markus Müller, Rector of MedUni Vienna, underscoring the importance of Ignaz Semmelweis.
"Based on his own observations and insights, Ignaz Semmelweis fought to establish hand hygiene as part of the everyday hospital routine. We are now aware of the crucial importance of correct hand hygiene for protecting the patients entrusted to our care and our colleagues as well. The statue of Ignaz Semmelweis is there to remind us that providing safe care by maintaining consistent hand hygiene is the personal responsibility of every one of us," points out Sabine Wolf, Director of Nursing at Vienna General Hospital.
The discovery of hand hygiene
In the mid 19th century, Semmelweis observed that the mortality rate on obstetric wards where patients were cared for by nuns or midwives was much lower than on wards where doctors and medical students ( who also performed autopsies) worked. "At the time there was an enormous discrepancy: a mortality rate of 8.2% as opposed to 1 – 2%," says Elisabeth Presterl, Head of the Department of Hospital Epidemiology and Infection Control at MedUni Vienna/Vienna General Hospital.
Semmelweis discovered that the infections, and hence the associated mortality, were caused by the transfer of infectious material (bacteria were not known about at the time). He instructed the doctors and medical students to disinfect their hands thoroughly with a chlorine solution, and later with chlorinated lime, before each delivery or before examining a pregnant woman. This hygiene measure was extremely effective and the mortality rate fell to 1.3%. Later on, Semmelweis tightened up these rules so that doctors had to disinfect their hands before every examination, with the result that, after a few months, there were no fatalities at all.
Hand hygiene brings immediate results and saves millions of human lives
We now know: good hand hygiene reduces the infection rate by up to 30% – just by following a quick and simple routine. "Hand hygiene is simple, effective and takes less than 30 seconds – but can save many lives," stresses Presterl. "In view of the growing number of multi-drug-resistant pathogens, we must always be mindful of the importance of preventing the transfer of infections and the pathogens that cause them." International studies have shown that, merely by increasing the hand disinfection rate from 48% to 66%, it is possible to reduce the infection rate from 17% to 10%. The Europe-wide compliance rate currently lies at around 50%.
"By taking an appropriate multimodal approach, including the use of alcohol-based hand disinfectants as an important system change, the advancement of hand hygiene can save up to eight million human lives a year worldwide," stressed Didier Pittet, Head of the Division of Hospital Hygiene at Geneva University Hospitals and external head of the WHO "Clean Care is Safer Care" programme. He is also the world's leading "hand hygiene ambassador" and helped to develop the "5 moments of hand hygiene in hospitals" international guideline for correct hand disinfection.
Even more resources needed for hand hygiene
Current figures from the prevalence survey for hand hygiene in Europe show that Vienna General Hospital and the doctors who work there are now well above the European average in terms of compliance. "We have improved to a good level," says Presterl. However, for various reasons, hand hygiene is not (yet) 100%, one reason being that, until recently, hand hygiene was to some extent "forgotten about" and only returned to prominence in medicine a few years ago and another being the emergence of multi-drug-resistant pathogens, which are primarily found in critically ill patients – for example in intensive care medicine.
Says Presterl: "As a result of modern medicine, the patients who end up in intensive care are much more seriously ill and are treated using invasive methods. This means that infections are more likely to occur in the presence of multi-drug-resistant pathogens." And thirdly, hygiene habits also have to be practised. Hand hygiene has been taught in seminars as part of the University of Vienna's and MedUni Vienna's medical curriculum since 1995. "This has enabled us to train a new generation of doctors with perfect hand hygiene technique and even greater awareness of hand hygiene." What is also important here is to have role models to demonstrate hand hygiene in their daily work. To mark World Hand Hygiene Day on 5 May, representatives of Vienna General Hospital's medical management team and representatives from MedUni Vienna therefore staged a hand hygiene relay , following Didier Pittet's 5-moment model.
"We now face much more dangerous germs than were encountered in Semmelweis' day, primarily due to the inappropriate and careless use of antibiotics. In everyday life these multi-drug resistant germs do not pose so much of a problem but in hospitals and healthcare institutions they can be life-threatening to patients who are already in a weakened and vulnerable state. We must therefore be constantly aware of the importance of hand hygiene and encourage the political decision-makers in the healthcare system to make adequate resources available for hospital hygiene and to support all initiatives to reduce antibiotic resistance," stressed Bernhard Küenburg, founder of the Semmelweis Foundation.
Austria is one of the few European countries that has legislated on hospital hygiene in the form of the Federal Law on Hospitals and Sanatoria.