One mantra of modern health care is, “Hand hygiene saves lives.”
At hospitals, clinics and schools, it is emphasized continuously. The easiest way to avoid disease transmission is to wash your hands thoroughly and consistently.
The practice dates back to 1846 when Ignaz Semmelweis, a Hungarian doctor, was practicing at the Vienna General Hospital. He was one of the first to champion the idea of medical hand hygiene.
He noticed radically different mortality rates among patients in the physician- and medical student-run maternity ward versus the mortality rate among the patients of the midwife-run maternity ward.
Many of the physicians and students would see patients in the maternity ward after they had conducted autopsies. Semmelweis theorized that the exposure to dead bodies contaminated the physicians’ and students’ hands with what he called “cadaverous particles.” They then transferred these to the patients in their maternity ward.
As the midwives were not involved in autopsies, they did not transfer the same particles. This explained the lower mortality rate among new mothers and babies in the midwife unit.
Based on his observation, Semmelweis required physicians and students to wash their hands with chlorine, resulting in a lower mortality rate in the physician and student wards.
Handwashing was unpopular among European doctors as the germ theory of infection was not yet widely accepted. At the time, the prevailing assumption was that water and foul-smelling air were the offending substances that caused disease.
It was not until the late 19th century with the work of Louis Pasteur and Robert Koch that the germ theory was widely adopted. Even so, it was not until the 1980s that the U.S. Centers for Disease Control and Prevention released hand hygiene guidelines.
Almost 49 years later, findings in the World Health Organization’s report on water supply, sanitation and hygiene are shocking.
Released on August 30, the report says that 49% of the world’s medical facilities still lack all the WHO recommendations for basic hygiene and sanitation at the point of care, with 9% of facilities lacking any hygiene services, including soap and water. In the least developed countries, only 53% of health care facilities had water available from improved sources.
Put another way, the facilities that service 3.85 billion people do not meet the basic WHO requirements for hand hygiene and sanitation, and 688 million lack any services.
Why does this matter?
First, infection either by a cut or trauma, or by viral exposure like COVID-19, the flu or Monkey pox, can lead to death if the immune system is overwhelmed.
A 2017 Lancet study revealed that sepsis might actually be the leading cause of death in the world, taking the lives of 1 in 5 patients or 11 million people annually.
Sepsis occurs when the body’s immune system overreacts to an infection, resulting in tissue damage and organ failure. It accounts for 26.7% of deaths in hospitals worldwide.
Around 40% of sepsis cases affect children under the age of 5, and it is low-income countries that are the hardest hit. According to the WHO, 85% of sepsis cases occur in low-resource settings.
Most of these deaths could be avoided through adherence of basic contact precautions and hand hygiene.
Second, antimicrobial-resistant strains of bacteria are on the rise.
As bacteria are passed from patient to patient, health care workers are forced to administer antibiotics. In under-developed countries, professionals have to guess at the appropriate type of antibiotic to use. This leads to the development of new strains that are immune to traditional drugs, resulting in the need for new medications to be developed.
As poor countries lack the type of health care seen in industrialized nations, they functionally become a petri dish that generates novel super bugs, which infect both poor and rich nations alike.
The WHO is recommending an additional $10 billion in funding to assist the 46 least developed nations in meeting the recommended sanitation standards by 2030. That is a small price to pay to curb the death rate and slow the development of super bacteria and novel viruses that impact everyone, regardless of standard of living.
In industrialized nations, we take basic health care, including the availability of soaps and hand sanitizers, for granted.
I cannot walk 10 feet in my hospital without passing a bottle of alcohol gel or a can of antibacterial foam wash. We have sinks with antimicrobial hand wash and warm water in every patient room. Many facilities have sensors that will track if it takes staff longer than 20 second to perform hand hygiene after walking into a room.
This is a stark contrast to the facilities that the poorest people in the world are forced to visit. There may not be clean water let alone soap or hand sanitizers.
It is time for us to reconsider the wealth of health care resources that we hoard. We need to seriously consider sharing out of our abundance of resources. This not only would save lives but also protect the world from future diseases.