Hospital administrators and infection control professionals often underestimate the risks of nosocomial viral outbreaks. The risks have changed since the mid 20th century, when immunisation reduced or eliminated hospital admissions for many serious viral infections - smallpox, measles and varicella among others - but in the 1970s and ‘80s recognition of risks, to healthcare workers (HCWs) and patients, of blood-borne viral (BBV) infections radically changed our approach to many clinical and diagnostic procedures. We have reduced many of the risks but hospitals remain potential amplifiers of serious viral infections.
Outbreaks of respiratory and enteric viral infections occur regularly. They can be devastating for some groups of very vulnerable patients, but are usually mild or asymptomatic in HCWs, who are often the source or vectors of infection. Complacency and nihilism are understandable, but dangerous - not only for patients; HCWs have been severely affected by hospital outbreaks of viral haemorrhagic fevers and SARS. This raises serious ethical issues about the relative rights (to protection from harm and access to care) and responsibilities (to provide care for the sick and protect others) of healthcare organisations, HCWs, patients and the general community. And if these issues are managed poorly the ethical will inevitably become political – with potentially devastating effects on public confidence and the economy.
The risk to hospital patients and staff from emerging infections is unpredictable, but delayed recognition and limited compliance with “routine” infection control practices (hand hygiene, cough etiquette, isolation of patients with undiagnosed infection, laboratory biosafety/security,) mean that the crowded hospital environment provides an ideal setting for amplification in the hospital and further dissemination in the community. We know how to reduce the infection risks in healthcare settings, but the challenge it to be prepared for the unexpected so as to mitigate their effects.