Saturday 14 March 2020

Britain, besieged by coronavirus and time to honour Professor Graham Ayliffe, the Prince of Hand Hygiene.

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Graham’s death at the age of 91 in 2017, more or less, passed without note. Apart for one or two short obituaries in medical journals, he received no mention in either the Times, Telegraph, Guardian or Independent, yet his 'Ayliffe Technique', a
 six step hand-washing technique he helped to formulate in the 1960s, to reduce the spread of infection, was adopted by hospitals and endorsed by the World Health Organisation in 2009. It is impossible to verify how many lives have been saved as a result of its implementation, but it is probably safe to assume that that the figure runs into hundreds of thousands.

With Britain in 2020, besieged by the coronavirus, with hand-washing being seen as the best method to avoid the acquisition and reduce the spread of the disease, it would appear to be the appropriate time to honour Graham's memory and achievements in medicine. In addition, at this point in time, it might be useful to see the technique used by hospital staff.

In the 1960s, when he was in his forties, Graham had worked as Consultant Microbiologist at the 'Hospital Infection Research Laboratory' at the City Hospital, Birmingham, in the team led by the extraordinary pathologist, clinician and poet, Professor Edward Lowbury. It was funded by the Medical Research Council and Regional Health Authority. He recalled that Lowbury "was working on burns patients in Birmingham. He found in the 1950s that resistance emerged rapidly to tetracycline, erythromycin and ovobiocin and there was really little else left at that time for treating staphylococcal infections. The use of combinations only delayed the onset of resistance."

Under Lowbury he contributed to one of the first large 'Prevelance Survey of Hospital Infection,' involving 30 hospitals in the West Midlands and undertook a detailed assessment of an isolation ward in the prevention of the spread of staphylococal infection, the emergence of antibiotic resistance and surgical site infection and explored the necessity of hand hygiene, .

Working with Babb and Quoraishi, he developed  the six step hand-washing technique, known as the 'Ayliffe Technique' which was soon adopted by hospitals throughout Britain. He said that it evolved when it became evident that parts of the hands were being missed, particularly the thumbs and fingernails. One of his students had long thumbs and it was proving difficult to clean effectively, which is why the Technique included the action to rub the thumbs separately. With self-deprecating modesty, Graham said it just happened his name began with 'A' and that he was just one of three practitioners, 'A', 'B' and 'C', who invented the technique.

* * * * * * * * * 
Graham was born the son of Winifred and Arthur in the small village of Hambrook in Gloucestershire in 1926 and between the age of 11 and 18 was educated at Queen Elizabeth's Hospital School, an independent school for boys in Clifton, Bristol.

Founded in 1586 it was situated in the centre of town with a Charter granted by Queen Elizabeth I in 1590 when it was specifically charged with 'the education of poor children and orphans.' In fact, the school had nothing to do with medicine, with the term 'hospital' used to denote a charitable institution for the needy scholars who wore poor, blue coat uniforms.

After leaving school he joined the Royal Navy in 1945 and did a three year stint serving as a sick berth attendant and medical lab technician. It was his first taste of the world of medicine and was probably on board ship that his interest in the spread and prevention of infection was first ignited.

He took his initial step towards building a medical career when he graduated from Bristol University with a BSc degree in 1951 and then built his qualifications incrementally, with Bachelor of Medicine and Bachelor of Surgery degrees in 1954. Armed with these he gained his first medical appointment as a 'Tutor in Clinical Pathology' under Professor William Gillespie at Bristol Royal Infirmary Hospital where he worked for three years before moving to London.

With Lowbury, in 1975, he published 'Control of Hospital Infection : A Practical Handbook' and after Lowbury's retirement, he crowned his career as Director of HIRL and Professor of Medical Microbiology at Birmingham University's School of Medicine for eight years until 1989. He developed a practical course for medical students and focussed his own research interests on the control of MRSA, biological safety and endoscope decontamination.

In 1980 he became a founder member of the 'Hospital Infection Society', now 'Healthcare Infection Society' and chaired its Committee and edited its journal for its first four years and served as its President for six years until 1994.

In the last phase of his career, Graham worked as a consultant for the World Health Organisation until the age of 75 in 2001 and for the rest of his life was recognised Emeritus Professor in Medical Microbiology, University of Birmingham. In 2003, with Mary English, he published 'Hospital Infection: From Miasmas to MRSA', a wide-ranging survey of the long ­history of hospital-acquired infections and the battle against them which proved timely when the spread of "superbugs" was posing problems on a worldwide scale. Its contribution to the subject was recognised in 2004 when the Society of Authors and Royal Society of Medicine gave it the Award for the 'Best New Medical History Book.'

At the age of 87, he had the pleasure of seeing the 'Graham Ayliffe Training Fellowship' established in 2013. Its purpose is to enable trainees currently working in the field of infection prevention and control to take a one year paid leave of absence to pursue their specialist area by broadening their knowledge base and imparting that knowledge to the wider scientific community.

In life, wittingly or unwittingly, Graham had lived up to the motto of his old school, Queen Elizabeth's Hospital :

'dum tempus habemus operemur bonum'
           'Whilst we have time, let us do good'          

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