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Infection control in the Eastern Mediterranean

Region: Time for collaborative actionZiad A. Memish, MD, CIC, FRCPC, FACP, FIDSA,a,b Gwen Cunningham, RN, CIC,a  and Barbara M. Soule, RN, MPA, CICc

Riyadh, Saudi Arabia; and Seattle, Washington

Today’s approach to the control of health care–

related infections is rooted in principles and practices

that date back many eras. History shows that the

scientific application of antisepsis, principles of micro-

biology, and segregation of infectious persons began

Ziad A. Memish, MD, CIC, FRCPC, FACP, FIDSA

Gwen Cunningham, RN, CIC

Barbara M. Soule, RN, MPA, CIC

From the Infection Prevention and Control Programa and the Depart-

ment of Medicine,b

King Abdulaziz Medical city, King Fahad NationalGuard Hospital, Riyadh; and Joint Commission Resources, Olympia,WA.c

Reprint requests: Ziad A. Memish, MD, CIC, FRCPC, FACP, FIDSA,Executive Director; Infection Prevention and Control Department-MC 2134, King Abdulaziz Medical City, King Fahad National GuardHospital, PO Box 22490, Riyadh, Saudi Arabia. E-mail: memish@ngha.med.sa.

Am J Infect Control 2005;33:131-3.

0196-6553/$30.00

Copyright ª 2005 by the Association for Professionals in InfectionControl and Epidemiology, Inc.

doi:10.1016/j.ajic.2005.03.001

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over 150 years ago. Since the Bronze Age, many

efforts, customs, and practices have been adopted to

prevent transmission of infectious disease among man.

As we moved through the ages, several themes

emerged regarding infection prevention and safe care

practices for patients with and without infections and

infectious diseases. Examples of these themes includethe evolution of hand antisepsis from the advances

made by Semmelweis to its current application in

health care, the development of the principles and

techniques of disinfection and sterilization, and the

role of the inanimate environment as a factor in health

care–associated infections.

Today, in the 21st century, infection prevention is

acknowledged to be a global concern. An extraordinary

solidarity and unity of purpose on this global challenge

can be achieved as individuals, a ssociations, and

organizations link in this endeavor.1,2

Although organized preventive health services arereported to have started in Saudi Arabia in the early

1950s, it is not clear when the discipline of infection

control was integrated into the system.3 However, its

current practice in the Kingdom and Middle Eastern

Regions has taken significant leaps to join the global

community in a common endeavor. But much work is

yet to be done: strategies that inevitably must bring

individuals and groups to cohesion need to be

developed and executed. 4

This 1st Middle East Conference on Prevention and

Management of Healthcare-related Infections aims to

connect the links in the chain for global infection—prevention and control. Of great importance is the

forum it provides for the sharing and exchange of 

scientific information, bringing the regions together

and thus bridging distances. It also serves to pool ideas,

outline action plans, and build bonds by establishing

a network of experts for collaborative research to fur-

ther enhance the discipline and prevent or minimize

duplication of efforts.

In the mid 20th century, there was a convergence

of ideas that resulted in the establishment of the dis-

cipline of infection control with its associated groups

and professional organizations. These influenced ma-

 jor advancement in knowledge, systems, standards,

and scientific research. The time is right for the Gulf Co-

operation Council (GCC) states to converge to solidify

networks, establish professional societies and organi-

zations, and develop regional quality standards for pro-

fessional practice and certification.

At its first meeting in February 1976, the Health

Ministers’ Council for the GCC States made a decision

to bring together the collaborative efforts of all

aspects of health care. Principal among its objectives

were the unification of efforts to improve and ad-

vance the highest level of health care, the establish-

ment and maintenance of standards and policies for

the delivery of health care, the prevention and eradi-

cation of communicable diseases in the GCC states,

and the promotion of combined research to provide

technical advice on health-related issues. These reso-

lutions set the stage for a collaborative health care

sector.5Some testaments to the results of collaborative

actions are evident when the evolution of the infection

control discipline and the establishment of its many

groups and associations are reviewed. These groups

and associations—Infection Control Nurses Associa-

tion (ICNA) and Hospital Infection Society (HIS) in the

United Kingdom; the Association for Professionals in

Infection Control and Epidemiology, Inc (APIC) and

Society for Healthcare Epidemiology of America (SHEA)

in the United States, The Community and Hospital

Infection Control Association (CHICA) in Canada; and

the International Federation of Infection Control(IFIC)—to name a few, have influenced practice guide-

lines and standards and established a body of knowl-

edge that is used internationally. This knowledge is

evident in the characteristics that define the specialty

of infection control in the GCC states.

The World Health Organization (WHO), in its recent

proposal for expansion of programs, has outlined its

action plans for patient safety with infection preven-

tion and control as a major component. The Centers

for Disease Control and Prevention’s Draft Guidelines

on Standard Precautions and Expanded Precautions

(2004) also addresses health care–related infectionsinstead of nosocomial infections. The ongoing chal-

lenges, such as antibiotic resistance, multi-drug–resistant

organisms (MDRO), and emerging new pathogens, are

issues concerning which infection control profession-

als must establish a progressive consensus. It is by the

strength of our common endeavors that we achieve

more. Challenges remain, and as the complexity of 

health care and society increases, it sometimes feels

that we are making little progress in improving care

and reducing risk. ‘‘The chasm between what is pos-

sible and what is routinely achieved in health care has

never appeared wider.’’6 It is only by the strength of our

common endeavor that we achieve the best results for

our patients and caregivers. For example, the Hajj, one

of the world’s largest mass movements of people

occurs annually, when it is estimated that approxi-

mately two million pilgrims converge on one site, in

one city, in one country of the GCC states. Any con-

sequence of this event could impact the entire region.

The Hajj presents a unique inf ection control event

that calls for collaborative action.7

The nations of the GCC states are facing a major

impact from health care–related infections and the

related issues of quality of care and patient safety.

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‘‘The challenge for the future is not just to advance

the science but to advance the sociology of healthcare,

specifically of the practice of infection control.’’1 We

must create partnerships and groups and engage

experts and leaders who will seize opportunities

to interact, to address common concerns, and to meet

our mutual challenges. Our future and time forcollaborative actions is now. ‘‘The best way to predict

the future is to create it.’’8 In creating the future of 

infection control, at their 85th meeting in Muscat,

Oman, February 14-15, 2005, the GCC Ministers of 

Health named the King Abdulaziz Medical City–Riyadh

as the collaborative center for infection control in the

region. This sets the stage for establishing an organi-

zation of infection control professionals.

This Special Issue of the American Journal of 

 Infection Control  documents some of the key topics

that will be discussed at the 1st Middle East Conference

on Prevention and Management of Healthcare-relatedInfections, scheduled for May 21-25, 2005. A primary

focus of this conference, evidenced by the interna-

tional collaborators listed below, is to establish global

linkages to further espouse the cause of connecting the

links in the global chain for infection prevention and

control.

World Health Organization (WHO)

International Federation of Infection Control (IFIC)

International Society of Chemotherapy (ISC)

European Society of Clinical Microbiology and Infec-

tious Diseases (ESCMID)

The Joint Commission International

Executive Board of the Health Ministers’ Council for the

GCC States

Association for Professionals in Infection Control and

Epidemiology (APIC)The Society for Healthcare Epidemiology of America 

(SHEA)

The Community and Hospital Infection Control Asso-

ciation (CHICA-Canada)

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