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The evolving relationship between infection and length of stay in antibiotic-era hospitals
Sally Sheard

Hospital acquired infection (HAI] - referred to as ‘nosocomial’ infection in US terminology - emerged as a specific policy concern in the mid-twentieth century, although it has a much longer lineage. This chapter uses a comparative Anglo-American perspective to repositions the debate on the history of HAIs, which has to date been focused on scientific understanding of infection through the use of evolutionary paradigms, the development of new approaches such as clinical epidemiology and the enduring fascination with the discovery, use and abuse of antibiotics and associated rise of antimicrobial resistance (AMR). Some of this historical research has marginalised or ignored (by choice or ignorance) the key issue that health care is an economic, as well as a scientific-clinical activity. These lacunae are particularly evident when historians discuss how responses to HAIs resulted in the formation of protocols and teams, which they invariably articulate as comprised of clinical/technical staff (surgeons, physicians, nurses, microbiologists and epidemiologists). There has been minimal recognition that hospital administrators and managers could (and did) play key roles in these developments because of the significant and increasing impact of HAIs on hospital costs, arising in part through concerns about length of patient stay, and through the roles of insurance companies in the Unites States and economists at national policymaking levels in the UK.

in Germs and governance
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Using the past
Marguerite Dupree, Anne Marie Rafferty, and Fay Bound Alberti

This volume shows how history can enrich our understanding of current issues of hospital infection control, including AMR, and inform perspectives on the future. For example, while efforts to develop new classes of antimicrobial drugs are undoubtedly important, they should not overshadow the financial, personnel and governance methods necessary to maintain high standards of infection control in the hospital environment, which have proven successful in recent years. The essays in this volume have shown the value historical understandings of the past can bring to modern day concerns, as well as the ways history has been misused to justify the notion of ‘progress’.

in Germs and governance
The Pathologist’s role in infection prevention and control at St Bartholomew’s Hospital, London, 1892–1939
A01 Rosemary and

Historians have perceived the cleanliness of hospitals to be the responsibility of the Matron. This chapter focuses on the roles of doctors and matrons at Barts in managing and reporting issues relating to cleanliness, and the work of the Sanitary Officer, in order to explore the different responsibilities for infection prevention and control. It shows that pathologists were involved in hospital management, patient care and infection control at a much earlier stage than has been suggested by the existing historiography of infection prevention and control.

in Germs and governance
Jennie Wilson

The hands of healthcare workers have been acknowledged as a key vehicle for the transmission of healthcare associated infections (HAI). There is evidence that they acquire transient micro-organisms through touch and that these are readily transferred onto other surfaces and to patients. Hand hygiene has been perceived as a cornerstone of infection prevention and control in protecting patients from HAI, but since the mid-1980s, non-sterile clinical gloves have come into widespread use. Attitudes to both hand hygiene and the use of gloves have evolved over time and this chapter explores how changes in perceptions in recent decades have influenced clinical practice and contributed to glove misuse.

in Germs and governance
The past, present and future of hospital infection, prevention and control

Infection control is one of the twenty-first century’s most challenging health problems, as witnessed by global debates about microbial resistance and several high-profile hospital infection scandals. This interdisciplinary volume brings together work from leading historians, researchers, healthcare professionals and policy makers to consider the history, practice and future of hospital infection control in the UK. Through personal reflections, historical case studies, policy debates and accounts of specific hospitals this volume explores the roles of technology, healthcare professions, emotional attitudes, and human factors and ergonomics in the translation of scientific knowledge into clinical practice. These insights into the theory and practice of infection control in the operating room, bedside, laboratory and boardroom, provide vital reading not only for historians of medicine, practitioners and policy makers, but also for researchers in the arts, humanities and social sciences.

Flurin Condrau

The historiography of hospital infections conceptualises most bacterial infections occurring in hospitals as inherently institutional. This paper challenges this notion and argues that from very early on, microbiologists working inside and outside of hospitals began to understand the link between the hospital and the community when explaining outbreaks of infections in hospitals. Looking at discussions in Britain and elsewhere in the era of the Staphylococcus aureus crisis after the Second World War, this chapter draws particular attention to key sites of hospital-community transfer, i.e. neonatal infection, as well as influenza. It argues that in both examples, the institutional nature of hospital infections remains unclear and that the community needs to be seen as a crucial site for infection control in hospitals.

in Germs and governance
The past, the present and the future
Alistair Leanord

This chapter, also from the perspective of a participant observer, explores the emergence of recent infection control policy in Scotland, and the ways in which this differs from England. With specific reference to MRSA and C. difficile, it considers how and why infection control policy and implementation can lag behind scientific knowledge. It explores how infection control became a priority area for government policy in Scotland in 2002, and how ‘migration’ into and out of the hospital and ‘localism’ have become key concepts in policy development. The chapter ends with some reflections on the future of infection control, based on experience, evidence and developing technologies.

in Germs and governance
John H. Bowie and the Royal Infirmary of Edinburgh, c. 1945–1970
Susan Gardiner

Since the early 2000s, medical historians have shown a growing interest in the role of the bacteriologist in the twentieth-century hospital. Collectively, scholars suggest that in the 1950s, bacteriologists emerged as authorities on hospital infection and its control. Focusing on the years between approximately 1945 and 1970, this chapter provides a more in-depth exploration of the day-to-day work of bacteriologists in the mid-twentieth-century hospital than has hitherto existed, further unpacking their role in the control of infection. In so doing, it focuses on one particular hospital – the Royal Infirmary of Edinburgh (RIE) – where hospital staff participated in many important developments in infection control and where aspects of infection control practice soon became exemplary. Such an exploration is important in gaining a fuller understanding of why bacteriologists came to be viewed as authorities in the area of hospital infection and control.

in Germs and governance
The era of patient safety
Neil Wigglesworth

This chapter focuses on infection prevention and control towards the end of the twentieth century, offering a senior participant observer’s account of the shifting nature of infection control policies in England. It considers how past events might influence current and future policy, especially with regards to the well-funded and successful role of infection prevention and control in dealing with methicillin-resistant Staphylococcus aureus (MRSA). Exploring the historical incidence of MRSA from the late-1990s to the early2000s and the ways in which that outbreak produced a sea change in the roles and responsibilities of infection specialists, it considers how and why infection prevention and control strategies have engaged with the wider patient safety agenda. It also explores what possible futures we might see for infection prevention and control in England, in the light of recent historical experience.

in Germs and governance
Abstract only
Marguerite Dupree, Anne Marie Rafferty, and Fay Bound Alberti

The introduction sets out the scope of this book, an interdisciplinary volume that includes work from ten leading historians, healthcare professionals and policy makers who consider the history, practice and future of infection control since the mid-nineteenth century. Infection prevention and control is one of the twenty-first century’s most challenging problems, as indicated by global concerns about antimicrobial resistance (AMR). But most attention has been paid to antimicrobial drugs, rather than the personnel, practices and alternative technologies associated with hospital infection control, or the history of hospital practice. The essays in this volume bring a new perspective to a pressing global problem.

in Germs and governance