The transmission of infections in hospitals by staff carriers, methods of prevention and control.

Since the times of Semmelweis, life-threatening hospital acquired infections have been transmitted on the hands of hospital personnel. For several years Semmel-weis desperately tried to convince the colleagues in his gynecological department to wash and disinfect their hands. Most of the professors of surgery and gynecology in Vienna and other medical centers in Europe considered him a fool. They believed in the transmission of infectious diseases by some kind of miasma in the air. There has not been much change in the past 100 years. Hospital epidemiologists continue to teach that hand-washing and hand disinfection is the most important measure in controlling cross-infection in hospitals. Many physicians still seem to believe that disinfection of air is as important as disinfection of hands. Other medical professionals sometimes consider hospital epidemiologists an ancient species who have learned nothing but to teach the gospel of Semmelweis. Even today most hospital cross-infections are transmitted by hands, and hospital epidemiologists have to realize that the attitude of hospital personnel has not changed much since the time of Semmelweis. Patients in intensive care units (ICU) are highly susceptible to nosocomial infections. It has therefore been suggested that ICU personnel wash their hands more frequently than personnel in other units (at least before and after contact with every patient). In 1981, 134 years after Semmelweis' original recommendation, Albert and Con-die from the Washington Veterans Administration Center in Seattle evaluated the compliance of intensive care unit personnel with this internationally accepted recommendation. 1 Contact with 28 patients was observed (40 different physicians and residents and 15 nurses had patient contact). Handwashing occurred after only 41% of the contacts. Physicians washed significantly less frequently than did nurses. For example, urine bags were manipulated , intravenous dressings were changed and respiratory equipment was adjusted without an intervening handwash. Only 28% of physicians in University hospitals and only 14% in private hospitals washed their hands after patient contact. Private patients—although paying more—might be at higher risk for acquiring nosocomial infections. Larson investigated the hand flora of 103 hospital personnel over a mean of 35 days. One or more of 22 different species of gram-negative bacteria were found to be carried persistently on the hands of 21% of hospital personnel. Persons who washed hands less than 8 times per day were significantly more likely to carry the same species of gram-negative bacteria on the hands. Predominant organisms were species of Acinetobacter and …