The Issue

Healthcare associated infections (HAIs), caused by pathogens such as MRSA, multi-drug-resistant coliforms, norovirus, and Clostridium difficile, are a substantial problem in developed and developing countries around the world [1] and within the NHS. In April 2014, the WHO produced a global map [2] of antimicrobial resistance, warning that a ‘post-antibiotic’ world could soon become a reality and in May 2014 there was a warning that ‘without an international commitment to tackle the issue, the world faces a future in which simple infections that have been treatable for decades become deadly diseases’ [3]. In addition to the distress caused to patients who acquire a hospital pathogen, the cost of HAIs for acute services in NHS Scotland was estimated in the last national prevalence survey at £183 million [4]. Educational interventions are a key component in the battle against HAIs, specifically areas such as: the transmission of infection; hand hygiene; use of personal protective equipment; and maintenance of a clean environment and clean equipment [5]. However, a particular challenge underlying attempts to explain and instruct in these areas is that the pathogens responsible for HAIs are invisible to the naked eye.













[1]  Allegranzi, B., Nejad, S.B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L. and Pittet, D., 2011. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet, 377(9761), pp.228–241.

[2]  WHO, 2014. Antimicrobial Resistance: Global Report on Surveillance 2014.

[3]  Woolhouse, M. and Farrar, J., 2014. Policy: An intergovernmental panel on antimicrobial resistance. Nature, 509(7502), pp.555–557.

[4]  Health Protection Scotland, 2007. NHS Scotland National HAI Prevalence Survey. [online] Available at:

[5]  NHS Education for Scotland, 2014. Introduction to cleanliness champions. [online] Retrieved May 5, 2014, from