Confronting infection in the English National Health Service

Abstract

It is exactly 160 years since Ignac Semmelweis was removed from his post as lecturer in obstetrics in Vienna for introducing hand decontamination for medical students between the autopsy room and the delivery suite. Fortunately, he was later reinstated and then was able to continue his pioneering work as Professor of Obstetrics in Budapest. Yet even now the challenge of healthcare associated infections (HCAI) for the NHS in England is represented by over 7000 reports of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia in each of the five years since mandatory surveillance was instituted in 2001, and by mandatory surveillance of Clostridium difficile associated diarrhoea showing over 44,000 cases in 2004 and nearly 52,000 cases in 2005 in patients over 65 years old. The programme to address HCAI in the NHS in England is one of biology, politics, and performance management, which are not always comfortable partners. The first 100 years of the modern medical era, since the time of Pasteur and Semmelweis, established initially that microbes caused disease. This was followed by the work on antiseptics by Lister and the development of aseptic practice. Prevention also came with vaccine development and then there was a stuttering start to the era of antibiotic and chemotherapy in the early twentieth century. In 1941 we entered the antibiotic era and a period of great success and euphoria which led to the view encapsulated by the Surgeon General of