Hospital Infections: Past, Present and Future

Together with anaesthesia, introduced more or less at the same time. Antisepsis transformed surgery from skillful butchery, severely limited in scope to the limbs and superficial lesions, into a craft, art and science. No part of the body was now inaccessible. Children with acute appendicitis and adults with perforated ulcers no longer inevitably died. Lister lived long enough to become the first surgical peer, president of the Royal Society and, in 1901, founding member of the Order of Merit. Ironically, by then, antisepsis was giving way to a new and more radical approach to combatting hospital infection, a change which Lister himself deplored.

If surgery could be rendered comparatively safe by killing noxious germs, how much safer would it be if germs were never allowed near wounds in the first place? The answer was the doctrine of asepsis, as distinct from Listerian antisepsis. Gowns, masks, caps, rubber boots, the thorough and prolonged scrubbing of hands preliminary to the donning of rubber gloves and filtered air in the operating theatre made Lister's carbolic-acid spray obsolete. Asepsis was brilliantly successful and remained unchallenged until the 1950s.

Many medicines are produced with the help of fungi, most notably, the antibiotic, Penicillin.

In the 1950s, the advent of penicillin inaugurated the age of antibiotics, seemingly the final triumph over hospital sepsis. So effective were the new wonder-drugs in the few cases of infection which still occurred that in the 1960s some eminent and otherwise sane surgeons began to advocate that all patients admitted for surgery should be routinely started on antibiotics and kept on "antibiotic cover" while in hospital. This was madness, a return to Listerian antisepsis in a new and more dangerous guise. (Medical history would be an arid subject if human folly did not continually resurrect past situations.)

The doctrine never received official blessing; but the profligate use of antibiotics ruled and was inevitably accompanied by a relaxation of aseptic and even of basic hygienic precautions. The day of the new super-bug had arrived...

These superbugs are in fact neither new nor particularly super. Staphylococci were described by Pasteur 150 years ago: the hybrid term means berries in a bunch to distinguish them from streptococci which are berries in a chain. Thousands of different strains exist, most of them harmless inhabitants of the human nose, throat and skin. The dangerous strains were among the first successful targets of penicillin. When penicillin stopped being effective, other antibiotics came along. The trouble is that the survival of the fittest operates among invisible microbes even more effectively than it does in the visible world. Whether by adaptive selection or by genetic mutation, it is a fair guess that resistant strains will eventually be bred to every new antibiotic. Microbes have existed for millions of years before homo sapiens. They are likely to survive the species by many more million years. Of course, it is the micro time of decades and centuries which matters to us.