History of Infection Control

• Semmelweis

  Hungarian-Austrian physician who in 1847 investigated postdelivery mortality rates of mothers and found doctors had much higher rates than midwives, concluding doctors were becoming contaminated by cadavers and passing something deadly to mothers
• Semmelweis' findings

  • Healthcare has the potential to make people sick (nosocomial infection)
  • Interventions can be undertaken to reduce this risk (infection control)
• Semmelweis' superiors did not attribute the handwashing to the improved survival rates, instead crediting the hospital's newly installed ventilation system
• Germ theory of disease


  Microorganisms are responsible for infections
• Joseph Lister


  • Became aware of Pasteur's research and formulated methods of delivering antiseptic surgery, publishing his initial findings in 1867
  • Sought to find chemicals that would disinfect not only the wounds he operated on (antisepsis) but also the hands of the operators and the instruments (asepsis)
• Developments from Lister's work

  • William Halsted commissioned the Goodyear Rubber Company to make rubber gloves, worn by theatre nurses
  • Joseph Bloodgood started using rubber gloves to undertake surgery
• Willoughby Miller (1891)


  Wrote about disinfection of dental instruments in reducing the risk of patient-to-patient transmission of infection, citing examples of spread of syphilis due to dental care
• Miller recommended boiling of linen and the single use of rubber dam, and observed that bioburden remaining on instruments reduces the efficacy of chemicals to sterilise instruments</b>
• Boiling water was cited as the preferred method of instrument reprocessing during this period
• In 1902, an article by Young described how a device to boil dental instruments could easily be made
• In 1905, Fossume argued that frequent reasons dentists were not following infection control measures were time and cost
• In 1915 in the USA, the Public Health Service issued guidelines on infection control in dentistry under the auspices of the Hygienic Laboratory, which would later become part of the National Institutes of Health
• Hasseltine's 1915 guidelines

  • Encompassed asepsis, validation, cross infection, instrument reprocessing including the role of cleaning prior to sterilisation and methods of sterilisation
  • Favoured moist heat (80°C water bath) for sterilising instruments
  • Detailed single-use instruments and equipment, the surgery and dental chair, the maintenance of the cuspidor and the role of protective barriers
• Hepatitis


  Infectious jaundice due to a virus, classified as hepatitis A (infectious) or B (serum)
• In the 1940s, there was an increasing awareness of viral hepatitis posing a public health problem, and a 1952 WHO expert panel recognised that parental penetration of needles contaminated with blood would transmit hepatitis B
• It was not until 1963 with the discovery of the Australia antigen (hepatitis B surface antigen) that progress in the understanding of the virus increased at a greater pace
• The first commercial vaccination against hepatitis B was released in 1981
• Autoclave


  Invented by Charles Chamberland and Pasteur in 1879, an effective method of destroying microorganisms