Until the mid-1800s, doctors didn’t bother washing their hands – they would go from dissecting a cadaver to delivering a child. Then a Hungarian medic made an essential, much-resisted breakthrough. Religious handwashing rituals have been around for thousands of years in Islamic, Jewish and other cultures, but the notion of disease spreading by hand has been part of the medical belief system for only about 130 years. However, the first recorded discovery of handwashing’s life-saving power came 50 years earlier, in 1848, as a huge, unwelcome shock.
“If there had to be a father of handwashing it would be Ignaz Semmelweis,” says Miryam Wahrman, a professor of biology at William Paterson University in New Jersey and author of The Hand Book: Surviving in a Germ-Filled World. While working at Vienna General Hospital, the Hungarian doctor was at the forefront of a more scientific approach to medicine. Faced with a doctor-led maternity ward in which maternal deaths from the dreaded childbed fever were significantly higher than in the midwife-run clinic there, he racked his brain for clues as to why.
Germs were yet to be discovered, and it was still believed in the 1840s that disease was spread by miasma – bad smells in the air – emanating from rotting corpses, sewage or vegetation. Victorians kept their windows firmly shut against such malevolent forces. So it didn’t seem a problem that trainee doctors at Vienna General would hang out in the morgue dissecting corpses to figure out what had rendered them dead and then pop up to the maternity ward to deliver a baby without washing their hands.
One of them then accidentally got cut by a scalpel during a dissection and died, seemingly of the same childbed fever the mothers had been getting. Semmelweis hypothesised that cadaverous particles from the morgue were to blame, and that such particles on the hands of doctors were making their way into women’s bodies during childbirth.
To test his theory, he ordered doctors to wash their hands and instruments in a chlorine solution, a substance he hoped would dispatch the deadly smell of cadaverous particles. Before the experiment, says Wahrman, “the mortality rate for new mothers was as high as 18%. After Semmelweis implemented hand hygiene between the morgue and the delivery room, the rate of mortality for new mothers dropped to about 1%.”
Despite his success, his idea faced great resistance and met a tragic end. He lost his job, and is thought to have had a breakdown. He died in a psychiatric institution, “a very despondent person at the untimely age of 47”, says Wahrman
Part of the problem, says Tomes, was that people, “didn’t have that conception of themselves as sort of walking petri dishes”. And doctors were offended by the suggestion that they could be causing infections. “The majority of doctors in Vienna at this time were from middle- or upper-class families, and they thought of themselves as very clean people compared with the working-class poor. He was insulting them when he said their hands could be dirty.”
Understanding of germs
Over the next 40 years, an understanding of germs developed, and attitudes to hygiene gradually shifted. In 1857, while Semmelweis’s mental health declined, Louis Pasteur, of pasteurisation fame, raised awareness of pathogens, and how to kill them with heat. In 1876, the German scientist Robert Koch discovered the anthrax bacillus, kicking off the new research field of medical bacteriology. Cholera, tuberculosis, diphtheria and typhoid bacilli were subsequently identified.
Surgeons started handwashing in earnest. Tomes says: “If you’re cutting open someone’s skin – that protective layer – you need to take extraordinary precautions.” The British surgeon Joseph Lister pioneered antiseptic surgery, which included handwashing, “and by the 1890s and into the early 1900s,” adds Tomes, “handwashing moved from being something doctors did to something everybody had been told to do”.
Florence Nightingale helped. Despite still labouring under miasma theory, she intuitively improved hygiene in military hospitals during the Crimean war in the 1850s and, after returning to the UK, set about revolutionising nursing. “Nightingale influenced a new interest in household cleanliness as a goal that a good wife and mother needs to instil in her family,” says Tomes.
The turn of the century saw the first popular public health campaigns being launched around tuberculosis, says Tomes. “Koch had shown that tuberculosis was not something you inherited from your grandmother, but that your grandmother coughed on you, and that’s why you got it.” The anti-tuberculosis movement was aimed at both adults and schoolchildren. “You really were getting little kids taught these rules about being clean and washing your hands.”
Tomes adds: “People got totally phobic about shaking hands or kissing each other when they understood that their mouth, their skin and their hair had all these germs on them.” It’s one reason, she says, why young men started eschewing beards at the turn of the century. And why foods started being sold individually wrapped, because of “this fear of germs and hands touching things”. But this hygiene-centric era was short-lived.
The combination of public health messaging and the development of vaccines and antibiotics in the early 20th century saw death rates from bacterial diseases plummet. “The hyperattention to this kind of cleanliness became less important,” says Tomes. “A laxity crept in, I think, in healthcare and in everyday life after the second world war.”
