Beyond Semmelweis: Moving Infection Control into the Community

Respiratory and diarrheal diseases generate a substantial health burden globally and domestically, causing 7.0% and 3.5%, respectively, of all deaths worldwide each year (1). Among the infectious causes of death, lower respiratory tract infections rank first, causing an estimated 3.8 million deaths each year, and diarrheal diseases rank third, responsible for nearly 2 million deaths (1). The communicability of these illnesses is often demonstrated by the clustering of cases within households or among individuals in proximity. Such clustering also highlights the importance of personal hygiene practices to prevent further spread.

Several new and recurring infectious threats underscore the role of personal and community-based hygiene measures in preventing infection. Severe acute respiratory syndrome (SARS) first appeared in late 2002 in a community setting but spread worldwide a few months later after an ill physician spent 1 night in a Hong Kong hotel and transmitted the illness to more than a dozen other guests. How this transmission occurred is unclear, but exposure probably included close person-to-person contact, coughing and sneezing, and contact with surfaces or objects contaminated with infectious virus. The global outbreak was brought under control through strict adherence to classic infection control measures. These measures are particularly relevant during respiratory disease season. The primary strategy for influenza prevention is vaccination, but respiratory and hand hygiene practices may also reduce the risk for transmission. Another notable infection is community-associated methicillin-resistant Staphylococcus aureus, which has emerged in recent years in several populations, …