The origins of patient safety advocacy dates back to the time of Ignaz Semmelweis a Hugarian physician. Actually, Semmelweis began his career as a lawyer and transformed to become a physician to do good to humanity. His advocacy skills were rooted in his legal training, and his advocacy based on sound scientific evidence decreased both maternal and infant mortality. During his period, the incidence of puerperal fever was high and often fatal. He made some critical observations of maternal mortality between two wards. In one ward where the doctors were delivering the baby, the incidence of puerperal fever and subsequent mortality was high. In the other ward where midwives delivered the babies, the rate was much lower. Additionally, the mortality of mothers giving birth at home was also low. He made one more observation which was that when the hospital ward was closed, and mothers went elsewhere to deliver the baby, they did not die of puerperal fever. If the baby of a mother who died of puerperal fever later died, autopsies showed that the baby carried the same pathology as the mother who delivered the baby at the hospital.
A pathologist by the name of Klecza, who was a friend of Semmelweis, conducted all the cadaver exams. One day a medical student accidentally cut Kelcza with a scalpel and Klecza developed similar symptoms to the mothers dying of puerperal fever and he succumbed to death. The autopsy of Klecza’s body showed he carried the same organism as the women who were dying of puerperal fever. Semmelweis immediately connected the missing dots and proposed a theory that mothers delivered by the doctors were getting infected by germs from the cadavers. The medical students worked on the cadavers before examining pregnant mothers in the clinic. So, he suggested a simple hand washing with chlorinated lime solution could reduce the incidence of puerperal fever and related mortality. He picked chlorinated lime solution, because it would get rid of the putrid smell as well as the organisms he and his medical students were carrying from the cadavers they were working. He also advocated that they change the sheets between patients. He maintained that cleanliness and proper hygiene was the cornerstone to reduce puerperal fever. His hypothesis was considered very extreme, and the officials, including the charge nurse at the hospital in Vienna where Semmelweis was working, were outraged and Semmelweis was fired.
Years later Louis Pasteur discovered the principles of fermentation and pasteurization, scientifically connected some germs to be the causative agent of diseases, endorsed Semmelweis’s hypothesis and offered a scientific explanation for Semmelweis’s theory. Pasteur also discovered that you could destroy microorganisms by raising the temperature to a specific range of the medium in which the bacteria was present. He relentlessly researched to draw the connection between microorganisms and diseases. Sir Joseph Lister who was a British pioneer of antiseptic surgery, used Pasteur’s principles. Using Pasteur’s policies, he exposed wounds to chemicals. He did this by soaking dressings in carbolic acid (Phenol, C6H5OH), and covered the wound. The rate of infection drastically reduced. He has experimented with hand washing, sterilizing surgical instruments and spraying carbolic acid in the operating room before surgery. He was able to demonstrate lower infection rate and his principles were widely adopted. He was a visionary who changed the way we practice medicine forever. However, American doctors simply rejected Lister’s theory, and they did not believe that germs existed. Their ignorance cost the life of President James Garfield.
President Garfield was at the Baltimore and Potomac train station strolling to the platform. Even before he reached the platform, Charles Guiteau broke through the crowd and shot him point blank. One of the bullets lodged in his abdomen but there was no injury to the organs. The doctors faced two choices 1. Leave the bullet in its place. 2. Remove the bullet. His lead physician decided to remove the bullet using his non-sterile hands and instruments. As a direct consequence of the actions of the President’s lead physician and other physicians who assisted and explored his body with unclean hands and instruments, the President acquired infections which eventually cost his life. This was a preventable death if only the doctors had practiced Lister’s sterile technique. President Garfield died of septicemia and his assassin, to his defense argued in the court “the Doctors killed Garfield, I just shot him.” His arguments did not prevail; he was punished. It was not until the 1900s when healthcare providers embraced aseptic techniques and hand washing continues to prevent transmitting infections from one person to the next.
The once mocked germ theory was later embraced by scientists, researchers and medical professionals leading to more discoveries. Now molecular genetics has given us a window into how these tiny organisms quickly evolve, adapt and develop resistance to drugs and grow in an unpredictable fashion.
A lot has changed since the 1800’s to keep patients safe. But one thing that has not changed is the practice of retaliating against those who speak up about patient safety issues. Semmelweis was rebuked for his work, fired from his job, but, his principles of hand washing laid the foundation to protect patients from harmful bacteria to date. I hope in the future we create a culture that will allow people to speak up freely about patient safety issues without any fear of retribution. If we don’t, then some of the patient safety issues will never come to light, the unsafe practice and medical errors will continue and will only cost lives that otherwise could be saved.
Mitra Rangarajan is an expert in the healthcare field and strives to empower patients to take charge of their health and safety. Read more on her patient safety research here!
Hammill, Hunter A., “Puerperal Fever from Hippocrates to Pasteur” (2012). DigitalCommons@.e.Texas Medical Center, John P, McGovern Historical Collection and Research Center, Houston History of Medicine Lectures, Paper 9. http://digitalcommons.library. tmc.edu/homl/9
Fitzharris, L., “Butchering Art: Joseph Lister’s Quest to Transform The Grisly World of Victorian Medicine”(2017). Scientific American/Farrar, Straus and Giroux. ISBN:9780374117290.