THE SUNDAY TELEGRAPH – 19 February 1995
Wash your hands please Doctor
No, library books do not spread disease; human contact does, says Dr James Le Fanu.
MUCH OF what now passes for medical research involves identifying previously unknown hazards to health in our everyday lives. Nothing escapes scrutiny. Indeed, a curiously named American scientist, Dr Bruyninckx, reported in the most prestigious of all science journals, Nature, that the oxygen we breathe can cause cancer – at least, oxygen had tested positive in the standard tests investigating the cancer potential of chemicals. Clearly, if oxygen is dangerous (and many chemicals have been banned on the grounds of similar findings), then we will all have to stop breathing.
There is one area, however, where despite intensive investigation, scientists have been unable to identify a threat to human health; it is apparently very difficult, if not impossible, to catch infectious diseases from inanimate objects. Letters and parcels were obvious candidates for spreading such infections, especially smallpox and scarlet fever.
Throughout Western Europe and particularly the United States, elaborate attempts were made to disinfect the mail by baking it in an oven with formalin or chlorine gas, by dipping letters in vinegar, or by punching them with holes to let in disinfecting fumes. The practice was not popular with the recipients of correspondence tampered with in this way- a General F. E. Spinner, formerly treasurer of the United States, replied to a friend: "Your very kind letter came from the pure air of the Green Mountains, but the criminal fools at the fumigating station seized it, punched it full holes so it is almost illegible and then pumped an unbearable stink into it."
In spite of anecdotal reports that the first case of an infectious epidemic was contracted from a letter sent by a victim of the disease, the idea that viable viruses or bacteria might be transmitted by these means was eventually discredited and the practice fell into disrepute.
More recently, the lavatory seat has been suspected as a potential source of sexually transmitted diseases. An American venerealogist, Dr James Gilbaugh, took swabs from hundreds of public lavatory seats in hotels, department stores and hospitals but was unable to culture sexually transmitted organisms from any of them.
Indeed, there is only one case ever reported – and that was over 50 years ago – where such a mode of transmission has been documented. After several weeks confined to a hospital bed with both legs in plaster, a sailor developed the symptoms of acute gonorrhoea. His circumstances precluded the possibility of having acquired the infection by the usual means, and further investigation revealed the source to be a recently arrived patient in the next bed which whom he had shared a bedpan.
Now, Dr Sara Brook of Georgetown University has shown that library books are also free of hazard. The only bugs she was able to grow following bacteriological tests from a large random sample of children’s library books was the harmless staphylococcus epidermidis. "Library books are safe," she concludes.
If physical contact with inanimate objects is not a source of contagion, contact with human hands certainly is, as they provide a ready source of nutritional factors which enable bacteria to flourish. In everyday life, this is probably of no importance but in hospitals, with their nasty bugs and susceptible patients, it is a different matter. Hence the significance of an editorial in The Lancet at the end of last year: "Hand-washing – the Semmelweis lesson forgotten."
Ignac Semmelweis was the Viennese doctor who discovered the cause of childbirth fever. In the Vienna General Hospital in the 1840s, there existed, side by side, two obstetric departments, exactly the same in every way, each delivering approximately 3,500 babies a year. The only difference was that in one department all the deliveries were by obstetricians and students, and 800 mothers died each year from childbirth fever; while in the second, the deliveries were conducted by midwives and there were only 60 deaths a year.
The reason, Semmelweis speculated, was that the doctors conducted several autopsies a day, from which they must be transferring on their hands "some cadaver particles" to women while assisting them in labour. (These "particles" we now know to be the streptococcus bacterium.) He instituted a simple measure of washing hands with chlorine and within a year the mortality rate fell to that in the wards run by the midwives.
In The Lancet editorial, Dr William Jarvis of the National Center for Infectious Diseases in Atlanta, Georgia, argues that this vital element of prophylactic hygiene is ignored in modern hospitals. Despite repeated campaigns to encourage the practice, doctors and nurses "seldom wash their hands before patient contacts".
"Excuses include being too busy, skin irritation, or not thinking about it," Dr Jarvis says. "Some believe they have washed their hands even when observations indicate they have not." He proposes a radical solution. On admission to hospital, patients should be informed of the importance of hand-washing in reducing infection rates. "How many doctors and nurses would ignore a patient’s request that they first wash their hands?" he asks.
Copyright: Telegraph Group Ltd