Maternal Sepsis and Ignaz Semmelweis, the Father of Infection Control

Today is the first ever World Sepsis Day (WSD)! World Sepsis Day is an initiative of the Global Sepsis Alliance (GSA), involving organizations from sixty-nine countries, that aims to call attention to a neglected issue in global health.

The overall goal of the Global Sepsis Alliance is to reduce the global incidence of sepsis by at least 20% by 2020 through “promoting good general hygiene practices like proper hand hygiene and clean birthing conditions, as well as improvements in sanitation and nutrition, access to clean water, and vaccination programs for specific patient populations.”

What is sepsis?
According to the WSD website, “Sepsis is a life-threatening condition that arises when the body’s response to an infection damages its own tissues and organs. It can lead to shock, multiple organ failure, and death, especially if it is not recognized early and treated promptly. Sepsis is the leading cause of death from infection around the world, despite advances in modern medicine like vaccines, antibiotics, and acute care. Millions of people around the world die of sepsis every year.”

Sepsis and maternal health
According to the World Health Organization, the major complications that account for 80% of all maternal deaths are severe bleeding, infections (sepsis), high blood pressure during pregnancy (pre-eclampsia and eclampsia) and unsafe abortion.

The Kaiser Family Foundation (KFF) offers a brief review of the evidence around maternal sepsis:

Background
Maternal sepsis, also called “puerperal sepsis”, is defined by WHO as “infection of the genital tract occurring at any time between the onset of rupture of membranes or labor and the 42nd day postpartum, in which fever and one or more of the following are present: pelvic pain, abnormal vaginal discharge, abnormal smell/foul odor of discharge and delay in the rate of reduction of the size of the uterus”. This includes chorioamnionitis and endometritis. In the absence of treatment, maternal sepsis may lead to death and serious long-term morbidity such as chronic pelvic pain, pelvic inflammatory disease and secondary infertility.

Epidemiology
– Maternal sepsis causes at least 75,000 maternal deaths every year, mostly in low-income countries, and accounts for 14% of maternal mortality in Asia and Africa.
– For every death there are a number of women who suffer acute and/or long-term morbidity, although data for a precise estimate are lacking.
– There are multiple risk factors associated with maternal sepsis including home birth in unhygienic conditions, low socioeconomic status, poor nutrition, and caesarean sections.

Learn more from KFF about maternal sepsis here.

Ignaz Semmelweis
In honor of the first World Sepsis Day, the Maternal Health Task Force would like to take a few minutes to highlight the accomplishments of a man who some call “the father of infection control.” Others have named him “the savior of mothers.” While still others refer to him as “the unhappy hero.”

According to BMJ Quality and Safety:

Ignaz Semmelweis was a Hungarian born physician who received his MD degree in Vienna in 1844. In 1847 he was given a 2 year appointment as an assistant in obstetrics with responsibility for the First Division of the maternity service of the vast Allgemeine Krankenhaus teaching hospital in Vienna. There he observed that women delivered by physicians and medical students had a much higher rate (13–18%) of post-delivery mortality (called puerperal fever or childbed fever) than women delivered by midwife trainees or midwives (2%).

This case-control analysis led Semmelweis to consider several hypotheses. He concluded that the higher rates of infections in women delivered by physicians and medical students were associated with the handling of corpses during autopsies before attending the pregnant women. This was not done by the midwives. He associated the exposure to cadaveric material with an increased risk of childbed fever, and conducted a study in which the intervention was hand washing.

Learn more about Dr. Ignaz Semmelweis on BMJ Quality and Safety here.

Unfortunately, his ideas went against the accepted beliefs of the time about the spread of disease—and his peers adamantly rejected his hypotheses. According to Encyclopedia Brittanica, “The years of controversy gradually undermined his spirit. In 1865 he suffered a breakdown and was taken to a mental hospital, where he died. Ironically, his illness and death were caused by the infection of a wound on his right hand, apparently the result of an operation he had performed before being taken ill. He died of the same disease against which he had struggled all his professional life.”

Sadly, Ignaz Semmelweis has gone down in history as an “unhappy hero” despite saving the lives of numerous women and being the first physician to prove that hand-washing is a critical intervention for preventing infection. Eventually, though, about two decades after he died, he was given credit for his discoveries. Soon after Pasteur, Koch, and Lister developed significant evidence of the germ theory and antiseptic techniques, the medical community came to realize the significance of Semmelweis’ passion for hand-washing.

The Budapest medical school, where Semmelweis once taught, is now the Semmelweis University of Medicine.

More information:
– Learn more about World Sepsis Day here.
– Learn more about the Global Sepsis Alliance here.
– Click here for a factsheet on sepsis.
– And here for several interesting facts about sepsis.
– If you happen to find yourself in Budapest, and want to learn more about Dr. Semmelweis, be sure to visit the Semmelweis Medical History Museum!