Modern hospital IPC in Australia, had roots in the 1940s/50s, when newly developed antibiotics were enthusiastically embraced by doctors and outbreaks of hospital-acquired Staphylococcus aureus infections were investigated by hospital bacteriologists, who often functioned as the first infection control professionals (ICPs). In the 1960s, increasing surgical site infection (SSI) rates and antibiotic resistance prompted microbiologists and/or surgeons toform infection control committees and appoint ‘infection control nurses’ (ICNs), whose numbers increased during the 1970s and 80s, often in response to hospital accreditation requirements.
ICN/ICPs’ duties were often self-determined, in the absence of clear role descriptions or training. Initially, their main task was SSI surveillance, to which they soon added daily ward visits, on-the-spot IPC staff training, and extension of their influence throughout the hospital to improve other aspects of IPC, such as environmental cleaning, equipment sterilisation, ventilation etc. Often, in the absence of guidance from nursing hierarchies, their sources of technical and moral support were microbiologists. ICPs established local infection control associations for peer support and education, which amalgamated to form the Australian Infection Control Association, in 1985, and the Australasian College of Infection Prevention and Control, in 2011. ICP appointments, training and recognition as specialists have increased, gradually but haphazardly.
Many developments in hospital IPC were driven by changes in healthcare-associated infection (HAI) epidemiology, which has been dominated by S. aureus and particularly MRSA, since the 1960s. However, other multiresistant bacteria and emerging viral infections – HBV, HIV, HCV, SARS-CoV-1, H1N1pdm09, MERS-CoV, Ebola and SARS-CoV-2 – have raised awareness and improved IPC practice and/or antimicrobial stewardship, intermittently, but complacency often returns between crises. Hand hygiene compliance has increased, MRSA prevalence and S. aureus bacteraemia rates have fallen, but antimicrobial resistance and preventable HAIs persist, and national HAI surveillance is elusive.
Will the aftermath of COVID-19 be different? How can we consolidate the lessons, maintain IPC awareness, and embed best practice and resilience into the future?