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INFECTION CONTROL
admitted to the Massachusetts general hospital died
of mercury toxicity as he was treated with a concoction
containing high levels of sublimate of mercury(11).
Drug testing for saftey was rarely heard of at those
times (12). Wards were crowded, dirty and poorly
ventilated, with multiple patients occupying a single
bed. Care was often provided by prisoners or paupers
and nursing duties were performed by inmates.
Hospital mortality was still significant, with rates of 15%
mortality unusual.
Surgery was still deadly owing to the high rate of
infection. Before he 1800’s women rarely survived a
caesarian section due to surgical fever or surgical
gangrene(10). Surgeons wore overcoats to protect
his own clothes and were heavily crusted with dried
blood and pus. Strands of whipcord were seen to be
dangling from the button holes of the dirty overcoats,
which were used as a primitive means to ligate
arteries. Probes used on patients were not cleaned
between patients (13).
The first half of the 18th Century heralded the
beginning of the scientific study of hospital or
nosocomial cross-infection, and hence commenced
the start of the ‘Bacteriological Era’. Sir John Pringle,
a physician by profession, was remarkable among
these early pioneers, who strongly believed that
overcrowding and poor ventilation added greatly to
the problem of hospital infection. However, it took
another 100 years for Florence Nightingale, to
promote and put forth the hospital reform, based on
her experiences in military hospitals during the
Crimean War. In spite of having a cornucopia of
experience, she remained hostile to the ‘germ theory’
of disease for the remainder of her life.(14)
THE PROGRESSIVE ERA (1890 AD – mid 1920 AD)
Although this was a time of great advances in
knowledge of infectious diseases, treatment for
infections still consisted of primitive practices like
enemas, topical rubs, and phlebotomy. Despite these
practices, death rates from many common infections
July-August-September 2019
started falling in the 19th century. The late 1800s
brought immense volumes of work in the area of
bacteriology, particularly by Robert Koch and Louis
Pasteur. In 1876, Koch published his work on anthrax,
for the first time conclusively proving beyond a
shadow of doubt that a bacterium could be a
specific infectious agent.(15) In 1886, Pasteur successfully immunized a boy who had been bitten by a rabid
dog with inactivated rabies virus suspensions from the
spinal cord. Before this, rabies-prone wounds were
treated by cauterization or by inserting long, heated
needles deep into the wound or sprinkling gunpowder
on the wound and lighting it(16).
Streptococcal cross infection become a focus of
attention in the early 1900’s. The dissemination of
Streptococcus pyogenes by scarlet fever patients was
clearly documented in 1928(17). It also showed that
streptococcal infection occurred in burns and
maternity wards and airborne dust was implicated to
be the causative agent in the spread of infection.
By 1900, there were 4,000 hospitals in the United
States. Hospitals had advanced significantly in the
preceding 100 years. The hospital was no longer seen
as a place of last resort, largely due to advances in
aseptic technique and awareness of the same (18)..
The first radiography units were being installed in
hospitals. Intravenous fluid therapy and clinical
thermometry had recently been introduced(19).
Joseph Lister’s breakthrough concept of surgical
asepsis decreased postamputation mortality rates
from 45% to 15% through preoperative handwashing
and the use of disinfectant-soaked wound dressings.
Lister also insisted that wound dressings be kept clean
and wounds be kept covered to prevent contamination
trough air. William Halsted introduced rubber gloves
for use in surgery in 1890(16).
THE WORLD WAR ERA, THE POST WAR ERA
AND BEYOND (1920 AD – Till date)
The period from 1935 to 1950, which was marked by
intensive enquiry into streptococcal cross-infection,
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