A Look Back At Infection Control And Isolation Facilities At Guildford Hospitals

Published on: 20 Jul, 2020
Updated on: 23 Jul, 2020

With the opening on July 20, 2020, of the newly built isolation ward at the Royal Surrey County Hospital, Professor Rodney Cartwright, Consultant Medical Microbiologist to Guildford Hospitals 1973 – 1994, gives some reflections on infection control and isolation facilities in Guildford hospitals up to 1994

Pre-National Health Service

Infections have featured throughout the history of hospitals in Guildford. The first Consulting Physician at the Royal Surrey County Hospital when it opened in 1866 was Dr (later Sir William) Jenner whose investigations at the London Fever Hospital into cases of continued fever enabled him finally to make the distinction between typhus and typhoid.

A view of some of the buildings at The Woodbridge Infectious Diseases Hospital. The area is now the Midleton Industrial Estate, off the A25, off the foot of Woodbridge Hill.

There were two Guildford hospitals for smallpox and infectious diseases but they no longer exist. The Woodbridge Infectious Diseases Hospital and Smallpox Hospital at Whitmoor, Worplesdon (1900-1936) and also the Clandon Isolation Hospital (1901-1958), which is now the site of HMP Send.

The Royal Surrey County Hospital, Farnham Road, in the early 1900s.

The Royal Surrey County Hospital [Farnham Road] House Visitors Book in 1902, contains the observation “Jan 11th Visited the West Ward and Children’s Ward. The floor of the West Ward is very rough and presents many hiding places for microbes.” signed James Noon. An apt reminder of the importance of ensuring that the fabric of the building did not facilitate the survival of microbes.

The Royal Surrey County Hospital’s House Visitors Book.

The observation written in the book on January 11, 1902.

St Luke’s Hospital and the Royal Surrey County Hospital

By 1973, when I took up my post as a Consultant Microbiologist, the Guildford Hospitals had an isolation facility for patients with infections and infectious diseases in the grounds of St Luke’s Hospital.

The entrance to St Luke’s Hospital, Warren Road, Guildford, in about the 1980s.

It was a separate single-story building with six single-bedded rooms but no special ventilation. The admission of patients, both medical and surgical, was controlled by the Consultant Microbiologist but they remained under the clinical control of their original consultant.

Construction of the current Royal Surrey County Hospital in the late 1970s.

Shortly after the Royal Surrey moved to its present location, it was recognised that there was a need for isolation facilities on site and part of the original day ward was converted into a six-roomed isolation ward unit with individual ventilation.

Known as Birtley Ward, this facility remained operational until the 1990s when it was decided that an endoscopy suite had a higher priority for the space.

The microbiologists at the time stated that within time the hospital would need to re-establish designated isolation facilities. They did not envisage it would take over 20 years.

Infections managed in the isolation wards

Perusal of records of the diagnoses of patients admitted to both Parson and Birtley wards reveals a wide range of infections with varying degrees of infectivity.

The commonest cause of admission was due to gastroenteritis due to salmonella, campylobacter and Clostridium difficile.

It should be remembered that in 1973 campylobacter and Clostridium difficile had not yet been recognised as causes of gastroenteritis.

MRSA also appeared and cases were rapidly removed from other wards to Birtley.

The other new microbe to appear in the 1980s was the AIDS virus, HIV, and the first case diagnosed in Guildford was cared for in Birtley Ward where he subsequently died.

The list of other infections which led to patients being admitted to isolation included meningitis, Hepatitis B, Herpes Zoster, Herpes simplex, cellulitis, staphylococcal scalded skin syndrome, atypical pneumonia, Pulmonary TB, Tick Typhus, typhoid fever, measles, mumps, hand foot & mouth disease, Guinea worm, Schistosomiasis and malaria.

All of these conditions did not necessarily require strict isolation, but the unit provided care by staff specifically trained in the treatment of the infections.

New microbes continue to emerge, old microbes change and need new strategies for control. Infections are continually evolving and a previously held view ‘that with modern antimicrobial drugs and vaccines, infections are no longer a problem’ is patently unsustainable.

Meeting the challenges

Covid-19 has reinforced the importance of ensuring that all hospitals have a trained Infection Control Team that develops preventive as well as control measures. Adequate isolation facilities help infected patients to be safely managed reducing the risk of infection spreading to others in the hospital. Such facilities are a basic requirement for all hospitals.

This has been recognised by the Roayl Surrey with the opening of the Guildford Ward, an environmentally controlled isolation unit.

This unit adds to the hospital’s effective infection control programme. It is vital that we remember that ignore microbes at our peril.

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