It is questionable how many newly appointed consultant microbiologists relish the prospect of also acquiring the role of infection control doctor for their trusts. Recognised outbreaks are only a small proportion of hospital acquired infection but inevitably attract more attention. Indeed it was two major outbreaks and associated deaths in the mid-1980s and the adverse publicity concerning the hospital management that provided the impetus for the 1988 guidance, which was revised in 1995. As a result, the concept of an infection control doctor, usually a medical microbiologist, and infection control nurse is now well established. Published standards for infection control in hospitals exist, and yet it is estimated that still around one in 10 hospital patients will acquire an infection.

It was an American study, now 20 years old, that showed a strong association between the establishment of intensive infection surveillance and control programmes and reduction of the rates of hospital acquired infection over a five year period. Most studies, however, accept that even with optimal infection control procedures there is an irreducible, but unfortunately often undefined, minimum number of infections associated with, for example, mechanical ventilation, …