The legacy of I. F. Semmelweis; key milestones in the development of hospital hygiene and current challenges.

Overview

It was in 1847 that Ignaz F. Semmelweis first ordered his staff at the First Maternity Clinic in Vienna, Austria, to wash their hands in a chlorinated lime solution before examining patients, most particularly after examining dead patients before prenatal examinations, at delivery or post partum.

A lot has changed in the 160 years since then. Several milestones should be noted with regards to these developments, connected with names such Florence Nightingale, Louis Pasteur, Joseph Lister and Robert Koch.

Semmelweis later extended his demands to the use of protective gloves and other clothing where contact with body fluids or tissues was expected. Developments have been made in the use of antiseptics and instrument sterilization in invasive procedures. It is presumed that the problems of hygiene standards in hospitals of the 19th century are behind us – unfortunately this is not absolutely true.

The “golden age” of antibiotics has given way to an era that has witnessed a rapid increase in antibiotic resistance following the appearance of so called “super bugs” that are resistant to a wide spectrum of antibiotics. This has meant that a recent problem that currently drastically compromises hospital hygiene is connected with hospital acquired infections caused by methicillin resistant Staphylococcus aureus (MRSA). This is particularly dangerous in hospitals because MRSA poses a high risk to immunocompromised patients. The situation is complicated by the penetration of community associated MRSA strains into the hospital environment and vice versa. We are now facing a great challenge to arrest this growing threat.

Key words:
development of hospital hygiene, I. F. Semmelweis, F. Nightingale, L. Pasteur, J. Lister, R. Koch, antibiotic resistance, hospital infection, MRSA, community MRSA, antibiotic centre, quality of life.