Chapter 4 - Semmelweis, Credé, Lister, and Nightingale: Pioneers in Controlling Hospital Infections

Abstract

In the 1850s–1860s infections were the cause of death in surgical practice in high percentages of patients even in the most prestigious hospitals. In the 1850s, Semmelweis in Vienna observed differences in mortality from childbed fever following delivery of poor women in one clinic where doctors and students examined women after autopsies of puerperal fever cases while women attended by midwives had far fewer cases. Semmelweis asked doctors and students to wash their hands before examining pregnant women followed by a dramatic reduction in puerperal fever deaths. Carl Credé in Leipzig demonstrated that silver nitrate drops in the eyes of newborns prevented blindness from ophthalmia neonatorum from exposure to gonorrheal infection during birth. Florence Nightingale returned to England from the chaos of medical services in the Crimean War. She strongly influenced public health, vital statistics, hospital design, and administration with concepts of sanitation and good hygiene to prevent infections in hospitalized patients. In the mid-1860s, Joseph Lister, Professor of Surgery in Edinburgh, under the influence of Pasteur in France and Semmelweis in Vienna, developed a theory of “antisepsis.” Lister’s work on chemical disinfection for surgery in 1865 was a pragmatic development that led to major advances in surgical practice. He persisted with his antisepsis theory and his results became accepted so that sterile surgery became standard practice. Credé, Semmelweis, Nightingale, and Lister changed the world with safer hospital, obstetric, neonatal, and surgical care resulting in saving countless lives globally. Yet in the 21st century, maternal mortality remains a global crisis due to lack of hygienic safe delivery care in many countries. Health care acquired infections constitute a major public health clinical and ethical problem in high-, medium-, and low-income countries.