Science of Its Time
When Clean Was a New Concept in the Operating Room
Today, keeping things clean as a way to ward off germs and infections just makes sense. But before antibiotic-resistant superbugs became a hospital’s biggest concern, there were the bad old days when doctors would move from surgery to surgery without washing. And surprisingly it was only during the 20th century that sterilization evolved from a simple and very new concept into one of the most important life-saving practices in medicine.
In 1910, the United States was dealing with a public health crisis — the relatively unknown virus Poliomyelitis, more commonly known as polio, was infecting large swaths of the American population. The disease spread through cities and even climbed up the socioeconomic ladder into the ranks of the elite, infecting Franklin Delano Roosevelt, perhaps the malady’s most famous victim, more than a decade before his rise to the presidency. By 1932 the country was still struggling to contain infection rates —the vaccine that ended the epidemic would not be developed until the 1950s — but much had been learned about the way the virus behaved. Once it became known that polio could be transmitted through the nose and mouth many hospitals ordered their staff to wear one additional item: a simple plastic shield over the face, which kept the virus from spreading.
By the 1960s, hospitals were using a number of plastic items in the form of disposable supplies. The trend towards disposable products was credited in part to an even larger trend — growth in urban areas and the establishment of Medicare resulted in more people using hospitals. This influx of patients made disposable materials more affordable and necessary. But the idea of throwing away hospital supplies after one use was still strange and new, and its advantage had yet to be fully realized. In a New York Times article from 1961 describing the new procedure, Richard Rutter wrote:
“A pre-sterilized, disposable needle and other disposable-type equipment such as syringes, gloves, tubing, mattress covers, masks and waste container liners — is used only once and then discarded. Chances of cross-infection are said to be reduced drastically.”
As hospitals began focusing on infection rates, sterilization became their biggest priority. In 1971 St. Luke’s hospital in Denver decided to tackle its 9 percent post-operative infection rate through the use of a “clean room,” which included additional safeguards for patients during especially infection-prone surgeries. The state of the art surgical suite included fish-bowl helmets and fully enclosed astronaut-style suits developed by NASA. As a result St. Luke’s saw its infection rate drop to less than 0.5 percent and the rooms (minus the fish bowl helmets) are still used in many hospitals today.
As modern medicine advances we reap the benefits of better drugs, safer surgeries and smarter practices. But in some ways we’ve only created new problems. Should we worry about sterilization the way we’ve come to worry about antibiotic resistance? Is it possible to be too clean? Some experts argue that the more bacteria you embrace the healthier you are, and sterilization removes this good bacteria from the environment. But in many cases a clean hospital room means the difference between life or death. Like the invention of penicillin, sterilization has transformed modern medicine for the better, at least for now.