721LEADING ARTICLES

funds and facilities to the study of the cause of canceras it occurs in man would revive interest in those

possibilities of prevention that have too often beenovershadowed by our efforts to devise means of

treating the patient whose disease is already evident.

Infection in HospitalMedical Research Council workers have shown how

much the prevention, or reduction, of cross-infectionin wards depends on the informed and conscientiousbehaviour of the ward staff, particularly of the nurses.The Standing Nursing Advisory Committee of theCentral Health Services Council, with this in mind,have prepared several memoranda, based on M.R.C.papers and other authoritative sources, which havenow been issued to hospital boards and managementcommittees for their guidance.One set, addressed to hospital authorities, deals

with the administrative side of the problem. Everyhospital is advised to set up a Control of InfectionCommittee, on which the physicians, surgeons, patho-logists, and other staff, particularly the nurses, shouldbe represented. The matron, at least one ward-sister,and the sister in the reception or casualty department,and (in training schools) the sister-tutor, should bemembers; and the memorandum urges that themedical officer of health should also be invited to

join. The committee would be an advisory body ;a doctor appointed by the hospital authority wouldhave charge of measures adopted for the control ofinfection in the hospital, while the matron would beresponsible for seeing that nursing techniques wereproperly carried out. All staff dealing with patients,and all kitchen staff, would be required to reportat once any sore throats and colds, and a doctorwould decide whether they were fit to remainon duty or not. Those allowed back on duty wouldhave to wear masks until told by this doctor that theycould discard them. Gastro-intestinal disturbances,septic fingers, suspicious rashes, and " other possiblesources of infection " should also be reported. Medicaland nursing staff would be asked to instruct visitorsand patients, and official visitors such as chaplains andlibrarians, in the dangers of such infections andto insist that masks were worn when necessary. Allmembers of the hospital staff should be made awareof the possible danger of carriers. Other practicaladministrative measures include early discharge of

patients, especially children, and the use of equipmentsuch as vacuum-cleaners to reduce dust. Blanketsshould have cotton covers, which prevent the loss offluff and which can easily be removed and washed,and couches in outpatient departments could becovered with a fresh sheet of paper for each patientusing them. Patients should be encouraged to bringin with them their own dressing-gowns, slippers, andmghtwear ; they should each have a flannelette blan-ket, or two bath-towels, reserved for their personaluse during blanket baths. The present shortage oftextiles makes it very difficult to attain the’ideal ofa clean garment for each outpatient, and this is

unfortunate, especially in skin departments ; but thememorandum suggests that cotton gowns should bechanged as often as possible, and that bla,nkets shouldbe numerous enough for a third of the stock to bewashed each week. Dressing-gowns supplier by thehospital should also be washable, and slippers should

be of a material which can be disinfected by steam orby chemical means.The memoranda for the guidance of nurses have

been prepared with great care. Patients with infec-tious diseases are already nursed either in isolation orin bed isolation ; and while there is little new in themeasures advocated here they are set- out plainly andin some detail. Thus screens put round the beds asbarriers should be transparent and washable like thosewhich have proved their worth at the London Hospital;the outside can be regarded as

"

clean," the innerside as " infected." Utensils used by the patient areto be kept apart from those of other patients, or

sterilised by boiling for five minutes. Careful directionsare given to the nurse about washing and disinfectingher hands (and she is advised how to remove the smellof disinfectant when she goes off duty). Gowns areto have a conspicuous mark to distinguish the cleaninner side from the infected outer side. The properperformance of ritual in the nursing of these cases isthe chief defence of the other patients and of the nurseherself, and she must be imaginatively aware of this.She must bring the same sense of the value of ritualto the dressing of surgical cases : the memorandumgives a good account of " no touch " technique, withdetails of trolley-laying. Masks form the subject of aseparate memorandum, and their value is made veryevident ; they may be made of linen, balloon fabric,four thicknesses of butter-muslin, six layers of 40-meshgauze, or two layers of organdie ; others should includean impervious layer of paper or cellulose acetate.The nursing of tuberculous patients is considered

in memoranda addressed to both the administrativeand the nursing staffs. The recommendations for theprotection of the nurse’s own health are based on theprecautions recommended in the excellent memoran-dum on " The Supervision of Nurses’ Health," a newedition of which was recently published by KingEdward’s Hospital Fund. Here again technical perfec-tion in ritual can be achieved only if the nurse is

imaginatively aware of the risks she is avoiding, andthis attitude is not learned from memoranda, howevercarefully drawn up and attentively read. To acquire

- it the nurse must have a sound working knowledge ofbacteriology and must be taught to " think asep-tically," as the medical student is taught. A nursewho has only learnt aseptic technique by rote andnot -grasped it in principle is liable to make curiousmistakes-for example, to attend to a case of dysen-tery, and pause to shut a window, or move a chair,before washing her hands. She must be helped to forma mental picture of various types of organisms, andof the way in which she herself can transfer themfrom place to place. The recommendation to hospitalauthorities, that nurses should be given a short coursein personal hygiene and practical bacteriology as

applied to hospital hygiene, is therefore welcome. It

opens up the whole question of how nurses should betaught bacteriology, and how much they need tolearn as a part of their general training. There is somereason to think that this part of their syllabus shouldbe much expanded, possibly at the expense of someof the detailed anatomy which they learn at present.

These memoranda are a good solid foundation onwhich to build better hospital practice in the preven-tion of infection. The measures advocated are alreadyused in our best hospitals ; they could and should beachieved in all.