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The voice of nurses in hospital epidemiology and infection control: An example from the 19th century

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The voice of nurses in hospital epidemiology and infection control: An example from the 19th century

MARTISCHANG, Romain, et al.

MARTISCHANG, Romain, et al . The voice of nurses in hospital epidemiology and infection control: An example from the 19th century. International Journal of Infectious Diseases , 2020, vol. 96, p. 119-120

DOI : 10.1016/j.ijid.2020.04.030 PMID : 32325274

Available at:

http://archive-ouverte.unige.ch/unige:144321

Disclaimer: layout of this document may differ from the published version.

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Editorial

The voice of nurses in hospital epidemiology and infection control: An example from the 19th century

ARTICLE INFO

Articlehistory:

Received2April2020 Accepted10April2020

Unsurprisingly,over thelast 200 years,the accumulationof researchandtechnologiesconsiderablyimprovednursingscien- ces.Despitethisever-changinglandscape,therearestillsomecore pillarsadvocatedbypastpioneersinnursing,hospitalepidemiol- ogyandinfectionpreventionandcontrol(IPC)thathavewithstood thetestoftimeandremainatthecenterofcurrentclinicalpractice.

TheInternationalNursesDaythis12thofMaywillbetheoccasion tocelebratethe200thbirthdayofFlorenceNightingale,thefounder ofmodernnursing.Herworkhad astronginfluenceonapplied statistics,hospitalepidemiologyandarchitecture,andIPC.

BorntowealthyEnglishparents,andbenefitingfromarobust education,Florencedeviatedfromherparents’pathofstayingin an elite circle tobecome a nurse. Though nursingwas mainly definedaspalliativecareforinevitablesuffering,sheconsidered nursingas“beinginchargeofothers’health”for“wantofabetter”. (Florence, 2007) She defined rules of basic hygiene both in hospitalsandprivatehouses,bothforsickandhealthypeople.In 1854,shewasappointedbytheVictoriangovernmentduringthe CrimeanwartomanageadecrepitBritisharmyhospitalhosting 4,000 patients. While there, she improved hygiene measures, supplychainmanagement,anddespitefacingchallengessuchas overcrowding, an outdated structure, uncaring physicians, and bureaucraticinertia,shehelpedtodecreasethemortalityratefrom 22.7%to2.5%amongtroopsoverayear(Chenu, 1870).(MacDonald, 2014)Itwasduringthattimetherethatsheacquiredhernickname

“LadywiththeLamp,”whichshecarriedwithheronhersolitary nightly rounds. After she returned home, Florence dedicated herselftoasolitaryconfined lifetoreportherobservationsand advocatefor a changein modern nursing.Shepublished these pagesoffacts,figures,andchartsin“NotesonMattersAffectingthe Health,EfficiencyandHospitalAdministrationoftheBritishArmy,”

“NotesonHospitals”in1859,and“NotesonNursing”in1860.

FlorenceNightingale established good practices and recom- mendations based on her careful observations combined with epidemiologicalandstatisticalthinking.InNotesonHospitals,she readily acknowledged and criticized the presence of multiple

confounders in hospital death reports, including age and co- morbidities,andsuggestedimprovedcasereportformstoaccount forsuchvariables.(Nightingale,1863)Atthetimeofdrystatistical reports, she improved scientific communication byexcelling in datavisualizationandcreatedanow-famousmortalitypie-chart reporting the different causes of death from the Crimean war.

Today,modernclinicalandnursingsciencestillreliesonevidence, using data collection and visualization to enhance our under- standing of causality, allowing for more precise and targeted interventionsandpublichealthstrategies.

“Sufferings[...]areveryoftennotsymptomsofthediseaseat all,butofsomethingquitedifferent”.IntheseNotesonNursing, Florence advocated for basic hygiene principles to alleviate sufferingbycontrollingpreventablediseases, mostofthem still relevantinourdailyroutine.Thecoreoftheseprinciplesconcerns ventilation, light, warmth, cleanliness, quiet, and nutrition.

