Ignaz Semmelweis, our everyday hero
In recent weeks, we have again become particularly aware that hygiene regulations play an important role in the spread of diseases. Suddenly, the media is reporting on how to wash hands properly and the best way to do this is to cough in your elbows so that pathogens are not spread via your hands. But especially in the medical field, hygiene regulations were indispensable even before COVID-19. Particularly before and during an operation, meticulous attention is paid to ensuring that everything is as sterile as possible so that pathogenic germs do not enter the body. Clothing is changed, hoods, mouthguards and gloves are worn and the hands are thoroughly washed and disinfected before the operation.
However, this exemplary behaviour was not always on the agenda of the medical staff, as hygiene did not play a major role in hospitals for a long time. Because additional hygiene measures took some time, doctors often considered them unnecessary. They preferred to use them for the treatment of their patients. The importance of antiseptic prophylaxis was first discussed by the Hungarian doctor Ignaz Phillipp Semmelweis (1818-1865). With his research, he laid the foundation for the fact that today we naturally pay attention to hygiene in everyday life.
Dr. Semmelweis got on the right track in the 1840s, when childbed fever took the lives of up to 30% of women1 who gave birth in hospitals. During this time he worked in the maternity ward of the Vienna General Hospital, which was divided into two parts in 1833. In the first clinic, male doctors and medical students worked to take care of the birth of the mothers, in the second clinic, female midwives were responsible for this. However, in the clinic where the doctors worked, three times as many mothers2 died as in the midwife clinic.
Ignaz Semmelweis wanted to understand how these serious differences came about and began to examine the disease in more detail. He noticed that women in the first clinic almost always became ill when they were in labour for much longer than 24 hours1. This was not the case in the second clinic. He also discovered that the risk of falling ill was significantly lower in women who gave birth on the street than in women who gave birth in hospital3.
In the hospital, morning autopsies were also on the agenda before the doctors and medical students entered the clinic. When a colleague died from a wound made during an autopsy and had previously shown the same symptoms as the patients who had died of childbed fever, Semmelweis recognised the connection: since examinations of expectant mothers were carried out with bare hands following the morning autopsies, he hypothesised that particles found on the autopsy knife could later enter the uterus during an examination by a doctor with contaminated hands.
His investigations suddenly made sense. Only male doctors and medical students were allowed to perform autopsies. Midwives, on the other hand, were not allowed to enter the morgue as women. This meant that only female patients of the medical clinic could come into contact with the pathogens. If several women were examined, suddenly more became ill at the same time. The hypothesis also made it clear why the risk of contracting childbed fever was particularly high in women who had been in labour for more than 24 hours: they had to be examined several times, which increased the probability of infection. Women who gave birth on the street were not exposed to the contaminated hands of doctors.
In order to reduce the mortality rate again, Ignaz Semmelweis developed a chlorinated lime solution which was carried to the slopes before each examination to remove the germs on the surface of the hands. At a later stage, cleaning of the instruments was also introduced. After the introduction of the chloride lime solution for cleaning the hands, the mortality rate in the medical clinic fell from 11.4% (1846) to 1.3% (1848) 3.
Despite the enormous successes, Ignaz Semmelweis did not receive any recognition. In 1850 he left Vienna and took a job at the Szent Rókus (St. Rochus) Hospital in Pest, where his hand washing and sterilization techniques reduced maternal mortality to 0.85% 3. In 1855 he was appointed professor of obstetrics at the University of Pest.
Today it is hard to imagine medicine without hygiene. Hand hygiene is mandatory before and after every patient contact. The World Health Organization (WHO) has established the 5 indication groups (“five moments”)4 as a basis for the education and training of hand disinfection based on today’s knowledge of pathogen transmission via the hands. The aim is to disinfect hands before patient contact, before aseptic activities, after contact with potentially infectious material, after patient contact and after contact with the immediate patient environment. This is to protect patients and medical staff from the transmission of pathogenic germs.
Did you know that 30% of hospital infections5 can be prevented by these strict hygiene regulations and the careful organisation of hospital procedures? This is because the risk of coming into contact with infectious agents is particularly high in institutions in which medical staff look after patients. Thanks to Semmelweis’ discoveries, medicine has become more advanced and that is why he is still the hero who frees us from the risk of infection in our everyday lives.
3 Carson, E.A.; Toodayan, N: Ignaz philipp semmelweis (1818-1865): Herald of hygienic medicine. Medical Journal of Australia, 10 December 2018, Vol.209(11), pp.480-482