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The Evolution of Hand Hygiene

John Hines
March 27, 2018



Hygiene has always been critical to survival. From ancient civilizations to the present day, it plays a vital role in preventing the spread of infection and disease. In the modern world, hygiene still plays a critical role in health and well-being. However, in many situations, the biggest risk is complacency.


An increasingly clean-living environment separated from nature, the development of vaccines against a broad range of the most dangerous pathogens, and an over dependence on antibiotics has left people in a comfort zone when it comes to dealing with infection. Diseases that could once kill have in many cases been reduced to a mild discomfort. However, less than 100 years after their introduction, antimicrobial resistance (AMR) increasingly threatens to render the majority of our medicines ineffective in treating infectious disease.


Our understanding of how to prevent infection has taken thousands of years to develop, and the potential dangers of AMR highlight the need to remember the periods throughout history when hygiene could often be the difference between life and death.


How hand hygiene has shaped history


To better illustrate the need for society to maintain a focus on hand hygiene, here are three hand hygiene moments that changed the world and saved lives:


1. When hygiene became part of religion


Pretty much every single one of the world’s religions has, at some point, made a clear link between cleanliness and spiritual purity in their scriptures[1].


Washing in clear water before paying homage to the gods or deities became a ceremonial part of every religion[2] – and religious leaders encouraging followers to bathe is the first example of systematic hygiene practices in action.


Adherence to religious hygiene practice could – quite literally – save your life.


2. When hand hygiene became a science


In 1546, physician Girolamo Fracastoro came up with the revolutionary idea that infection could be passed on, not only directly from person to person but also via hands and surfaces such as clothes and the hands[3]. Sadly, this would be mostly ignored for centuries.


Fast forward to the 19th Century, however, and scientists had built on Fracastoro’s work to create ‘germ theory’[4] – identifying microorganisms as the cause of many diseases. This kick-started a total transformation in disease control – leading to the creation of modern hygiene practices that prevent the spread of bacteria.


Germ Theory, and the practical hygiene practices that it inspired, are fundamental building blocks of hygiene in modern society.


3. When hand hygiene became simple


Understanding how diseases worked did not just make it easier to treat them – it fuelled the development of focused/targeted ways to stop them spreading, through the use of synthetic chemistry.


So, where soap and water had been the only hygiene product for more than 2,000 years, the 20th Century saw the introduction of cleansers and sanitisers designed specifically to reduce microbes carried by the skin – in particular on the hands.


Whilst these innovations transformed health and wellbeing throughout the 20th century, we cannot forget the lessons of the past – most important of which is that hygiene is first and foremost about practical behaviours. The most advanced products will not work unless we remember to use them!


Why hygiene is vital to the world of today (and tomorrow)


The history of hygiene has been one of constant improvement and evolution, and much of this has come from understanding how vital it is for maintaining health. However, there are still major challenges that need to be overcome to avoid a future disease outbreak.


One of the major challenges is the recent research which increasingly shows that the microbiota which come to inhabit our body are vital to our health.  This has important implications for future development of hygiene. It means that we need to find ways to maximise protection against exposure to those microbes which are harmful, whilst at the same time sustaining exposure to the microbes we need.[5]


If individuals and organisations do not model their behaviour around recommended practices, the number of people suffering with infection and disease will quickly rise again. This is especially important in healthcare settings where the impacts of healthcare-associated infection (HCAI) include, prolonged hospital stay, fatality, more cases of long-term disability, increased resistance of microorganisms to antimicrobials, and additional financial burden for health care systems[6],


In Europe, HCAIs cause 16 million extra-days of hospital stay, and are attributed to 110, 000 deaths every year[6]. In the USA, approximately 75, 000 deaths were attributed to HCAI in 2011[7]. In England, 5,000 patients a year contract a fatal HCAI [8]. Canada attributes approximately 8,000 deaths a year to HCAI [9]. The full extent of the global economic burden and fatality rates related to HCAI remain unknown but through implementation of prevention strategies and measures their impact could greatly be reduced.


The numbers might be small when stacked up against history, but it shows that hand hygiene is very much still critical to good health. Organisations everywhere should adopt effective hand hygiene procedures – providing the right products in the right places, monitoring compliance and educating individuals on how they can break the chain of infection.


Learn About the Proper Hand Washing Technique




[3] Fracastoro, Girolamo (1546). On Contagion, Contagious Diseases and Their Cure


[5] Bloomfield SF, Rook GAW, Scott EA, Shanahan F, Stanwell-Smith R, Turner P. Time to abandon the hygiene hypothesis: New perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene Perspect Public Heal. 2016;136(4):213– 224

[6] Health at a Glance: Europe 2016 - State of Health in the EU Cycle

{7} CDC HAI Data and Statistics -

[8] House of Commons Committee of Public Accounts – Twenty-fourth Report 2004-05: Improving patient care by reducing the risks of hospital acquired infection: A progress report.

[9] The Chief Public Health Officer's Report on the State of Public Health in Canada 2013 – Healthcare-associated infections – Due diligence



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