How effective is handwashing? Petra Klepac, an assistant professor of infectious disease modelling at the London School of Hygiene & Tropical Medicine, looked into this question in 2018 while predicting how a flu pandemic would spread in the UK, for the documentary Contagion! The BBC Four Pandemic.
“We were looking for systematic reviews and meta-analyses, and pooling the results from these studies,” she says. One review, published in 2017, found significant effects from handwashing, compared with nonsignificant effects from face-mask use. When Klepac and colleagues drilled down into the highest quality data, gathered from a clinical setting, with clinical diagnosis and a control group (who didn’t increase hand hygiene) they discovered that if you washed your hands five to 10 times more than usual, “that would reduce your risk by a quarter”.
At the start of a pandemic, this is pretty much all you’ve got. “You don’t have pharmaceutical interventions,” says Klepac. “You don’t have a vaccine. This is why we’re looking at nonpharmaceutical measures that are easily implemented.”
You can say to people: ‘Here’s one thing you can do to lower your risk.’ It’s simple. It’s right there and doesn’t cost anything. Wash your hands with soap before you touch your mouth, your nose or your eyes. It’s empowering because it really does make a difference.
Global Handwashing Day
Each year on October 15, Global Handwashing Day highlights how consistently washing hands with soap and water is an effective and affordable way to prevent viruses and diseases, and ultimately save lives.
The special designation was initiated by the Global Handwashing Partnership, a coalition of international stakeholders working to promote handwashing with soap and recognise hygiene as a pillar of international development and public health. This year’s theme, Clean Hands Are in Reach, accentuates the important link between good handwashing practices and disease prevention. According to the organisation, great strides have been made in hygiene commitment and action in the past few years, but globally, better access and more practice is needed to achieve hand hygiene for all.
In a press release, Bradley Corp., an international manufacturer of commercial restroom fixtures, asserts that less than a fifth of people worldwide currently wash their hands at critical times. Even in areas where handwashing is an established practice—and soap and water are accessible—people still fail to wash their hands often enough.
As for school-aged children, Bradley states that more than a million children globally die each year due to diarrhoea but handwashing with soap could prevent two-thirds of those deaths. Further, children lose 443 million school days each year because of water-related illnesses. Without handwashing facilities in schools, children are more susceptible to illness and less able to learn, grow, and thrive.
Medical experts from the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) agree that developing a habit of consistent and thorough handwashing with soap and water is the best prevention of cold and flu germs and the spread of other contagious illnesses seen around the globe, like diarrhoea and pneumonia.
Earlier this year, Bradley released its annual Healthy Handwashing Survey, which revealed that 93% of adults believe handwashing is essential to maintaining their overall health and 75% wash their hands more diligently during flu and virus outbreaks. However, Americans’ handwashing activity, according to the survey, has dropped 30% over the past three years returning to pre-COVID-19 levels, and there has also been an increase in people taking handwashing shortcuts. In fact, 45% admit to just rinsing with water and skipping soap.
“The aim of our survey is to keep the health benefits of handwashing with soap top-of-mind, especially as we head into cold and flu season. Celebrating Global Handwashing Day is a natural outgrowth of that mission,” said Jon Dommisse, Bradley vice president of marketing and strategy. “Connecting handwashing with our daily habits or rituals is an effective way to form good handwashing practices.” Dommise further added that Global Handwashing Day is a good reminder of how businesses and facilities can support healthy handwashing by providing clean, well-stocked, and maintained restrooms.
World Hand Hygiene Day
World Hand Hygiene Day, observed annually on May 5th, is a critical reminder of the importance of maintaining clean hands when working with food. Hand hygiene is simple, yet vital. Proper hand washing drastically reduces the spread of harmful pathogens, decreasing the risk of food-borne illnesses that impact millions of Australians yearly.
There is plenty of data backing up the effectiveness of hand washing. Research conducted by the Centers for Disease Control and Prevention (CDC) indicates that washing our hands can help reduce diarrheal diseases by at least 30 per cent. Everyone should consistently wash their hands, from delivery drivers to Food Handlers and Food Safety Supervisors. In other words, proper hand washing is essential for all food industry workers, not just those directly touching food. There should be no excuses for not washing your hands well and often: it’s a basic action that could even help save lives.
This day reminds us all that something as simple as washing our hands can have a profound effect on our health and the safety of the food we consume.
Handwash Labels
At Labelservice we are specialist in supplying labels for over 500 different products, and handwash labels has been a big product since the outbreak of Covid. If we can help you with the design, consultancy and/or production of your handwash labels then please do get in touch.
