In the 19th century, obstetrician Dr Ignatz Semmelweis (1818-1865) instigated a handwashing regime on the labour ward of the Vienna General Hospital, where mortality rates from puerperal fever (a streptococcal infection) exceeded 12 per cent. Within weeks, mortality was 1.2% .
Despite such early evidence of the effect of handwashing on infection, the World Health Organization reviewed 77 hand hygiene peer-reviewed articles published between 1981 and 2008, and found that the baseline hand hygiene compliance rate of healthcare workers was a mere 38.7%. This figure is a disgrace.
It took until 2007 before Yvonne Zanele Cemane became the first nurse in England to be struck off for failing to wash her hands after treating a patient with MRSA. January 2009 saw the implementation of a so-called 'zero tolerance' approach to handwashing by the Scottish government, which meant that healthcare workers who failed to wash their hands could be sacked - an excellent idea in my view. However, given the 38.7% compliance figure, a tolerant approach is clearly operating in Scotland judging by the fact that since 2009 only one nurse, working in the Scottish Borders, has been dismissed.
'If hand hygiene is the most effective infection prevention and control activity of individual health professionals and they are held to account for their own practice, audit results that suggest poor practice could and should lead to investigation, correction and possibly withdrawal of employment,' wrote Dr Dinah Gould in the Journal of Infection Prevention (2014).
But what if an offender is part of the management team? A consultant microbiologist in the laboratory of a large teaching hospital where I once worked failed regularly to wash his hands after taking a wee. I reported him to the infection control team leader, and to one of his senior colleagues. Nothing was done.
Until poor handwashing becomes a sacking offence, laissez faire will be the norm.