What can the early infection preventing pioneers teach infection prevention and control teams today?

BACKGROUND

Puerperal fever and erysipelas were common Streptococcal infections of the 18th and 19th centuries which caused extensive nosocomial outbreaks. With dramatic clinical presentations and high-mortality, physicians struggled to understand and prevent them. Three infection prevention and control (IPC) pioneers (Gordon, Holmes and Semmelweis) in the pre-antibiotic and pre-epidemiology era made significant discoveries. Although much has been written of their breakthroughs, this has been selective and at times misinterpreted.

METHODS

The primary sources of the three IPC pioneers (1 translation) were reviewed to present 3 narratives of their discoveries. An interpretation of the pioneers' discoveries in the current context is provided.

RESULTS

The IPC pioneers' achievements are much wider than acknowledged in extant hand hygiene guidance - in relation to the role of indirect contact transmission (environment and equipment), e.g. Semmelweis considered the primary measure to prevent infection to be the avoidance of contamination - not hand hygiene.

CONCLUSIONS

The pioneers provided strong evidence of both direct and indirect transmission to significant 18th -19th century infections. They make a strong case for environment and equipment decontamination and cleanliness alongside decontaminating hands.