Hand hygiene and healthcare associated infections
Andrew McArdle and colleagues assess the importance of hand hygiene in controlling infections during delivery of health care
In 1847, Ignaz Semmelweis was house officer for a Viennese maternity ward that had a shocking mortality rate for maternal puerperal fever.1 His breakthrough was to realise that medical students and doctors were carrying the infection from autopsy specimens to patients. He instituted a policy of handwashing with chlorinated lime between autopsy and clinical work, and successfully reduced the mortality rate by a factor of five to a level comparable with that of the nearby midwives' maternity ward.
Today, healthcare associated infections are still a hugely important problem (see box 1 for types of infection). A 1995 study by the Department of Health showed that almost 8% of inpatients became infected in hospital.2 These patients had a 10% chance of dying (sevenfold higher than other patients) and stayed on average 14 more days in hospital, with added costs estimated at £3000 (€4400; $5900). The overall burden on the country has