Medical Journal of Dr. D.Y. Patil Vidyapeeth

EDITORIAL
Year
: 2018  |  Volume : 11  |  Issue : 3  |  Page : 199--200

Hand hygiene and hubris: Wax wings and plane crashes


Amitav Banerjee 
 Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Correspondence Address:
Amitav Banerjee
Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
India




How to cite this article:
Banerjee A. Hand hygiene and hubris: Wax wings and plane crashes.Med J DY Patil Vidyapeeth 2018;11:199-200


How to cite this URL:
Banerjee A. Hand hygiene and hubris: Wax wings and plane crashes. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2020 Oct 27 ];11:199-200
Available from: https://www.mjdrdypv.org/text.asp?2018/11/3/199/235567


Full Text



Some years ago, one of our colleagues had proceeded on study leave for super-specialty training under a renowned eye surgeon. When he returned from the super-specialty training, we were all very keen to know what state-of-the-art skills he had acquired under the great master. With admiration in his eyes, our colleague would explain how the expert eye surgeon would ask him to keep washing his hands with extra care before each procedure. Behind his back, we used to joke that the great surgeon wanted to keep our colleague away from any procedures in the tradition of “primum non nocere” or “do no harm.”

On a more serious note, the great master emphasized that more than any heroic surgical procedures, it is attention to simple details such as handwashing to prevent hospital-acquired infections that gives the best results.

Simplicity is deceptive. Truly, important things are simple. Simple things are difficult to implement, particularly by doctors. Doctors prefer the challenge of complicated things. This is tragically illustrated by the history of handwashing and hospital infections. Evidence on the effectiveness of the simple procedure of handwashing was first collected by Oliver Wendell Holmes and Ignaz Semmelweis.[1] Holmes after publishing a paper in 1843 on the effectiveness of handwashing in an obscure medical journal devoted himself to poetry which brought him more fame than medicine. Subsequent pioneering work on the efficacy of handwashing for preventing puerperal fever was done by Semmelweis.

Ignaz Semmelweis was a Hungarian doctor in a hospital in Vienna. This hospital trained physicians in postmortem examinations, who also conducted deliveries. When Semmelweis joined the hospital in 1846, he recorded that 10%–30% deaths were occurring due to severe postpartum infections. In another maternity hospital where deliveries were conducted by midwives and not by doctors, the death rate following childbirth was <3%. With these observations, he came to the unpalatable conclusion that doctors were the cause of maternal deaths. This belief was further reinforced by the death of a colleague who developed similar fever and died after sustaining cut from the knife while conducting a postmortem. Further evidence was provided when postpartum mortality came down to 1.2% after doctors washed their hands with chlorine water before conducting deliveries.[2]

One would have thought that such elegant evidence would convince all doctors to practice the simple task of handwashing with chlorine water before any procedure. However, his findings went against the medical consensus of the times. Those days, it was believed that infections were due to “bad air” or “miasma” or imbalance in “body humors.” The medical community's arrogance did not accept findings, suggesting that maternal mortality was higher in the hospital where doctors conducted the deliveries as compared to where deliveries were conducted by midwives. Moreover, Semmelweis's lack of tact earned him many influential enemies in the fraternity. He lost his job.[3] Bitter and lonely, his last years were spent in an asylum.

To this day, getting doctors and other health-care workers to take handwashing seriously is a challenge. Influential people are liable to the risk of hubris.[4] Doctors being human and influential are susceptible to hubris.

The term hubris has Greek origins indicating a heady mix of ambition, overconfidence, arrogance, and pride.[3] In Greek mythology, hubris was a dangerous trait responsible for the downfall of many a god. Icarus in his ambition flew too high near the sun defying the caution of his father. The heat melted his wax wings, and he fell into the sea. This story from Greek mythology illustrates the dangers of hubris. In more recent times, many a plane crash has been attributed to arrogance of the senior pilot.[5]

In the field of medicine, hubris among doctors may lead to neglect of simple precautionary measures such as handwashing. Perhaps, they develop a feeling that since they are special, their “gifted” hands can never carry infection and only cursorily wash their hands before any procedure. How else we explain the fact that after almost two centuries of the discovery of the benefits of handwashing, doctors have yet to adopt it as second nature.

The antidote to hubris is humility. Humility is more essential today than ever. Rapid technological advances in medicine are liable to lead to excessive self-confidence and feeling of being all powerful. These traits are the precursors of hubris among the medical profession. The consequences can be disastrous. Fascination with technology may lead to neglect of simple measures such as hand hygiene.

Doctors should cultivate greater humility and proactively endeavor to resist hubristic behavior. We were guilty of hubristic behavior ridiculing our colleague on study leave. The take-home message is that it is attention to simple details such as proper handwashing which contributes to good surgical outcomes perhaps more than good surgical skills. It is this attention to details which distinguish the expert from the mediocre.

References

1Lane HJ, Blum N, Fee E. Oliver Wendell Holmes (1809-1894) and Ignaz Philipp Semmelweis (1818-1865): Preventing the transmission of puerperal fever. Am J Public Health 2010;100:1008-9.
2Rice PL. The semmelweis tragedy: Iatrogenic illness. In: Health Psychology. Pacific Grove CA: Brooks/Cole Publishing Company; 1998. p. 40-1.
3Davis R. The Doctor who Championed Hand washing and Briefly Saved Lives. Shots Health News from NPR; 12 January, 2015. Available from: https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives. [Last accessed on 2018 Mar 29].
4Diamandis EP, Bouras N. Hubris and sciences. F1000Res 2018;7:133.
5Helmreich RL, Merritt AC, Wilhelm JA. The evolution of crew resource management training in commercial aviation. Int J Aviat Psychol 1999;9:19-32.