Hospital Acquired Infections - A History from Early Surgeries to Superbugs by John R. Mangiardi, MD FACS
History of the hospital infection

by John R. Mangiadi, MD FACS and Ray Marcovici


Today, hospital acquired infections are incurred by one in 20 patients admitted to the hospital (affecting 1.7 million patients each year). The medical term for this is “nosocomial infection” (Greek nosos. “disease,” komien, “to care for.” Roman military hospital orderlies were called nosocomi). The cost is enormous, adding more than $30 billion to the bottom line for healthcare in the US alone.

Antibiotic resistant infections due to “Superbugs” are on the rise. One superbug, called “MRSA,” affecting over 100,000 patients a year, caused the death of more than 18,600 patients in 2005. This number supersedes the death rate for breast cancer, AIDS and SARS combined.



“He rolled up his shirt sleeves and, in the corridor to the operation room, took an ancient frock from a cupboard; it bore signs of a chequered past, and was utterly stiff with old blood. On of these coats was worn with special pride, indeed joy, as it had belonged to a retired member of the staff. The cuffs were rolled up to only just above the wrists...” Leeds, England, 1884.

This was the state of affairs in surgery, before the introduction and acceptance of the principles and rituals of antisepsis.

Prior to the 1800’s, typhus was recognized as a “hospital” infection, running rampant in city hospitals caring for the poor and in military hospitals. Once surgery became more prevalent during the 19th Century, other hospital acquired bacterial infections became a frequent occurrence. The combination of surgery followed by serious infection was well over 80% for simple surgeries such as limb amputation, in Munich, during the 1870’s.

At that time, it was far safer to undergo an operation in bed at home (3–5 times safer) than it was to have the same procedure performed in the controlled environment of the hospital.

“Erysipelas” (streptococcus skin infection, causing bright reddening) was considered a part of hospital life, especially after surgery, prior to 1890. In the 1830”s the term for hospital-acquired infections was introduced by James Simpson in England, who called the problem “Hospitalism.”

The prevailing theory for the spread of infection was that poor ventilation and stagnant air (“corruption of the air,” “divine wrath”) was the culprit, not direct contact from infected source to patient. Therefore, physicians were more than strong in their opinions as to how to prevent infection: open the window and prevent overcrowding. “Germ theory” was not yet in favor, so the concept of personal hygiene was not a consideration. Any intimation that such might be true would be taken very personally.

Take the case of Ingaz Semmelweis.



History of the hospital infection
The Gross Clinic, Philadelphia 1875