By Victor Sierpina

‘Out, damned spot. Out, I say!” Thus, spake Lady MacBeth in the fifth act of the famous Shakespearean play. And she wasn’t chasing her dog named Spot out of the castle. This quote from Lady MacBeth came as she compulsively washed her hands, to cleanse them of the blood of someone she helped to murder. She would wash her hands repeatedly, up to a quarter of an hour at a time, only to mutter, “will these hands ne’er be clean?”

Hand washing has had somewhat of a bad rap over the centuries. Pontius Pilate famously cleansed his hands in a bowl of water, to absolve himself of his role in Jesus’ condemnation and death. Some religious persuasions won’t eat with the same hand they use for their bathroom hygiene. Perhaps historic experience with infectious diarrhea and maybe lack of sanitary facilities, and clean water, for hand washing in dry areas, led to this practice.

Dr. Ignaz Semmelweis was hounded into insanity and poverty, and ultimately death in an asylum, when he introduced hand washing into the medical profession. He noted, correctly as it turned out, that childbed fever was killing many women who had just given birth. The hospital he worked at in Vienna had among the highest mortality rates anywhere. The delivering doctors often hurried over from the cadaver room where they were dissecting human remains and went with unwashed hands to the obstetric clinic or delivery room.

When Semmelweiss demonstrated how infections could be prevented by the simple act of washing hands, he was consider a heretic and ridiculed out the profession. This was only about 150 years ago, by the way. Despite impressive results of reducing childbed fever related deaths from 35-40 percent to one percent, he could not explain his findings. It took another generation before Louis Pasteur discovered germ theory that proved Semmelweis a prophet before his time.

Today, we have come to know the importance of hand washing in health care, at least in the United States and developed world. I saw a picture of a bunch of long blue rubber gloves drying outside a hospital in Africa. Like a lot of soldiers, they offered mute testimony to the importance of cleanliness, hand washing and barrier methods to preventing the transmission of Ebola virus. This was rediscovered or at least implemented too late for some victims. In our clinics and hospitals, we educate providers to wash or use disinfectant gel before every patient contact. This prevents transmitting germs from one person to another or catching communicable diseases ourselves.

An overlooked area, I suspect, is the clinic or hospital room doorknob. If you think of how many patients with the flu and other infectious diseases come in and out of a clinic room daily, the doorknob may be the most dangerous site for breeding and retaining germs. These ought be wiped regularly. When using a public bathroom, especially during the flu season, I have gotten into the habit of using a paper towel to grasp the door handle on the way out. I saw an airline pilot at the Dallas airport doing this fastidiously during the mini-Ebola scare there a few months back.

So besides getting a flu shot, maybe one of the best ways to avoid contracting flu and other viral illness is regular hand washing. No need to get obsessive about it, as did the mentally troubled Lady Macbeth. Her maid and doctor noted she got up many times at night to wash hands, and to incarnadine the seas with the shed blood of Duncan.

For the rest of us, regular hand washing is just good health sense. If you are a health care worker, you already know this. Just be sure you do it consistently and if you are a patient, a gentle reminder to your nurse, doctor or other provider before their contacting you might occasionally be needed. And how about those stethoscopes? Just a little swipe with an alcohol wipe can likewise prevent these fomites from transmitting germs, cooties and boogers, rightfully feared by all children. In fact, just having coming back from the gym, I wonder about all the sweaty palms on the equipment I just used. Wet wipes and washing of hands was required before a refueling at the Trattoria. If cleanliness is next to Godliness, salvation may be as close as the nearest soap and water.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.