This chapter reflects on the author’s experiences and memories of infection control through her nurse training and career. Having been taught microbiology, common infectious diseases and how to prevent the spread of infection in the 1960s, the author explores the differences between theory and practice in nursing, the roles of human actors, and the ways the culture of the ward shifted over the course of her nursing career. One of the first infection control nurses and the first Director of Infection Prevention and Control at Great Ormond Street Hospital for Children in London, she also stresses the importance of political will for implementing effective infection control measures.

During the period between 1900 and 1935, surgical success depended not only on the surgeon’s operative skill in the face of difficult challenges during surgery, but also on the prevention of sepsis. Pre- and post-operative care was mainly directed at preventing or managing infection, and was the relatively new professional sphere of the nurse. Training nurses skilled in surgical nursing was therefore vital to both the patient’s recovery and the surgeon’s success. This chapter uses the idea of ‘dirt’ to explore how sepsis, particularly in its most dangerous form of pus, shaped surgical nurse training and practice in the 1900-1935 period.

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’.

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 This chapter explores the use of innovative technologies for infection control in surgical operations. Beginning with the uptake of surgical gloves in the late nineteenth century, the author explains the relative disinterest of many surgeons by situating their use in the context of other contemporary strategies of infection control. He demonstrates that technological change in surgery and infection control does not happen in a vacuum: understanding of the alternatives to surgical gloves that were not taken up is necessary to explain the evolution of modern surgery and infection control.

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.

This chapter examines how doctors, nurses and other hospital staff, groups often overlooked in favour of patients, experienced septic finger, wound sepsis and related diseases within the British hospital between 1870 and 1970. The focus on sepsis, as opposed to other types of infection, is significant. Hospital staff were, of course, at risk of contracting all manner of diseases. Yet, widespread concern over sepsis and hospital attempts at prevention and control of sepsis in pre- and post-operative wounds form an often neglected part of the story and span this hundred-year period, as well as recent history with rising antibiotic resistance and hospital mismanagement of infections. While other infections tend to fit more neatly into epidemic periodic cycles, wound sepsis was and still is a continual chronic challenge, one that becomes more important following a serious outbreak or death. Drawing on hospital ledgers and reports, this chapter pays particular attention to occurrences of wound sepsis among staff at four of Britain’s large teaching hospitals, two in England – King’s College (KCH) and St Thomas’ – and two in Scotland – the Royal Infirmaries in Edinburgh (RIE) and Glasgow (GRI).

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.

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.

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.

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.