Tuesday, March 22, 2016

Infection Control: A Brief History

There were some events earlier in history that are related to matters of infection control, but it was in the early 1800s that things really began to pop. That’s when it began to be recognized that clean healthcare worker (HCW) hands equaled lower infection rates.

As early as 1822, a French pharmacist noted that chloride solutions got rid of the nasty smells that lingered on hands after handling corpses. He also urged HCWs who came in contact with patients who had infectious diseases to use liquid chloride solutions to disinfect their hands. In 1843, Oliver Wendell Holmes touted the benefits of handwashing after he concluded childbed (puerperal) fever was spread by the hands of HCWs. In 1846, Ignaz Semmelweis observed that students and physicians carried with them a foul odor picked up in the autopsy suite that persisted despite hand washing. When Semmelweis insisted that students and physicians disinfect their hands with a chlorine solution between working patient to patient and patient to cadaver, mortality rates dropped, providing evidence that use of an antiseptic agent lowered rates of infection more effectively than handwashing alone.

Discovery of microorganisms and the acceptance of the germ theory in the late 1800s only reinforced the reasonableness of the trend toward clean HCW hands. Clean HCW hands, to this day, continue to be at the core of infection control and prevention.

Discovery of the importance of clean hands and discovery of antibiotics are two of the most important factors in infection control as we know it today. The discovery of antibiotics to control spread of pathogenic organisms was considered nothing short of a miracle; in fact, antibiotics were often referred to as miracle drugs early on.

Penicillin, while discovered in 1928, did not begin being used as a therapeutic agent to treat infections in humans until the 1940s. Initially, penicillin was held by the government and became known to the public following a devastating fire at the Cocoanut Grove in Boston where hundreds of people died. The 200 survivors were, essentially, members of an historic clinical trial for this unique drug. Penicillin was so successful in treating infections such as Staphylococcus, common in skin wounds of burn patients, that it launched a quest to find more antibiotics.

Unfortunately, with antibiotics arose the issue of resistance, an enormous problem in the healthcare environment today and one predicted by penicillin’s discoverer, British bacteriologist Alexander Fleming. In a 1945 interview with The New York Times, Fleming predicted that misuse of penicillin could lead to selection and propagation of mutant resistant bacteria. In the time since antibiotic use has become common, most bacteria that were previously susceptible to antibiotics are now resistant to at least some antibiotics, and in some cases, to many different ones. We will talk about more about antibiotic resistance in an upcoming blog.

Another milestone in infection control was the organization of the Communicable Disease Center (CDC) in Atlanta, Georgia, in 1946. It sprang from the Malaria Control in War Areas program, which was responsible for keeping the southeastern states malaria-free during World War II and, for approximately 1 year, from murine typhus fever. In 1970, it was once again renamed, the Centers for Disease Control and Prevention, to reflect its mission and activities more accurately.

When CDC was born, the world was under threat of infections we hardly give a passing thought to these days. CDC played a large role in the eradication of smallpox, for instance. Later, in the 1970s and 1980s, CDC gained attention by tracking down emerging infectious diseases such as Legionnaire’s disease, toxic-shock syndrome, and HIV.

In the 1980s, gloves became used increasingly in response to the establishment of Universal Precautions, now called Standard Precautions, in the Bloodborne Pathogen Standard (OSHA 29CFR 1910.1030 [3] [1]). With the prevalence of HIV, hepatitis B, and hepatitis C came increased need for HCWs to protect themselves against exposure to bloodborne infections during procedures such as blood draws and insertion of central venous catheters.

In the 1970s and 1980s we began to see formal guidelines published by organizations such as CDC, the Society for Healthcare Epidemiology of America, established in 1980, and the Association for Professionals in Infection Control and Epidemiology, Inc, established in 1972, on a wide variety of issues including but not limited to handwashing, disinfection and sterilization, prevention of intravascular catheter-related Infections, isolation precautions to prevent transmission of infectious diseases, and environmental infection control in healthcare facilities.

It seems incredible to think that, much as the importance of hand washing was once unrecognized, the environment as a source of cross-transmission was very much underappreciated until fairly recently. In a 2013 study published in the Current Opinion in Infectious Diseases, Weber et al noted, “Contact with the contaminated environment by healthcare personnel is equally as likely as direct contact with a patient to lead to contamination of the healthcare provider's hands or gloves that may result in patient-to-patient transmission of nosocomial pathogens.”

Over the last decade, a new cross-contamination point has been discovered: computer keyboards. In fact, it’s become such an issue that specialized medical keyboards are made for hospitals, and HCWs typically have a policy in place to disinfect them. The need for safe and easy keyboard disinfection is met by Seal Shield. Seal Shield medical keyboards, medical mice, and remotes are 100% waterproof. They can be cleaned with hospital-grade disinfectants and even soaked in a bleach solution. Seal Shield waterproof technology, by enabling the user to clean the keyboard, helps protect the user from cross contamination infections. Read more about medical keyboards.

In addition to computer keyboards, high-touch electronics such as touch screens, mobile tablets, and cell phones need disinfection, too; however, these delicate electronics are extremely difficult to clean without harming them. One hi-tech solution is UVC disinfection technology. The germicidal wavelength of UVC light disrupts the DNA of bacteria, viruses, and protozoa, rendering them incapable of reproducing and infecting. Read more about UV disinfection.

Products such as these contribute to the trend toward prevention rather than just control of infection. They help further the goal of “zero tolerance.” It was once thought that the best healthcare facilities could do was to hold down the number of infections. That is no longer acceptable. Facilities are aiming for zero infections.

No doubt, the Centers for Medicare and Medicaid Services have contributed to the goal of zero infections—and attention directed toward developing new products designed to thwart infection—by refusing to pay for hospital-acquired infections. Infections are so very costly, and, if you want to get a medical facility’s attention, one sure way is to hit the pocketbook. More on that in our next blog.

Susan Cantrell, ELS 
Infection Control Corner
Contributor Writer

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