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Hand hygiene in hospitals: anatomy of a revolution

  • T. Vermeil
    Affiliations
    Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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  • A. Peters
    Affiliations
    Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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  • C. Kilpatrick
    Affiliations
    Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
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  • D. Pires
    Affiliations
    Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

    Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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  • B. Allegranzi
    Affiliations
    Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
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  • D. Pittet
    Correspondence
    Corresponding author. Address: Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland. Tel.: +41 22 372 9828/+41 22 372 9833.
    Affiliations
    Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Published:September 17, 2018DOI:https://doi.org/10.1016/j.jhin.2018.09.003

      Summary

      Healthcare-associated infections (HAIs) affect hundreds of millions of individuals worldwide. Performing hand hygiene is widely accepted as a key strategy of infection prevention and control (IPC) to prevent HAIs, as healthcare workers' contaminated hands are the vehicle most often implicated in the cross-transmission of pathogens in health care. Over the last 20 years, a paradigm shift has occurred in hand hygiene: the change from handwashing with soap and water to using alcohol-based hand rubs. In order to put this revolution into context and understand how such a change was able to be implemented across so many different cultures and geographic regions, it is useful to understand how the idea of hygiene in general, and hand hygiene specifically, developed. This paper aims to examine how ideas about hygiene and hand hygiene evolved from ancient to modern times, from a ubiquitous but local set of ideas to a global phenomenon. It reviews historical landmarks from the first known documented recipe for soap by the Babylon civilization to the discovery of chlorine, and significant contributions by pioneers such as Antoine Germain Labarraque, Alexander Gordon, Oliver Wendell Holmes, Ignaz Philip Semmelweis, Louis Pasteur and Joseph Lister. It recalls that handwashing with soap and water appeared in guidelines to prevent HAIs in the 1980s; describes why alcohol-based hand rub replaced this as the central tool for action within a multi-modal improvement strategy; and looks at how the World Health Organization and other committed stakeholders, governments and dedicated IPC staff are championing hand hygiene globally.

      Keywords

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