Lessons learned from Florence Nightingale could prevent the spread of harmful bugs by allowing friendly bacteria into hospitals, an expert has claimed.

... Florence Nightingale said if you have an open window where air from the environment is coming in, you’ll have less illness

Sterile conditions in wards and operating theatres may be doing more harm than good by wiping out organisms that keep dangerous microbes at bay, Jack Gilbert believes.

Florence Nightingale, the 19th-century mother of modern nursing, advocated cleanliness, but also plentiful fresh air for patients.

Dr Gilbert, who heads an international project to construct a bacterial field guide of all the world’s known bugs, thinks she was right, despite knowing nothing about microbial diversity.

He points to emerging evidence that what happens in buildings mirrors what occurs in the gut. It is well known that beneficial bacteria, or “flora” in the intestinal tract help to ward off infection by out-competing potentially harmful organisms.

British-born Dr Gilbert, who is based at the Argonne National Laboratory near Chicago, said: “There’s a good bacterial community living in hospitals and if you try to wipe out that good bacterial community with sterilisation agents and excessive antibiotic use you actually lay waste to this green field of protective layer. Then these bad bacteria can just jump in and start causing hospital borne infections.

“This is going back to Florence Nightingale. Florence Nightingale said if you have an open window where air from the environment is coming in, you’ll have less illness.

“You open up these windows, you keep it nice and airy, and you’ll see less sick soldiers in this hospital theatre.

“You let in all these bacteria from outside, and you will either dilute out the pathogens (harmful infectious agents) or you don’t allow the pathogens to establish themselves.

This is because there is too much competition for the nutrients and energy that the bacteria need to survive.”

He cited a study published just last month conducted by Dr Jessica Green, from the University of Oregon.

She carried out an experiment in which bacterial samples were taken from clinic rooms that either had their windows open or closed.

The rooms with open windows had a more diverse range of microbial types.

The sealed and artificially ventilated rooms had less variety of bugs, and more of the kinds of bacteria that could potentially be harmful.

Dr Gilbert delivered his message at the annual meeting of the American Association for the Advancement of Science (AAAS) in Vancouver, Canada.

He said: “You imagine when surgery first started 300 years ago.

“You’d have people walking around with blood and pus all over their outfits etc.

“In that situation it makes a lot of sense to make the system very clean. But if you go into any wound infection clinic, speak to any surgeon.

“These guys are constantly exposed to a situation when they sterilise the living bejabers out of their operation room – there’s theoretically nothing there, they’ve scrubbed themselves constantly with sterilisation agents – and somehow magically a pathogen gets into the person when they’re in the operating theatre and they get sick.

“This is a situation where one organism from one person that may be a pathogen hasn’t had any competition from any other microbes on the skin or in the environment because there’s nothing else there. So it’s had no barrier to actually go for it.”

Dr Gilbert said he had a colleague who carried out field operations in Venezuela using unsterilised surgical instruments that were merely scrubbed with soap and water.

“He sees less acquired infections from surgery in that environment than they do in Chicago,” he added.

The potential number of microbes on the planet was estimated to be a “nonillion”, Dr Gilbert told the meeting. That is 10 followed by 30 noughts.

No-one knew how many different types of bacteria there were, but he had taken part in a sampling study that found the English Channel alone held around 100,000 species.

“This is a microbial world,” he said. “There are a billion more bacterial cells on this earth than there are stars in the known universe. Biological numbers are the big numbers.

“These guys have been around for 3.8 billion years and they’re living on every single one of us.

“There are a hundred trillion bacterial cells in your body and only 10 trillion human cells.

“You’re a lump of flesh ... and these guys have jumped on you and are now living on you and in you and making their living doing it. But without them you’d be dead.”

Florence Nightingale spoke of the need for fresh air in her Notes On Nursing, dated 1860.

She wrote: “Always air from the air without, and that, too, through those windows through which the air comes freshest. From a closed court, especially if the wind does not blow that way, air may come as stagnant as any from a hall or corridor.”

Microbiologist professor Mark Enright from the University of Bath said: “I do think that opening windows is a good thing. Air flow is a good thing in hospitals, you don’t want pockets where organisms can pool and swarm and pass on.”

But he described the idea that hospitals were too clean as “quite an extreme view”. “Given the opportunity, any bacterium that gets into the bloodstream and into sterile tissue will invade and cause problems and produce toxins that can kill,” he said.

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