Infection control and hospital epidemiology outside the United States.

Abstract

Florence Nightingale (1820-1907) is considered the first infection control (IC) nurse.1 Her work with the epidemiologist William Farr in England was one of the first examples in history demonstrating the effectiveness of close collaboration between IC nurses and hospital epidemiologists. Another very important European contribution to the science of IC was that of Ignaz F. Semmelweis of Vienna, Austria, who demonstrated in 1847 the impact of hand antisepsis on cross-infection and maternal death from puerperal fever.1 Readers may have noticed that many of the articles in the January issue are from countries outside the United States. This was not the result of any effort of the editors to cluster international contributions, but rather a simple chance event that reflects the increasing number of quality submissions from international authors. In the United States, landmark studies by Haley et al2 in the 1970s triggered the rapid evolution of IC in the clinical setting. Ongoing surveillance of nosocomial infections (NIs) then was initiated and was stimulated further when IC and surveillance activities were mandated by the Joint Commission for the Accreditation of Healthcare Organizations. The implementation of diagnosis-related groups added a financial incentive to reduce the incidence of NIs. In contrast, routine surveillance and large-scale trials to limit the incidence of NIs were not performed in Europe in the 1970s. IC efforts in Europe and other countries rely primarily on the microbiology laboratory and hospital hygiene. IC often is not mandatory. Most hospitals outside the United States still are reimbursed based on a fee for service or on days of hospitalization. Therefore, these countries lack financial incentives to reduce NI rates. However, morbidity and mortality associated with NIs are wellrecognized problems in non-US countries. In Europe, the rapidly evolving healthcare system awaits changes such as those observed in the late 1980s in the United States that will add a financial incentive to combat NIs. Human and financial resources allocated to IC have increased markedly in Western Europe. In Germany, a national reference center for NIs was created in the early 1990s (Nationales Referenzzentrum fur Krankenhaushygiene in Berlin and Freiburg). The Netherlands relies on a sophisticated network for IC linking all teaching hospitals. In Belgium, the Institut Scientifique de la Sante Publique Louis Pasteur provides scientific support for hospital epidemiology activities. Moreover, the Association Belge pour l’Hygiene Hospitaliere (IC nurses) and the Groupement pour le Depistage, l’Etude et la Prevention des Infections Hospitalieres (IC doctors) are working together to conduct surveillance and promote IC nationwide. A first national study of the prevalence of NIs in the United Kingdom was conducted in 1980. An audit coordinated by the Public Health Laboratory Service in Colindale (London) and funded by the Department of Health was conducted from 1993 to 1994 with the objectives of developing a national database and IC practice guidelines that could be used by National Health Service, private, and voluntary hospitals. Local surveillance and control of NIs is the current practice in the United Kingdom. A recent report by a combined working party could be given as an example of a trend toward a global and nationwide approach to IC.3 Currently, the Nosocomial Infection National Surveillance Scheme (NINSS) is being established by the Public Health Laboratory Service to develop surveillance of NI in the health service.4