Lowbury Lecture. Infection control--a challenge in a land of contrasts

The general level of health care in any country will dictate to a large extent the amount of attention paid to the control of nosocomial infections. In South Africa the apartheid era, although initially supporting a strong economy, did little to foster a good education system among the mass of the population. With the imposition of sanctions and the decline in the economy, the health services which had been curative in nature and centred around the medical schools of the country and their teaching hospitals, began to suffer the effects of rampant inflation and financial cutbacks. Nevertheless, virtually all the medical schools support infection control programmes of one sort or another. In addition, there are a number of Infection Control Societies in the country. With the present political instability and violence in the country, the health services have not escaped. Staff cutbacks are inevitable and wards may have to close; the academic hospitals are under threat. Privatization is strongly favoured by government. The present population of approximately 30 million could double by the year 2020, putting enormous pressure on limited resources. The squatter problem worsens every month. The spectre of human immunodeficiency virus (HIV) infection increases yearly. Any assessment of priorities must therefore be made against this background. Only proven methods of infection control should be encouraged. In the light of the foregoing, three areas of practical activity are examined: the re-processing of heat-labile equipment, the re-use of disposables and the disposal of clinical waste.(ABSTRACT TRUNCATED AT 250 WORDS)