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EDITOR'S CHOICE: Fiona Godlee Next to cleanliness BMJ 2008; 336: 0 [Full text]

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Back to cleanliness

Stephanie J Dancer   (23 January 2008)

Back to cleanliness 23 January 2008
Stephanie J Dancer, Consultant Microbiologist Hairmyres Hospital, Eaglesham Road, East Kilbride, G75 8RG Send response to journal: Re: Back to cleanliness	It is quite true that there is little or no evidence for basic hygienic interventions to impede the transmission of infectious microorganisms. Hand hygiene, masks, gowns, isolation and environmental cleaning rarely inspire innovative research, despite the fact that they are practised routinely across the world in a variety of situations. Is it that such menial activities are of so little importance, to us, the inhabitants of the 21st century? Are we so taken up with iPods, computers, satellites and space travel, that we have no time to wash our hands? Nowadays, there is a gadget or gizmo to assist us with virtually any task we choose. Regarding healthcare, we have come to expect a pill for every ill, or indeed, the proverbial magic bullet to make us better from everything. The trouble is, there isn’t an easy way to remove dirt, whether visual or microbial, and therefore ignoring the reservoirs of pathogens colonising ourselves, or lurking in the environment, will result in the inevitable transmission of infection. As for those magic bullets, they are all spent, as microbes become ever more resistant. Complacency emanating from the provision of antimicrobials sixty years ago has eroded the importance of basic hygiene, so that now, painfully, we have to relearn the lessons from the past. Has it been forgotten so quickly, why we used to have isolation hospitals full of isolation rooms? And yet today, we regularly place an infected patient in the middle of a busy ward, whether it be MRSA, C.difficile, SARS, pandemic flu or tuberculosis, simply because there are no beds left in the hospital. It stands to reason that you should strive to keep infected patients away from others – particularly in a hospital where people are so vulnerable. Perhaps there isn’t much evidence for isolation and all those other menial tasks just yet but common sense will eventually become scientific evidence at some stage, you just have to wait for it. How are we going to regenerate interest in basic hygienic activities? Not until the antimicrobial armamentarium finally runs dry, and the vaccine trail finally goes cold. We will then have to do what we did before the advent of anti-infective technology. We will clean our environment, our hands and ourselves. We will build hospitals comprising entirely of isolation facilities. Given the recent flailing directives imposed in the name of infection control, the government should focus on the provision of isolation rooms rather than the provision of universal MRSA screening, and the removal of dirt, rather than removal of the white coat. There is nothing wrong with lessons learned from the past, other than 21st century arrogance in forgetting them. Competing interests: None declared