175 Years Later: HAIs Remain a Top 10 Cause of Death


Times have changed, and the adoption of hand hygiene monitoring technologies is needed to speed up innovation and transformation.

Hand hygiene   (Adobe Stock 100963119 by peterschreiber.media)

Hand hygiene

(Adobe Stock 100963119 by peterschreiber.media)

Health care-associated infections (HAIs) were first discovered in 1846 when Hungarian physician Ignaz Semmelweis realized that children delivered by midwives had a lower childbed fever mortality rate than those delivered by physicians. His analysis found that assisting medical students often arrived at the delivery room directly from the morgue with cadaverous materials still on their hands.1 Unfortunately, his discovery, along with that of British physician John Snow, who traced an 1854 cholera outbreak to the oral transmission of fecal matter, was rejected by the medical community, which believed infection transmission was due to miasma, or exhaled vapors.1

Although the idea of infection prevention is rooted in these 19th-century discoveries, it was not until the 1950s that US hospitals established the discipline of infection control and not until the 1960s that surveillance to identify HAIs began, and hospitals implemented interventions to protect patients and staff. Yet, despite this growing awareness of and concern about the spread of HAIs in health care settings, it took another 20 years for The Joint Commission, in 1976, to require accredited hospitals to have an infection control program.1 And it was not until the 1980s that the CDC established the first national hand hygiene in health care guidelines as a means of reducing HAIs.2

Over the next 20 years, as HAIs earned a spot among the top 10 causes of death in the US3, the health care industry was awash with epidemiologic data and survey insights confirming that proper hand hygiene was the most effective means of reducing HAIs. This led to the development of hand hygiene compliance recommendations, guidelines, and performance criteria from the World Health Organization, The Joint Commission, the Association for Professionals in Infection Control and Epidemiology, the Society for Healthcare Epidemiology of America, the CDC, the Leapfrog Group, and others.4

Although these documents resulted in powerfully supportive direction and guidance, viable technology solutions to help health care providers effectively adhere to the outlined strategies did not exist. It was not until 10 years ago, following the commercialization and wide public and industry acceptance of wireless communications, connected devices, and the Internet of Things in other industries, that electronic hand hygiene compliance monitoring (EHHCM) systems came to market.

With a combination of wirelessly connected hand sanitizer dispensers and an online dashboard, EHHCM systems automate and standardize the collection of hand hygiene activity data—data which was, and still often is, otherwise collected manually with direct observation, a pencil, and a piece of paper. Every time a health care worker uses a connected hand sanitizer and/or soap dispenser, that data is captured and sent in real-time to the dashboard, where it is collated and analyzed, providing infection preventionists with actionable insights and feedback that support individual goal progression, targeted interventions, and positive reinforcement.

At just 10 years old, EHHCM technology is still in its infancy and not without its flaws—systems can be complex and costly, and there can be inconsistencies and inaccuracies in data collection. As such, most health care providers are leaving EHHCM systems in the hands of the industry’s early adopters to uncover barriers to use, identify unmet needs, and influence the development of future EHHCM systems—a development that cannot come soon enough.

Over the course of 175 years, HAIs were discovered, improper hand hygiene was found to be the primary cause, hospitals adopted infection control programs, guidelines to monitor hand hygiene were developed, and early EHHCM systems were introduced. Despite those achievements, HAIs continue to cause thousands of deaths every year and remain a leading cause of death in the US.5 The question now is if it will take another 175 years to drastically reduce, if not eradicate, HAIs. The answer depends equally on how quickly manufacturers can deliver transformative innovations and how quickly health care providers adopt them.


1. Dixon, RD. MMWR Morb Mortal Wkly Rep. CDC. Oct. 7, 2011. Accessed August 6, 2023. https://www.cdc.gov/mmwr/preview/mmwrhtml/su6004a10.htm#:~:text=By%20the%20late%201950s%20and%20early,centers%2C%20not%20in%20public%20health%20agencies.&text=By%20the%20late%201950s,in%20public%20health%20agencies.&text=late%201950s%20and%20early,centers%2C%20not%20in%20public

2. “WHO guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care.” NLM. Accessed Aug 6, 2023.https://www.ncbi.nlm.nih.gov/books/NBK144018/

3. Stone, P W. “Economic burden of healthcare-associated infections: an American perspective.” National Library of Medicine. February 24, 2010. Accessed August 6, 2023. https://www.ncbi.nlm.nih.gov/books/NBK144018/

4. “Morbidity and Mortality Weekly Report.” CDC, Oct. 7, 2011. Accessed August 6, 2023. https://www.cdc.gov/mmwr/preview/mmwrhtml/su6004a10.htm#:~:text=By%20the%20late%201950s%20and%20early,centers%2C%20not%20in%20public%20health%20agencies.&text=By%20the%20late%201950s,in%20public%20health%20agencies.&text=late%201950s%20and%20early,centers%2C%20not%20in%20public

5. Liu J-I, Dickter J K. “Nosocomial infections: A history of hospital-acquired infections.” National Library of Medicine, October 30, 2020. Accessed August 6, 2023. https://pubmed.ncbi.nlm.nih.gov/32891222/

Ashley Butler is vice president and general manager of Skincare at GP PRO, a division of Georgia-Pacific and a leading manufacturer of hygienic solutions for health care for 50 years.

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