Elsevier

The Lancet

Volume 400, Issue 10369, 17 December 2022–6 January 2023, Pages 2250-2260
The Lancet

Review
Innovation for infection prevention and control—revisiting Pasteur's vision

https://doi.org/10.1016/S0140-6736(22)02459-XGet rights and content

Summary

Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.

Introduction

During the 17th century in Europe, hospitals accommodated poor and sick people, often with incurable diseases, in large dormitories together with older people, children, and healthy alike. A need for hygiene was felt by many, and despite some architectural measures to improve air quality, infections persisted and so-called hospital rot continued to kill. The collective work of contemporary physicians, nurses, and scientists, including Ignaz Semmelweis on hand hygiene, Robert Koch on microorganisms and infection causality, Ernst von Bergmann and Joseph Lister on the asepsis in surgery, Florence Nightingale in implementing innovative concepts in nursing, and Louis Pasteur with his demonstration against the theory of spontaneous generation, eliminated alternative theories (that of miasma in particular).1

Pasteur's era is characterised by the acceleration of knowledge on infection prevention and control (IPC) and the early formation of practices that we now take as central to safe health care. Louis Pasteur, although a chemist, was a key contributor to modern IPC, public health, and much of modern medicine. His non-medical background, and use of an evolutionary process of learning by doing, provided a fresh approach to medicine and the health-care system. Being a scientist and not a surgeon did, however, pose other challenges in terms of acceptance of ideas from the medical world. After being elected to the Académie Nationale de Médecine (National Academy of Medicine, Paris, France), he was invited to visit a hospital for the first time. Pasteur immediately perceived the greatest IPC challenges to be in health-care settings and associated with advances in medicine and surgery. His near obsession in the fight against microbes is as relevant today because of the levels of drug resistance we now see globally. His observation of health-care workers showed that they ignored the presence of microbes. Without Pasteur's work on developing and implementing IPC methods, the tremendous advance of medical and surgical techniques by the end of the 20th century would have been impossible.2 Despite substantial progress and increased efforts in IPC in the past two centuries, health-care-associated infections (HAIs) remain a substantial global burden.3, 4 In low-income countries, the prevalence of HAIs was estimated to be 15·5 per 100 patients, much higher than proportions reported from Europe (6·5%) and the USA (3·2%).3, 5, 6 In 2017, the European Centre for Disease Prevention and Control calculated that 8·9 million episodes of HAI occurred every year in patients admitted to acute care hospitals and long-term care facilities in EU or European Economic Area countries.5 HAIs generate 16 million extra days of hospital stay for a direct cost of €7 billion per year for hospitals, nearly 100 000 attributable deaths, and 501 disability-adjusted life years per 100 000 general population each year.4 Prevention of HAIs reduces the need for antimicrobials, contributing to mitigate the burden of bacterial antimicrobial resistance in health care.7

Innovation in health care refers to the development of a new process, policy, product, or programme that increases quality, impact, and efficiency.8 Pasteur's drive for innovation was as much in response to economic problems as to health science questions and also for a range of industries. A multidisciplinary approach including (micro) biology, agriculture, medicine, hygiene, and engineering meant that his discoveries and innovations improved the medical and health industry as well as beer, wine, farming, and silk industries in France, with learning between these industries. For IPC, value encompasses the public health and economic case for policy makers, the patient-centred case for public and patients, the scientific and ergonomic case for end users (professionals and health-care organisations), and the return on investment for innovators. Value at the global level additionally means alignment with the Sustainable Development Goals, including the sustainability and green agenda requiring input from industries outside of health care.

In honour of the 200th anniversary of the birth of Louis Pasteur, we present examples of Pasteur's vision and six key areas of pioneering work that had implications for IPC and how we need to revisit these concepts when innovating to prevent HAI.

Section snippets

Pasteur's vision of the hospital as a reservoir of microorganisms

Louis Pasteur showed that microbes are everywhere; in water, in the air, on objects, and on the skin, and that some of them are responsible for illnesses (figure 1). In 1862, he stated that “les poussières de l’atmosphère renferment des micro-organismes qui se développent et se multiplient” (“the dust in the atmosphere contains microorganisms which develop and multiply”) and “les liquides les plus putrescibles restent inaltérés, si après les avoir chauffés, on les laisse à l’abri de l’air, donc

Pasteur's vision of the hospital as an amplifier of transmission

After Pasteur's demonstration of the existence of microbes that affected grape juice, the recognition that many diseases were accompanied by specific microorganisms was becoming more accepted.23 Around this period (1875), after an episode of 64 fatalities caused by childbirth fever in the Paris Maternity Hospital, Pasteur strongly proposed that the infection was being spread by physicians and hospital attendants. Although Pasteur never mentioned that the hands of the obstetricians could

Aseptic technique and the origins of modern surgery

In 1878, Pasteur's speech addressed to surgeons from the French Academy of Sciences: “If I had the honour of being a surgeon, penetrated as I am by the dangers to which the germs of microbes expose…not only would I only use perfectly clean instruments, but after having cleaned my hands with the greatest care and having submitted them to a rapid buckling…I would only use lint, strips and sponges previously exposed to air brought to a temperature of 130 to 150°C; I would only ever use water that

Multidisciplinary and cross-boundary working and leadership

Pasteur's highly multidisciplinary approach, bringing together engineering, chemistry, and medicine, led to major innovations in IPC. In contemporary times, we see applications in the design of surfaces for hospital infrastructure and surgical instruments, but also in advanced modelling of patient flows through hospitals. Less advanced is our tracking of patients through the health system. A recent example of cross-industry translation is the adoption of the surgical safety checklist from the

Pasteur's vision of health-care settings as a platform to spread public health education

Louis Pasteur said that “L’hôpital doit être le lieu de la formation publique sur l’hygiène, aidé en cela par les assistantes sociales et les infirmières visiteuses des dispensaires qui vont au-devant de l’humanité souffrante” (“The hospital must be the place of public education on hygiene, helped in this by social workers and nurses visiting dispensaries who go to meet suffering humanity”).69

The mounting clinical and technical complexity of IPC, together with the growth in the expertise and

Vaccines as armoury to protect health services and patients

Pasteur's discovery of vaccines had an indirect positive effect on health-care services. Vaccination of health-care workers prevents the risk of disease to them and to patients,82 and keeps the health-care system functioning. For example, US data show that the COVID-19 case incidence ratio during periods after vaccination versus before vaccination decreased by 53% in adults aged 65 to 74 years (95% CI 50–55) and 62% in adults aged 75 years and older (95% CI 59–64). Similar results were shown

Innovation from IPC with application to the wider health system

Innovation to address the first of Pasteur's discoveries, that the hospital, and health-care itself, is a major source of infection and a threat to patient safety, leads us to strategies that minimise hospital stay, or keep patients out of hospitals altogether. We need to look at health-system-level transformation; advances in day surgery and step-down services, but also the developments in virtual wards. From China, we can learn from social care, where virtual care homes have been implemented

Future challenges to infection control

In the context of ageing populations, patients in modern hospitals are increasingly sicker, with multiple comorbid conditions, and increasingly receive therapies that modify both the immune system and the personal microbiota. Outpatient and day-care procedures also grow increasingly complex and invasive. IPC in the health-care setting traditionally relied on minimising the cross-transmission of bacteria from patients and environment by way of health-care-worker hand hygiene. Although many

Declarations of interest

We declare no competing interests.

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