Forty years of control of healthcare-associated infections in Scandinavia.
In the early 60s the first specialists for hospital hygiene came on the scene in Scandinavia too. From the outset this new discipline was based on cooperation between doctors and nurses, with the support of hospital-based microbiology laboratories and of sterilization departments. Teaching programs were soon devised, with training being underpinned by manuals featuring working instructions. Automated washing facilities for bedpans, etc. or washing machines for medical instruments became widespread practice very quickly; these initially used hot water, and later steam, for disinfection. For many years now, this equipment is found not only in hospitals but in virtually all healthcare establishments too. This has considerably helped to reduce chemical disinfection of medical instruments. As regards disinfection of heat-sensitive instruments the Scandinavian countries adopted different approaches: Finland gave preference to ethylene oxide sterilization, while Sweden opted for lower temperatures and for formaldehyde (low-temperature, steam formaldehyde (LTSF) sterilization), a technique imported from England and further developed in Sweden. During the 70s there were several cases of hepatitis B infections contracted in hospitals, particularly in dialysis units and by hospital personnel. The requirement that gloves be worn when carrying out working procedures has resulted in a major decrease in the infection rate and has helped to prevent HIV (AIDS) infections. However, to date it has not been possible to offset the risk of bloodborne infection against latex intolerance. Infection statistics were introduced in the 80s and since the late 90s we, too, are waging battle (later than other countries) against resistant bacteria (MRSA, VRE, multi-resistant Gram-negative bacteria). For some years now we no longer use the term "hospital hygiene" either, using instead "infection in healthcare settings" in view of the extended fields of application. Whether our strategy has proved successful for prevention of infection? Who could give a clear answer to such a question? Cost pressures in the healthcare sector will have a negative effect on the infection rate despite the fact that the progress made by science should really bring about a reduction in this rate. This conjures up a situation analogous to that of a downward escalator that one is trying to ascend: it is as if one were not moving, not making any progress.
Nyström
Bertil
B
Former head of Hospital Infection Control, Huddinge Hospital, Stockholm, Sweden.