Everything old is new Again: An Infection Control Update

The relationship between nursing and infection control has often been a blend of old-fashioned tradition and inspired innovation based on observation. Florence Nightingale's 1859 Notes on Nursing states that "(observation) is not for the sake of piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort." Through the years, nurses have used the nursing process to make observations and interventions to improve the health of their patients and communities. Though the environment of nursing has changed, this article will show how many basic infection control measures are as valid now as they were in Nightingale's time.

Florence Nightingale - 1850

Nightingale served in the military hospital in Scutari, Italy. The soldiers in Scutari were in deplorable conditions, often put into bed unwashed in the same uniform they were wearing when they were injured. They had poor food, no blankets, and unsanitary conditions. Cholera and dysentery led to high mortality rates. Nightingale's observations in Scutari led her to believe that cleanliness, hygiene, and healthy food would lessen the mortality rate.

When she returned to England, Nightingale championed the cause of improved hygiene, food, and living conditions for the hospitalized soldiers. She attacked the hospital conditions, but her comments were interpreted as an attack on the professionalism of the military, and she was not wellregarded. The germ theory of disease had not yet been adopted, and the connection between hygiene and illness was not well known.

Not to be deterred, she turned to the newspaper editorial as a means to spread her message. She called for basic public health and infection control measures, cleanliness and hygiene, and education about the importance of these issues. After a great deal of publicity, she was given a barracks hospital to organize. She improved the quality of the sanitation, which dramatically reduced the death rate; in time, more people accepted her point of view.

Over the years, cholera has virtually disappeared in Europe and is no longer a plague of military hospitals. But cholera has not been banished. In the winter of 2003, the Ministry of Health, Mali, reported 1,216 cases of cholera. Of these, 106 deaths resulted from cholera. The World Health Organization (2003) recommends improvements in water supply and sanitation as the most sustainable approach for protecting against cholera. But in the impoverished populations where cholera takes its heaviest toll, such improvements are often not feasible. The World Health Organization recommendation continues by stating, "Outbreaks can be mitigated and fatality rates reduced through public health measures. Human behaviors related to personal hygiene and food preparation contribute greatly to the occurrence and severity of outbreaks." These are the same infection control measures championed by Nightingale 150 years ago.

Lillian Wald - 1900

In the 1900s, another nurse was instrumental in utilizing infection control measures to make her community healthier. Lillian Wald graduated from New York Hospital's school of nursing and began working with the immigrant community of New York's East Side. She established a class in home nursing for the women in the community.

One day after class, a student asked her to treat a very sick person in an apartment. During this home visit, Wald directly observed the squalid living conditions, with many people cramped into small quarters and the lack of sanitation or running water. She believed these impoverished circumstances contributed to the high incidences of influenza, pneumonia, and dysentery within the community, and was compelled to do all she could to help. She recruited another nurse, and they soon set up practice in a fifth floor apartment.

The nurses gave care to anyone who needed help. In addition to acute medical care, they educated families about how diseases are transmitted, cleanliness, burning refuse, and proper food preparation. These nurses saw the need and the value of infection control basics in promoting the health of a community. In addition, Wald was not shy about fund-raising. She raised enough money to open the Henry Street Settlement House, and by 1916, she had more than 100 nurses working for her.

One hundred years later, influenza and pneumonia continue to infect communities. Nurses today have additional resources to fight these diseases. Technology and worldwide surveillance of virus activity allows for the manufacture of pneumonia and influenza vaccines. The challenge facing technology is to accurately predict what strains of influenza will be in circulation each year and provide enough of the appropriate vaccine. The challenges nurses face are to educate patients about vaccines and to vaccinate as many people as possible.

While nurses utilize the most advanced knowledge and technology, the basic infection control measures must be employed as well. An example of the continued relevance of infection control basics was seen in the 2003-2004 flu season. One circulating strain of influenza was not included in the vaccine that year. There were shortages of vaccine, and the flu season began earlier than anticipated. In response to these challenges, public health and nursing provided community education focused on how viruses are spread, the importance of hand hygiene, and containing the virus with tissues or facemasks. These are the same infection control measures Wald promoted a century ago.