Maria Cann attended the British Science Festival at the University of Bradford this month, where there were opportunities to visit many exhibitions, workshops and demonstrations.  The afternoon's activities were hosted by the Bradford Infection Group, School of Medical Sciences, University of Bradford.

Consultant microbiologist Professor Kevin Kerr explored the causes and effects of Hospital Acquired Infections (HAIs) followed by an interactive laboratory exhibition, where there were opportunities to find out more about the pathogens that cause HAIs (including MRSA and C. difficile), and methods used to combat them.  Professor Kerr welcomed SURF to the event and included a slide in his presentation.

Hospitals: why are they a common source of death and disease?
Professor Kevin Kerr - Harrogate and District NHS Foundation Trust

In his presentation Professor Kerr spoke of hospitals in the 15th century and their design, history depicts crowded beds and beds close together which would have explained why disease would spread from person to person easily.

Nuns nursing in a 15th century hospital
 
A physician visiting the sick in a hospital.
German engraving from 1682

It wasn't until the 1840s that the significance of hand hygiene was first brought to the attention of medical practice by Ignaz Semmelweiss.  He was the Director of the maternity clinic at the Vienna General Hospital in Austria. He noted that women who had babies delivered by his midwives did not succumb to puerperal (childbed) fever, whereas students and doctors who performed autopsies on dead bodies appeared to be introducing the illness to the women.  Women feared the hospital in Vienna and would bribe the cab driver to take a longer route to avoid the hospital.

Semmelweis suggested that the dead bodies that medical students were examining contained cadaverous particles and the particles were transferring from the hands of the students to the uterus of the women in the maternity ward, entering the bloodstream of the women, causing childbed fever.  The Viennese women who gave birth without ever reaching the maternity hospital did not come into contact with doctors. They were not examined during the process of giving birth so there was no opportunity for them to become infected with cadaverous particles. It made sense that they did not become ill with childbed fever. 

Having proposed his theory, Semmelweis then went about testing it and making predictions based on his observations. He proposed that the cadaverous particles would be destroyed by chemicals and he ordered all of the medical students to wash their hands in chlorinated lime after they had performed autopsies. The data that he collected following this step showed clearly that death rates in the wards where students and doctors practised dropped to levels similar to those where only the mid-wives worked. His predictions were correct.

Despite his conviction that his ideas were correct, Semmelweis did not immediately publish them in order to share them with other scientists and doctors. He was proud to have found a method of prevention, but also deeply aware of the offence that he might cause to other doctors if he pointed out that they had caused the deaths of patients they were trying to help, a feeling that even today many patients share when asking nursing staff about the risks of infection, and asking them to wash their hands!  He went mad and ended his days in an asylum.

In his writings he said "God knows the number of patients who went prematurely to their graves because of me," adding that before he had realised how to prevent childbed fever, he too had moved from autopsy room to maternity ward without washing his hands.


A Nightingale Ward at Kings College Hospital

Florence Nightingale introduced principles in nursing and brought about change.  Ventilation was considered important in reducing infections, as was lower bed occupancy, with scrupulous attention to hygiene and the Nightingale Ward became the standard design in hospitals. Florence Nightingale's Notes on Nursing published in 1859 stated "the very first requirement in a Hospital that it should do the sick no harm"

William Halsted Professor of Surgery at John Hopkins medical school, Baltimore and founder of surgical training in the USA, introduced the use of rubber gloves, primarily to protect the delicate hands of a theatre nurse who had particularly sensitive skin reactions to the mercuric chloride used at the time.  The idea that preventing the transmission of pathogens came later.

Professor Kerr looked at the more recent stories in the media that had brought about fear from patients on going into hospital, like the women who bribed the cab driver who didn't want to be taken to hospital, there was now good reason to fear going into hospital with the press full of stories about superbugs. 


Maidstone and Tunbridge Wells was the subject of close attention from the Healthcare Commission who gave a damning indictment of the standards in the hospital.  The beds were close together, resembling standards that we had in medieval times, and hygiene and the environment had not been considered a priority at the hospital, clearly this had played a major role in the spread of Clostridium difficile and the high numbers of deaths.

With pressure from patients and lots of media attention regarding the unacceptably high number of infections we witnessed at the beginning of this decade, infections began to decline.  The obvious solution to the problem was not just about hand hygiene, cleanliness and a return to Matrons.  Numbers are still high with the reported bloodstream infections accounting for only a tiny proportion of the infections we see in hospital.

The environment plays a big role in the transmission of microbes that cause infections.  Trials had been conducted investigating airborne transmission and innovations such as ionisation were being used to combat pathogens such as Acinetobacter in ICU units.


Dr Anna Snelling - School of Medical Sciences, University of Bradford led the interactive lab exhibition to meet the Superbugs that cause Hospital Acquired Infections and learn about the technologies used to fight them.

Microbiologists from the Bradford Infection Group demonstrated technologies and there were opportunities to view pathogens through the microscope and on agar plates.

Staphylococcus aureus

MRSA

We saw how copper was being used on high touch surfaces to help kill bacteria.

When bacteria contact copper the copper dissolves from the copper surface and causes cell damage. The cell membrane ruptures because of copper and other stress phenomena lead to loss of membrane potential and cytoplasmic content.  The copper ions induce the generation of reactive oxygen species which cause further cell damage.  Genomic and plasmid DNA becomes degraded.

The visit to the lab was an excellent way to finish the afternoon's events.