MICROBIOLOGY AND INFECTION PREVENTION AND CONTROL; FOUNDATIONAL COMPETENCE IN NURSING AND MIDWIFERY PRACTICE

Mr. Reginald Arthur-Mensah Jnr and Mrs. Agnes Codjoe

Department of Nursing and Midwifery, Pentecost University

Florence Nightingale is credited as the founder of modern-day nursing. She was also a strong British social reformer, one of the first and best female statistician and the first nurse theorist in environmental cleanliness. She was born on 12th May 1820 into a wealthy and well-connected British family at the Villa Colombaia, in Florence, Tuscany, Italy. She was the second daughter of her parents. Her name “Florence” is from the city of her birth. Her parents were Frances Nightingale and William Edward Nightingale.

Florence came to prominence while serving as a manager of nurses during the Crimean war. She is still in history, “The Lady with the Lamp” as the heroine of the Crimean war from 1853-1856. [The Crimean war in Crimea was between Russia (the assailant) and a group of nations including England, France, Turkey and Sardinia]. During the war, when reports got to Britain about the appalling conditions of the wounded British soldiers at the Barrack Military Hospital (where the wounded soldiers were kept) on the Asiatic side of the Bosporus, opposite Constantinople, at Scutari (modern-day Üsküdar in Istanbul), Florence and a team of 38 volunteer nurses were mobilized and sent to “camp” in October 1854 to aid in the care of the wounded soldiers.

True to the reports, on arrival at the Barracks Hospital in November 1854, Florence and her team were met with rats, mice, flies, defective drainage, gross defects of the toilets and sewers, frightful overcrowding of wounded soldiers with infected wounds, dangerous holes in the floor, defective ventilation, want of cleansing, lack of beddings, nuisances, dead and unburied animals, contaminated water supply, contaminated foods, defective clothing, damp and wet grounds, unclean walls, unclean cobweb-covered ceilings, bushy marshy dirty environments, filth and stench (see Figure 1). Interestingly but rather grave, the Barrack hospital was “too close to a burial ground” and the hospital itself sat on top of a large cesspool. The environmental and living conditions of the Barrack Hospital are summed up as ‘utterly chaotic, horrific, unsanitary and inhumane’. More soldiers were killed by preventable diseases caused by the unsanitary environment of the Hospital than by battlefield wounds. The major diseases that killed the soldiers were cholera, typhoid, diarrhoea and dysentery (McDonald, 2010).

Figure 1: Deplorable state of wounded British soldiers at the Barracks Military Hospital

Florence and her team set to work immediately. They scrubbed every room of the hospital from ceiling to floor, reduced overcrowding by rearranging the soldiers in the hospital rooms and hallways, flushed out the sewers, improved ventilation of the rooms, improved sanitary conditions of the hospital, improved the food given to the soldiers, established a laundry to provide clean linen and bedding, etc. (see Figure 2). It is reported that Florence reduced the death rate in the camp from 42% to 2% (McDonald, 2010). In the evenings after the physicians had left, she moved through the rooms and hallways of the soldiers carrying a lamp and further attending to the nursing care needs of the soldiers which were shabbily done by the physicians (see Figure 3). These practices were to bring tremendous changes in the field of healthcare.

Figure 2: Team of nurses caring for the wounded soldiers

Figure 3: Florence carrying a lamp and further attending to the nursing care needs of the soldiers

Today, the bedrock in providing healthcare and combating diseases are infection prevention and control practices (IPC). IPC refers to actions to avoid the transmission and/or spread of infections and/or microorganisms (Presterl, Schahawi & Reilly, 2021). Such actions include;

1. Regular hand washing
2. Regular body cleansing
3. Wearing personal protective equipment when necessary
4. Respiratory etiquettes when necessary
5. Physical distancing when necessary
6. Environmental cleanliness

In the just-ended COVID-19 pandemic, these actions were cardinal to reduce morbidities and mortalities globally as frontline nurses and midwives strengthened institutional IPC measures such as;

1. Antisepsis
2. Disinfection
3. Sterilization
4. Antimicrobial therapy
5. Vaccinations
6. Enforcing quality in the medical environment
7. Management of healthcare waste
8. Education and training to disseminate knowledge and information about behavioural change strategies to protect against infections.
9. Advocating for laws and policies to protect the public health.

Microbiology is the branch of biology that studies microorganisms and their effects on humans. Any microorganisms, e.g. bacteria, viruses, fungi, etc., causing infection are called pathogens. Microorganisms that cause no disease in healthy persons but cause disease in immunocompromised or otherwise severely ill patients are called opportunistic pathogens (Presterl, Schahawi & Reilly, 2021).

At present, IPC remains the basic and effective model to prevent and control the transmission of pathogens. Though it is a responsibility for healthcare staff especially nurses and midwives, IPC is a public health demand, and everyone must rise to the task.

References

1. McDonald, L. (ed), (2010). Florence Nightingale; The Crimean War; Volume 14 of the collected works of Florence Nightingale. Wilfrid Laurier University Press.
2. Presterl, E., Schahawi, M., D-E., & Reilly, J. S. (2021). Basic Microbiology and Infection Control for Midwives. Springer Nature Switzerland AG.