The COVID-19 pandemic has impacted every country across the globe, with nurses, doctors, paramedics, hospital janitors, administrators, and social care workers, among others, putting their own lives at risk to care for others.
Since the onset of the pandemic, more than 3000 healthcare workers in 79 countries have died of COVID-19[i]. Countries with the highest reported death tolls so far include Russia (545), the UK (540), the USA (507), Brazil (351), and Mexico (248) among others[ii].
As we honour the dedication and contributions of healthcare workers worldwide, we take a look back on another poignant example of a healthcare worker who dramatically changed the way we think about hygiene and how important it is in protecting healthcare workers and their patients.
The 200th birthday of Florence Nightingale
This year marks the 200th anniversary of the birth of one of hand hygiene’s most prominent pioneers, Florence Nightingale. The work and methods that Nightingale researched, developed and promoted would have a monumental impact on healthcare within British society and eventually worldwide. Especially within the context of the current COVID-19 pandemic, it is important to recognize the work and dedication of healthcare workers, both past and present.
A new attention to hygiene
Nightingale gained notoriety during the Crimean War (1853-1856), where she served as a field nurse at a British military camp. Upon arrival at her post at the Selimiye Barracks in Scutari (modern-day Istanbul) in November of 1854, she and her team of nurses encountered extremely poor conditions. The hospital was overcrowded and exceptionally unsanitary, the floors, walls and ceilings were filthy, and lice and fleas were rampant in the clothes and wounds of soldiers.[iii] Mortality rates were high, with more deaths attributable to infections than the battlefield itself.[iv] Nightingale recorded the deplorable conditions, and set her team to work to improve them. She and her nurses bathed and clothed the patients, fed them, and laundered linens to give them clean clothes and beds to lie in.[v] In addition to sanitizing the wards, these changes to patient care led to hospital case fatality dropping to just 2% within a 6 month span.[vi] Nightingale’s approach to hygiene and patient care would eventually go on to help revolutionize modern medicine.
Statistics in medicine
Nightingale’s contributions to medicine go beyond enhancing sanitation and hygiene in military hospitals. She also played a significant role in implementing evidence based statistical research into healthcare. Nightingale was one of the first in Europe to grasp the principles of the new science of statistics and apply them to military, and eventually, civilian hospitals.[vii]
In the above diagram, Nightingale shows the causes of death during the Crimean War: blue: deaths from infectious diseases; red: deaths from wounds; black: other causes of death. © Wikipedia
By using diagrams for her statistical analysis, Nightingale made information typically meant for doctors, accessible to other healthcare professionals and eventually the general population. This access would lead to a greater understanding of the spread of infection, which paved the way for commissions and legislation that would set and enforce hygiene standards in the best interest of public health.
Nightingale’s accomplishments and contributions to healthcare are numerous, but are even more impressive considering the significant barriers that a woman in medicine faced during her time. While her impact in the field of healthcare is her most recognized accomplishment, Nightingale was also a noted feminist, author, and advocate for the advancements of women’s rights. The fact that she was able to make such significant advancements hygiene and healthcare in a profession dominated by men is a true testament to her determination and resolve. Nightingale was honoured in her lifetime by receiving the title of Lady of Grace of the Order of St. John of Jerusalem and by becoming the first woman to receive the Order of Merit.[viii]
Into the future
As we celebrate 200 years since the birth of Florence Nightingale, the beliefs and methods that she helped bring to the mainstream still bare a great deal of importance. The tireless work of Nightingale still serves as shining example of the impact that healthcare workers have on society.
In the wake of the COVID-19 pandemic, we must also take time to remember and honour the lives of the thousands of healthcare workers who put their lives at risk – and those who succumbed to the virus – in their efforts to save others. The entire OPHARDT team would like to acknowledge the dedication, sacrifice and contributions of all healthcare and frontline workers, past and present, working around the clock to help break the chain of infection.
[i] Amnesty International. (2020). Global: Health workers silenced, exposed and attacked. https://www.amnesty.org/en/latest/news/2020/07/health-workers-rights-covid-report/
[iii] Keith, J.M. (1988). Florence Nightingale: statistician and consultant epidemiologist. Int Nurs Rev. 35(5):147-50.
[iv] Gill, C.J. & Gill, G.C. (2005). Nightingale in Scutari: Her Legacy Reexamined. Clinical Infectious Diseases 40(12): 1799-1805.
[vi] Winkelstein W. Jr. (2009). Florence Nightingale: Founder of Modern Nursing and Hospital Epidemiology. Epidemiology, 20(2). 311.
 Amnesty International. (2020). Global: Health workers silenced, exposed and attacked. https://www.amnesty.org/en/latest/news/2020/07/health-workers-rights-covid-report/
 Keith, J.M. (1988). Florence Nightingale: statistician and consultant epidemiologist. Int Nurs Rev. 35(5):147-50.
 Gill, C.J. & Gill, G.C. (2005). Nightingale in Scutari: Her Legacy Reexamined. Clinical Infectious Diseases 40(12): 1799-1805.
 Winkelstein W. Jr. (2009). Florence Nightingale: Founder of Modern Nursing and Hospital Epidemiology. Epidemiology, 20(2). 311.
 Cohen, I.B. (1984). Florence Nightingale. Scientific American 250(3): 128-37.