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.