(Florence,2007)She enunciated thedefects that she observed inexistinghospitalplans.Sheprovidedexhaustiveguidelinesto improvethedesignofhospitalenvironments,makingsuggestions fortheheightsofwards,cubicspaceperbed,andmaterialused,so thatventilation,luminosity,space,andisolationwerechampioned.

(Nightingale,1863)Thisapproach,integratinghospitaldesignwith environmentalhygiene,wasentirelyinnovativetonursingandis still discussed today among infection prevention professionals.

(Zimringetal.,2013)

Today, theimportance ofthe work system,the construction environmentandhowmaterialsandequipmentfacilitateIPCare highlightedbytheWorldHealthOrganization(WHO)asoneofthe corecomponentsforeffectiveIPCprograms.(Storretal.,2017)The crucialroleofenvironmentalhygieneinIPChasbeenincreasingly proven in the literature. (Hobday and Dancer, 2013) A recent multicenterrandomizedtrialperformedin11Australianhospitals observed an effect from a cleaning regimen on cleaning thoroughness,andincidenceofvancomycin-resistantenterococci infections (0.35 to 0.22 per 100000 occupied bed-days). This regimenincluded optimizingtypes ofcleaning agents, cleaning

https://doi.org/10.1016/j.ijid.2020.04.030

1201-9712/©2020TheAuthors.PublishedbyElsevierLtdonbehalfofInternationalSocietyforInfectiousDiseases.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

InternationalJournalofInfectiousDiseases96(2020)119–120

ContentslistsavailableatScienceDirect

International Journal of Infectious Diseases

j o u r n a l h o m ep a g e : w w w . e l s e v i e r . c o m / l o c a te / i j i d

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frequency, cleaning technique, staff training, auditing with feedback, and communication, for routine cleaning. (Mitchell etal.,2019)Thisconceptisalsochampionedthroughothermeans suchasthroughCleanHospitals-aninternationalpublic-private partnershipworkingtopromoteresearch,raiseindustrystandards, andraiseawarenessabouttheimportanceofhospitalenvironment inpatientcare.(CleanHospital,2020)

Nightingalealsowas faraheadof hertime concerninghand hygieneandproclaimedthat“Everynurseoughttobecarefulto washherhandsveryfrequentlyduringtheday.”Only13yearsafter Semmelweis’thesisontheimportanceofhandhygienetocontrol healthcare-associatedinfections,Florencewrotethisrecommen- dationinherpublication“NotesonNursing”asarequirementfor personalcleanliness.Atthistime,handhygienetopreventsuch infectionswaspoorlyrecognizedinthescientificcommunityas indispensabletoIPC.Itremainedsountilthe1970sand80swith the publication of the first national hand hygiene guidelines (Simmons,1983;Vermeiletal.,2018),anditsinclusionasakey factor in CDC guidelines on healthcare-associated infections prevention.(StewardsonandPittet,2017)Inthe90s,implementa- tionofalcohol-basedhandrubinamultimodalstrategytoimprove handhygienecompliancefinallycreatedasystemthatwasableto ultimatelysatisfy Nightingale's recommendations. (Pittet et al., 2000)

Both the WHO, 5 May 2020, SAVE LIVES: Clean Your Hands campaignandtheInternationalNursesDay2020areparticipating significantly in this tribute to Florence Nightingale, as they concentrate on the prevention of hospital-acquired infections through clean care. The WHO SAVE LIVES: Clean Your Hands campaignaimstoengageallrelevantactors,includinghealthcare professionals,patients,hospitaladministrators,and government representatives,inthepromotionoftheimportanceofcleanhands in patient care. Health facilities can join this campaign by registeringonthefollowing website: http://www.who.int/gpsc/

5may/register/en/. To facilitate the implementation of this campaign, advocacy toolkits are made available by the WHO:

http://www.who.int/gpsc/5may/tools/en/.

