When hand washing cleaned up

Surprisingly, this basic act of hygiene had been neglected so much by medical professionals that an awareness campaign was needed. By Jeremy Laurance
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The Independent Online

The life-saving benefits of soap were first recognised by Ignaz Semmelweis, a Hungarian physician, who discovered in 1847 that hand-washing by obstetricians and midwives could prevent puerperal fever, a post-childbirth infection that killed up to a third of women in European hospitals in the 19th century.

Semmelweis became known as the "saviour of women", but more than a century and a half later, surveys showed one in four doctors and nurses in Britain still did not wash their hands consistently between patients. That abysmal record has been improved dramatically by the CleanYourHands campaign, launched in England and Wales in 2004.

It has instilled into medical staff, patients and visitors the importance of washing hands to prevent the spread of superbugs. It was the first such campaign in the world to be rolled out nationally and the results from the first study of its effects are published online in the British Medical Journal today.

They show that over the four year period to mid-2008, orders for soap and alcohol hand rub almost tripled, while infections with MRSA and C Difficile almost halved. There were 1,000 deaths from MRSA and 4,000 from C Difficile annually in the mid-2000s. A halving of the infection rate implies a saving of 2,500 lives a year.

The researchers from University College London (UCL) Medical School and the Health Protection Agency say the "strong and independent associations" between the rise in soap orders and the fall in infection rates "remained after taking account of all other interventions".

Sheldon Paul Stone, senior lecturer at UCL Medical School, who led the study, said: "Without a doubt, lives were saved by the campaign. I would say 10,000 lives over the four year period of the study was a reasonable estimate.

"If hand hygiene were a new drug, pharmaceutical companies would be out there selling it for all they were worth. This campaign has changed the culture in the NHS. It shows that central government enacting a national policy can do something we are at risk of losing under the proposals to devolve control in the Health and Social Care Act."

But Dr Stone warned there was a danger the gains could be lost since the CleanYourHands campaign ended in 2010. "It is obvious the campaign should be continued. Independent groups have suggested it should. It needs a new focus on staff who use gloves.

"They deal with the most infectious patients, but they are much less likely to use soap." Asked why it had taken over 150 years to get the message through to doctors and nurses, who already had the professional knowledge about the risks of hand contamination and transmission of bacteria, he said: "As Basil Fawlty said, it's stating the bleeding obvious. But sometimes the obvious needs stating. The problem is it doesn't sound very sexy compared with high tech medical innovations."

Louise Teare, consultant microbiologist and chair of the Independent Alliance of Patients and Healthare Workers for Hand Hygiene, said: "The CleanYourHands campaign was unelievably successful. It is extraordinary that it has taken 150 years to get the message across. But throughout history that is, sadly, what happens. Our challenge now is how to make it sustainable."

The campaign was accompanied by posters and regular audits and backed by the Health Act 2006 which imposed a legal duty on NHS trusts to provide "adequate hand washing facilities and hand rubs" and was reinforced by regular visits by Department of Health inspectors.

Key to its success was the high profile political drive to cut infection rates. In the mid-2000s, the Blair government recognised that something had to be done about soaring hospital infection rates which had become a touchstone for the failings of the NHS.

Scandals at Stoke Mandeville hospital and Maidstone and Tunbridge Wells, where hundreds of patients died, fuelled public alarm.

Patients understood that medical treatment carried a risk but were not prepared to accept that hospitals themselves could pose an even bigger one, by spreading lethal infections.