Hospital infection

Abstract

It is more dangerous to be in a hospital ward than on the battlefield at Waterloo," remarked Sir James Simpson (1849) when referring to wound sepsis in hospitals. "It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm," wrote Florence Nightingale some ten years later. Although one hundred years later Sir James Simpson's statement is no longer tenable, we are far from attaining Florence Nightingale's principle, particularly in the realms of Hospital Infection.Hospital Infection, or Cross Infection, or Added Infection, may be defined as a clinical or bacteriological infection which has been acquired from the hospital environment. It is therefore possible, and important to appreciate, to have an overt (clinical) or symptomless (bacteriological) infection. Hospitals are ideal places for acquiring organisms. The patients are usually of lowered resistance; there is a high concentration of people loaded with organisms; and as the ratio of patients to ward staff is always high, the possibility of transmission is greatly increased.... It would seem that in dealing with hospital -infection members of staff must make themselves alive to their personal responsibilities. Each hospital should have a control-of infection- committee, headed by a respected senior doctor, which ensures that all wards keep records of infection and that never tires in looking for improvements. It is also important that the doctors of tomorrow receive more instruction than they do, and that the authorities of the teaching hospitals see that they can practice what they preach.The ministry of health must inspire the treasury to give more money for improvements such as engineers, efficient ventilation, isolation blocks, more nurses and bacteriologists. This would all tend to raise the morale and the standard of asepsis and antisepsis. Thus perhaps in 5 years the government would have saved the money expended.Patients putting their lives in the hands of the profession, are entitled to be protected from any avoidable ignorance and indifference; the time has not yet come when we can feel sure that they have such protection. Florence Nightingale's principle is therefore still a dream.