Before the availability of antibiotics minor infections could become life threatening. Nurses working in voluntary and public hospitals in Britain were exposed to such risks. This thesis uses both oral testimonies and published sources in order to examine their practices concerning the management of infection risks. The detail of nursing work in this period has been generally hidden in nursing histories of the 1930s and 1940s which have addressed mainly political, recruitment, educational, registration and status issues. Whilst these histories may comment about menial duties, and the culture and discipline in clinical areas, they lack detailed exploration of the day-to-day work of the nurse. This novel study contributes to redressing the balance by examining nursing practice between the discovery of penicillin in 1929 and its widespread availability in Britain in 1948. Data analysis, including the oral testimonies of nineteen former nurses who worked between 1929 and 1948, suggests that nursing practice during this period placed enormous emphasis on cleanliness and hygiene. It is argued that this was linked to sanitarianism which influenced nursing practice before its replacement by germ theory. Probationer nurses learnt their skills in managing infection risks to themselves and their patients in a disciplined and safe way. This was achieved through the exercise of strict routines and a hierarchy of tasks that provided a graduated exposure to the patient and infection risks. This thesis draws on debates in the literature about purity, vocation and status to explore, and add weight to this argument. The analysis also identifies that the introduction of sulphonamide drugs and antibiotics altered nursing practices in the management of both infection risks and patients with infection. Whilst the full effects of these changes are not examined in this thesis, it is argued that the significant impact of these drugs was such that the emphasis on cleaning and hygiene became diminished in importance and nursing had to redefine its role. It suggests that more prominence needs to be given to changes in clinical practice in the history of nursing. This study breaks new ground by suggesting the rigorous training of nurses in cleaning and hygiene tasks was needed in order to manage the infection risks faced by nurses before the availability of antibiotics.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-29T14:48:03Z No. of bitstreams: 1 marialuciamorcerfbouzada.pdf: 9067703 bytes, checksum: 2940aab07899460cc22fb287a8d86abc (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-30T11:21:50Z (GMT) No. of bitstreams: 1 marialuciamorcerfbouzada.pdf: 9067703 bytes, checksum: 2940aab07899460cc22fb287a8d86abc (MD5) / Made available in DSpace on 2017-03-30T11:21:50Z (GMT). No. of bitstreams: 1 marialuciamorcerfbouzada.pdf: 9067703 bytes, checksum: 2940aab07899460cc22fb287a8d86abc (MD5) Previous issue date: 2009-09-25 / É bem estabelecido que patógenos putativos bacterianos são ubíquos e amplamente distribuídos no ambiente hospitalar. Este estudo teve como objetivos detectar a persistência bacteriana no ambiente nosocomial, após a limpeza por varredura úmida pela equipe associada ao serviço de Higiene e Limpeza Hospitalar e determinar os perfis de susceptibilidade dos microrganismos persistentes a drogas antimicrobianas e aos desinfetantes comumente utilizados no serviço de saúde. A água de enxágüe da varredura úmida para limpeza de áreas críticas do Hospital Universitário da Universidade Federal de Juiz de Fora foi processada para isolamento seletivo de representantes da família Enterobacteriaceae (ENT), bastonetes Gram negativo não fermentadores (BGNF), estafilococos coagulase negativo (SCN) e enterococos (ENT). Os microrganismos foram caracterizados bioquimicamente e os perfis de susceptibilidade a antimicrobianos e desinfetantes avaliados pelos métodos de difusão em disco e diluição em ágar. Quinhentos e quarenta e sete linhagens bacterianas foram recuperadas mas, somente estafilococos coagulase negativo e bastonetes Gram negativo não fermentadores foram isoladas em todas as áreas críticas. Foi detectado resistência a todas as drogas testadas com exceção para vancomicina em estafilococos coagulase negativo. Pelo menos 44% das bactérias isoladas apresentaram resistência a mais de uma droga. Os padrões de susceptibilidade aos desinfetantes variaram entre as concentrações 0,125 a 1,0% (quaternário de amônia, hipoclorito de sódio e ácido peracético/H2O2). Hospitais podem funcionar como reservatório de microrganismos, muitos dos quais podem se apresentar mutirresistentes aos antibióticos. Alguns destes microrganismos podem ser veiculados por pacientes e funcionários. Prevenir o espalhamento de microrganismos de relevância clínica depende da qualidade do serviço de limpeza hospitalar. O monitoramento da susceptibilidade bacteriana a antimicrobianos e aos desinfetantes pode ajudar no gerenciamento de infecções hospitalares. / It is well known that putative pathogenic bacteria are ubiquitous and widely distributed in the hospital environment. This study aimed to detect bacterial persistence in the nosocomial environment after mopping by the cleaning staff. Microorganism susceptibility patterns to antimicrobial drugs and disinfectants commonly used in health services were also investigated. Rinse water of mops used to clean critical areas of the Federal University of Juiz de Fora University Hospital was processed for selective isolation of enterobacteriaceae (GNR), non-fermenting Gram negative rods (NFGNR), coagulase-negative staphylococci (CNS) and enterococci (ENT). Isolated bacteria were biochemically characterized and their susceptibility patterns to antimicrobial drugs and disinfectants evaluated by disk diffusion and agar dilution methods. Five hundred and forty seven bacterial strains were recovered but only CNSs and NFGNRs isolated in the critical areas. Resistance was detected against all drugs with exception of CNS to vancomycin. At least 44% of the isolated bacteria were resistant to more than one drug. Susceptibility patterns to disinfectants were determined to concentrations in the range of 0.125 to 1% (quaternary ammonium, sodium hypochlorite and peracetic acid/H2O2). Hospitals provide reservoirs of microorganisms many of which may be multiresistant to antibiotics. Some of these organisms are borne by patients and staff, but the hospital environment is a substantial repository for others. Preventing the spread of clinical relevant bacteria depends on the quality of hospital cleaning services. Monitoring bacteria susceptibility to antimicrobials and disinfectants may help the management of nosocomial infections.