Hygiene drive leads to health miracle

Hospital hand-washing campaign saves 10,000 lives

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, an infection following childbirth that killed up to a third of women in European hospitals in the mid-19th century.

Click here to see the 'Soap star in numbers' graphic

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 dramatically improved 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 including MRSA and Clostridium difficile.

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 deaths from C. difficile annually in the mid-2000s. A halving of the infection rate implies a saving of 2,500 lives a year. Researchers from University College London 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 selling it for all they were worth."

But Dr Stone warned the gains could be lost after 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 more than 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 Fawlty Towers once said, it's stating the bleeding obvious. But sometimes the obvious needs stating. The problem is it doesn't sound very sexy compared with hi- tech medical innovations."

Louise Teare, consultant microbiologist and chair of the Independent Alliance of Patients and Healthcare Workers for Hand Hygiene, said: "The CleanYourHands campaign was unbelievably 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 was backed by the Health Act 2006 which imposed a legal duty on NHS trusts to provide "hand-washing facilities and hand rubs". It was reinforced by 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 trust, 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 infections.

Doctors had regarded their main task as treating patients, and had seen hospital infections as an unfortunate but inevitable complication of medical care.

That resulted in a fatalistic attitude to the occurrence of infections and an over-reliance on antibiotics to deal with them. Cases of MRSA grew from less than 100 a year in the early 1990s to 6,378 cases in 2006-07 when the infection was linked with more than 1,000 deaths. The number of MRSA infections has since fallen to 1,114 in 2011-12.

C. difficile cases grew from a few hundred in the early 1990s to 55,681 in 2006-07 and caused about 4,000 deaths. They have fallen to 18,005 cases in 2011-12.

The National Audit Office estimated in 2007 that hospital infections cost the NHS over £1bn a year to treat. The CleanYourHands campaign cost £500,000 over four years and, by halving the infection rate, may have saved £500m.

The rise in hospital infections was linked with the ageing of the population and advances in medicine. The bugs thrive in people whose immune systems are weak – as older and sicker patients were being treated infection rates grew.

According to the Organisation for Economic Co-operation and Development (OECD), hospital acquired infections accounted for more days spent in hospitals in Europe than all other causes of infectious disease – flu, pneumonia, tuberculosis, Aids – combined.

In the case of MRSA, more powerful antibiotics have been required to shift the bug. In the case of C. difficile, antibiotics are themselves a key cause of the infection. They knock out "healthy" bacteria in the gut, allowing the C. difficile bacteria, which are normally held in check, to gain the upper hand.

But Britain's experience with the CleanYourHands campaign shows that with the right initiative and the right political backing it is possible to cut infection rates dramatically. Cases of MRSA are down almost 85 per cent and C. difficile down 67 per cent since 2006-7.

Cutting the rates further will be tougher. It depends on cleaning up diarrhoea, washing down wards, monitoring antibiotic prescribing – and washing hands. These are not glamorous activities and they will not yield breakthroughs, claim headlines or win Nobel prizes. But they will save lives.

Suggested Topics
News
Waitrose will be bringing in more manned tills
newsOverheard in Waitrose: documenting the chatter in 'Britain's poshest supermarket'
Life & Style
life
Arts & Entertainment
Jack Gleeson as Joffrey Baratheon in Game of Thrones
tv
Arts & Entertainment
Ken Loach (left) and Mike Leigh who will be going head to head for one of cinema's most coveted prizes at this year's Cannes Film Festival
filmKen Loach and Mike Leigh to fight it out for the Palme d'Or
VIDEO
Arts & Entertainment
Ian Anderson, the leader of British rock band Jethro Tull, (right) and British guitar player Martin Barre (left) perform on stage
musicJethro Tull frontman leads ‘prog rock’ revival
Sport
Gareth Bale dribbled from inside his own half and finished calmly late in the final to hand Real a 2-1 win at the Mestalla in Valencia
sport
Arts & Entertainment
Who laughs lass: Jenny Collier on stage
comedy... writes Jenny Collier, the comedian whose recent show was cancelled because there were 'too many women' on the bill
News
House proud: keeping up with the Joneses now extends to children's playhouses
newsLuxury playhouses now on the market for as much as £800
News
news
Extras
indybest
News
The academic, Annamaria Testa, has set out on her website a list of 300 English words that she says Italians ought to stop using
newsAcademic speaks out against 'Italianglo' - the use of English words in Italian language
Life & Style
tech
Arts & Entertainment
Ricky Gervais at a screening of 'Muppets Most Wanted' in London last month
tvRicky Gervais on the return of 'Derek' – and why he still ignores his critics
Sport
Luis Suarez of Liverpool celebrates his goal
sport
Arts & Entertainment
James Franco and Chris O'Dowd in Of Mice and Men on Broadway
theatreReview: Of Mice and Men, Longacre Theatre
Independent
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
santorini
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Have you tried new the Independent Digital Edition iPad app?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Apprentice IT Technician

    £150.00 per week: QA Apprenticeships: This company is a company that specializ...

