"If I walked into the kitchen without washing my hands as a kid, I'd hear a loud 'A-hem!' from my mother or grandmother. Now I count on other people to do the same.” Maya Angelou

Growing up my Grandma would constantly admonish me to wash my hands to stay healthy. At the time I thought she was just old. I was a modern girl, we had vaccinations and powerful cleaners to take care of those ancient illnesses that my Grandma had survived. As time went on, and my Grandma went on for 99 years, I learned the error of my naivety and realized Grandma was right!

Humans have always sought to identify the source of disease. Hippocrates (460 – 370 BC), considered the father of Medicine, theorized that "all disease begins in the gut". Future discoveries would prove his broad brush theory incorrect but some of his ideas have survived the passage of time, particularly this ...

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health”

Despite rumours to the contrary ancient civilizations also recognized cleanliness to be a source of good health. Indeed the phrase "Cleanliness is next to godliness" has been traced back to 2nd-century writings. Many religions incorporated ritual bathing as the way to cleanse the spirits and demons from the body. Today some of those demons have been identified as bacteria and viruses.

However, it was not until the mid-1800's that the spread of infectious disease and hand hygiene was connected. In a Vienna maternity ward, Dr. Ignaz Semmelweis noted that women were dying of a postpartum infection called puerperal fever at higher rates on the doctor maternity ward than the mid-wife maternity ward. He concluded it was because unlike the midwives, the doctors were going between autopsies and assisting in births (a practice that thankfully no longer exists!) and as a result spreading deadly "particles." Dr. Semmelweis ordered that doctors use a chlorine solution after autopsies and the mortality rate dropped from 17% to 3%.

Unfortunately for 19th-century women, other doctors ridiculed Dr. Semmelweis' theory and refused to follow the procedure. It would be almost ten years before another innovative healthcare practitioner introduces the concept of hand hygiene to reduce infection.

Florence Nightingale is considered the founder of modern professional nursing and she literally combatted poor hygiene on the battlefield during the Crimea War. In 1854 Nightingale noted that more soldiers were dying from diseases like typhoid than from their wounds. She believed, without knowing the actual origin, that this mortality was due to the unsanitary conditions of the wards. She ordered the nurses to scrub everything clean, including themselves and the patients. Deaths due to infection declined, and sanitizing wards and hand washing became standard practice.

Two years after Florence Nightingale began fighting germs on the battlefield, Louis Pasteur was investigating the cause of spoiled wine. He discovered that the fermentation of yeast was caused by a living organism. Some organisms were beneficial but others would spoil the wine. He further determined that these organisms were responsible for the spoilage of other beverages. Pasteur went on to prove that heating between 60 and 100 °C killed the bacteria and pasteurization would soon become another tool in the prevention of infectious disease.

His discovery of bacteria led to a new field of science, Germ Theory. In the ensuing years scientists would identify numerous pathogens and identified two sources of infectious disease, bacteria and viruses. Science now knew what the ancient healers, Dr. Semmelweis and Nurse Nightingale had been washing away in their fight to save the lives of their patients.

Despite discovering the connection between hand hygiene and the spread of illness, it would take an epidemic to remind 20th-century society how infectious diseases can spread from one source to many. In 1906 in New York city a typhoid outbreak was linked to one woman Mary Mallon. A cook by profession she worked in several different homes, each experiencing an outbreak while she was employed. By the time authorities identify and quarantined her, 51 people had contracted typhoid directly from Mary. Mary showed no signs of typhoid, and after a thorough investigation, she became the first person identified as an asymptomatic carrier.

In 1910 Mary was released from quarantine on the promise to not resume her career as a cook. Unfortunately after working as a laundress for five years, Mary returned to her former profession at a hospital! Another outbreak occurred. Mary fled the area. When authorities finally caught up with her she spent the rest of her life in quarantine.

Mary admitted that she did not practice good hygiene and said that because she wasn't sick, she didn't see the point. The man responsible for linking Mary and the outbreaks commented that her famous peaches and ice cream dessert combined with her lack of handwashing were the perfect storm,

“I suppose no better way could be found for a cook to cleanse her hands of microbes and infect a family,” George Soper

Yet, the benefit of hand hygiene to save lives continued to be ignored even by healthcare professionals! In 1962 a research in a Cleveland Ohio hospital made a direct link between the spread of Staphylococcus aureus and staff hand washing. The difference, 92% of infants were infected by staff who did not wash their hands compared to 53% by those who did, even more importantly with proper hand hygiene protocols the spread dropped to 14%.

Still, history continues to repeat itself, and infections spread from poor hand hygiene continues to be reported. Part of this may be due to differing scientific studies and the complexities of the germs found in modern society that has resulted in people not being sure what they are supposed to do.

While gloves are considered barriers to spreading infections, they are only as good as the practices of the person wearing them. If gloves are not changed between different uses, or in the case of healthcare patients, then the glove themselves become contaminated and spread infection.

So if you use gloves remember to remove them! And remove them properly as touching a contaminated glove with your fingers can spread the infection to the new glove!

Alcohol-based hand sanitizers kill most bacteria and are the tools of choice in healthcare settings. However, recent studies have found the most effective way to combat the spread of C. difficile and norovirus type viruses is soap and water. The Centre for Disease Control recommends using hand sanitizers in combination with proper soap and water hand washing.

And I would be remiss if I did not mention keeping up to date with vaccinations to reduce the transmission of identified diseases particularly for those who work with vulnerable individuals in hospitals or long-term care facilities.

Regardless of the debate between gloves, sanitizers and soap and water, there is universal agreement that keeping our hands clean reduces the transmission of infectious diseases.

Add a balanced diet, and healthy lifestyle and you will be better armed to fight the war on germs.

So take the advice of Hippocrates and your Grandma, 'Wash your hands, eat your fruit and go outside and play!'

Hand hygiene is a simple and effective solution to reduce both the spread of infection and multiresistant germs, and to protect patients from health care-associated infection.

World Health Organization