Lay personnel and professionals alike assume and expect the highest levels of cleanliness in health-care facilities. The general impression is that this is a strong tenet and almost every facility is immaculate to the eye, leaving the impression of an extraordinary security from environmental contaminants. But it is that which cannot be seen t hat is the enemy, infection control is about microorganisms, not the dirt patients track in.

Mankind has engaged in at least crude attempts at surgical processes since before the Middle ages, though these efforts would appear barbaric by current standards. Even in those early days, however, people discovered that applying some chemicals, like mercuric chloride, to open wounds prevented a deterioration of the wound. The reason for the untreated wound to fester was unknown, and the care giver was never suspect in causing a problem.

The journey of medicine through time has not been smooth, quick or pleasant, with the population at large fully believing they were more likely to die if they saw a healer than if they just toughed it out. With the limited number of medicinal compounds and limited understanding of physiology and histology, they had a good point. As time passed, more compounds were discovered and the science of medicine improved, in 1826 hypochlorite, an ester, was introduced, in 1839 iodine came into common use.

But despite the obvious difficulties a lack of knowledge caused, even with the information and chemical compounds available, the problem continues. Countries still struggling to provide clean water and energy to their people have even more trouble, and the mortality rate in their health-care facilities remains high. Modern hospitals, however, have to constantly fight against spreading illnesses and still there is the occasional egregious outbreak.

In some ways, the fact that antiseptics and clean water is readily available works against us in the fight against illnesses. Because most physicians have the ability to sterilize their hands readily available, everyone assumes they do. Statistics show, however that more the 75,000 patients die each year from illnesses contracted while they were being treated. When people are ill they go to a hospital, so it stands to reason that there is a concentration of sick people in these facilities, which would make containment problematic.

Like many professionals, questioning their own practices is not an easy thing. Over 150 years ago Doctor Holmes realized that in two separate wards, one where childbirth was attended by midwives and another attended by interns, the ward with interns had more than three times the fatalities. He concluded the difference was that interns were moving from the morgue doing autopsies and dissections to treating the women, and that the interns were transmitting disease; his colleagues ridiculed the idea.

Health-care providers no longer have the excuse of ignorance, the mechanism of transmission is well known, as are the preventive techniques. But the hectic pace of medical practice makes compliance with the hand washing ritual more difficult than it might seem. If hospitals are serious about infection control, then they will have to strenuously monitor the care givers and ensure they vigilantly stick to aseptic procedures.

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Filed under: Infection Control

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