    1st Line Technical Service Desk Analyst IT Apprentice

    £153.75 per week: QA Apprenticeships: This company is an innovative outsourcin...

    1st Line Helpdesk Engineer Apprentice

    £150.00 per week: QA Apprenticeships: This company has been providing on site ...

    Sales Associate Apprentice

    £150.00 per week: QA Apprenticeships: We've been supplying best of breed peopl...

    Day In a Page

    Ricky Gervais: 'People are waiting for me to fail. If you think it's awful, then just don't watch it'

    Ricky Gervais: 'People are waiting for me to fail'

    As the second series of his divisive sitcom 'Derek' hits screens, the comedian tells James Rampton why he'll never bow to the critics who habitually circle his work
    Mad Men series 7, TV review: The suits are still sharp, but Don Draper has lost his edge

    Mad Men returns for a final fling

    The suits are still sharp, but Don Draper has lost his edge
    Google finds a lift into space will never get off the ground as there is no material strong enough for a cable from Earth into orbit

    Google finds a lift into space will never get off the ground

    Technology giant’s scientists say there is no material strong enough for a cable from Earth into orbit
    Westminster is awash with tales of young men being sexually harassed - but it's far from being just a problem in politics

    Is sexual harassment a fact of gay life?

    Westminster is awash with tales of young men being sexually harassed - but it's far from being just a problem in politics
    Moshi Monster creator Michael Acton Smith: The man behind a British success story

    Moshi Monster creator Michael Acton Smith

    Acton Smith launched a world of virtual creatures who took the real world by storm
    Kim Jong-un's haircut: The Independent heads to Ealing to try out the dictator's do

    Our journalist tries out Kim Jong-un's haircut

    The North Korean embassy in London complained when M&M Hair Academy used Kim Jong-un's image in the window. Curious, Guy Pewsey heads to the hair salon and surrenders to the clippers
    A History of the First World War in 100 moments: A forgotten naval victory in which even Nature played a part

    A History of the First World War in 100 moments

    A forgotten naval victory in which even Nature played a part
    Vespa rides on with launch of Primavera: Iconic Italian scooter still revving up millions of sales

    Vespa rides on with launch of the Primavera

    The Vespa has been a style icon since the 1950s and the release this month of its latest model confirms it has lost little of its lustre
    Record Store Day: Independent music shops can offer a tempting alternative to downloads

    Record Store Day celebrates independent music shops

    This Saturday sees a host of events around the country to champion the sellers of well-grooved wax
    Taunton's policy of putting philosophy at heart of its curriculum is one of secrets of its success

    Education: Secret of Taunton's success

    Taunton School, in Somerset, is one of the country's leading independent schools, says Richard Garner
    10 best smartphones

    10 best smartphones

    With a number of new smartphones on the market, we round up the best around, including some more established models
    Mickey Arthur: Aussie tells ECB to stick with Ashley Giles

    Mickey Arthur: Aussie tells ECB to stick with Ashley Giles

    The former Australia coach on why England must keep to Plan A, about his shock at their collapse Down Under, why he sent players home from India and the agonies of losing his job
    Homelessness: Why is the supported lodgings lifeline under threat?

    Why is the supported lodgings lifeline under threat?

    Zubairi Sentongo swapped poverty in Uganda for homelessness in Britain. But a YMCA scheme connected him with a couple offering warmth and shelter
    A History of the First World War in 100 Moments: When the world’s biggest shed took over Regent’s Park

    A History of the First World War in 100 Moments

    When the world’s biggest shed took over Regent’s Park
    The pain of IVF

    The pain of IVF

    As an Italian woman vows to keep the babies from someone else’s eggs, Julian Baggini ponders how the reality of childbirth is often messier than the natural ideal