AlthoughmuchofNightingale'sworkwas performedaround 1860,thequalityofherworkwasremarkable.Itputpatientcare and well-beingat thecenter of nursing,and a number of her recommendationsarestillappliedtothisdayinnursing,IPC,and hospitalepidemiology.

Conflictofinterest

Didier Pittet works with WHO in the context of the WHO initiativePrivateOrganizationsforPatientSafety–HandHygiene.’ TheaimofthisWHOinitiativeistoharnessindustrystrengthsto alignandimprovetheimplementationofWHOrecommendations forhandhygienein health carein differentparts of theworld, including in the least developed countries. In this instance, companies/industrieswithafocusonhandhygieneandinfection controlrelatedadvancementhavethespecificaimofimproving accessto affordable handhygiene productsas wellas through education and research. All listed authors declare no financial support,grants,financialinterests,orconsultancythatcouldlead toconflictsofinterest.

Theauthorsaloneareresponsiblefortheviewsexpressedin this article, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. WHO takes no responsibility for the information providedortheviewsexpressedinthispaper.

Acknowledgments

Thisworkis supportedby theInfection ControlProgramme (SPCI),Universityof GenevaHospitals, andFacultyof Medicine, Geneva,Switzerland.

References

FlorenceNightingale.NotesonNursing.Firstedition“reprint.”Saiwaishobo.2007.

MacDonaldL.Historyofstatistics:FlorenceNightingaleandherCrimeanWar Statistics: Lesson for hospital safety, public administration and nursing.

GreshamCollege/BritishSocietyof theHistoryof Mathematicsconference 2014;.

NightingaleFlorence.NotesonHospitals.3rdeditionLondon:Longman,Green, Longman:RobertsandGreen;1863.

ZimringC,DenhamM,SteinbergJ.Evidence-BasedDesignofHealthcareFacilities:

Opportunitiesfor Research andPractice in InfectionPrevention. Infection Control&HospitalEpidemiology2013;.

StorrJ,TwymanA,AllegranziB.Corecomponentsforeffectiveinfectionprevention and control programmes: new WHO evidence-based recommendations.

AntimicrobResistInfectControl2017;.

HobdayRA,DancerSJ.Rolesofsunlightandnaturalventilationforcontrolling infection:historicalandcurrentperspectives.JHospInfect2013;.

MitchellB,HallL,PatersonD.Anenvironmentalcleaningbundleandhealth-care- associatedinfectionsinhospitals(REACH):amulticentre,randomisedtrial.The LancetInfectDis2019;.

CleanHospitals-CleanHospitals.https://cleanhospitals.com/.AccessedFebruary 26,2020.

SimmonsB.CDCguidelinesforthepreventionandcontrolofnosocomialinfection;

Anticipatics,handwashing,andhandwashing facilities.AmJ InfectControl 1983;.

VermeilT,PetersA,PittetD.HandHygieneinhospitals:Anatomyofarevolution.

JournalofHospitalInfection2018;.

StewardsonA,PittetD.HistoricalPerspectives.HandHygiene:AHandbookfor MedicalProfessionals.JohnWiley&Sons;2017.

PittetD,HugonnetS,HarbarthS,etal.Effectivenessofahospital-wideprogramme toimprovecompliancewithhandhygiene.TheLancet2000;.

RomainMartischanga AlexandraPetersa AndrésNicolásReartb DidierPitteta,*

aInfectionControlProgrammeandWHOCollaboratingCentreon PatientSafety,UniversityofGenevaHospitalsandFacultyof Medicine,Geneva,Switzerland

bInfectiousDiseasesSection,CEMICUniversityHospital.BuenosAires, Argentina

* Correspondingauthorat:InfectionControlProgrammeand WHOCollaboratingCentreonPatientSafety,UniversityofGeneva Hospitals,4RueGabrielle-Perret-Gentil,1211,Geneva, Switzerland.

E-mailaddress:didier.pittet@hcuge.ch(D.Pittet).

Received2April2020 Accepted10April2020 120 R.Martischangetal./InternationalJournalofInfectiousDiseases96(2020)119–120

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