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(Not) Visiting Isolation Hospitals in Mid-Victorian Britain

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Infection and Citizenship:
(Not)Visiting Isolation Hospitals in Mid-Victorian Britain

Graham Mooney

Local authority provision for the sequestration of infectious people mushroomed in Great Britain from the mid-1860s. By the First World War, more than 750 isolation hospitals contained almost 32,000 beds for infectious patients, most of whom were children. Trips to an isolation hospital were problematic because visitors might contract infection there and spread it to the wider community. Various strategies sought to minimise this risk or eliminate it altogether. This chapter argues that the management of isolation hospital visitors was typical of Victorian public health’s tendency to regulate people’s behaviour. By granting rights to, and conferring responsibilities on, the relatives of patients, visiting practices enshrined notions of citizenship that sought to govern‘through’ the family.

The isolation of people with infectious disease has attracted an increasing amount of attention from historians. The fundamental rationales for the institutional exclusion of the infected – namely the protection of the wider population, the prevention or stamping out of an epidemic outbreak – are practically self-evident. Yet scrutiny in a variety of metropolitan and colonial contexts also reveals a set of practices that, over the course of the nineteenth century, seemingly were ever more laden with undertones of coercion, moral and physical rehabilitation and normalisation. The removal of biologically dangerous individuals from their community surroundings and into confinement has been characterised as a strategy of government power. In common, then, with penal incarceration and confinement of the mentally ill, isolation of the infected demonstrates a central contradiction of liberal governance: freedom was a means to govern because practices such as isolation created, in the words of Nikolas Rose, ‘the conditions in which subjects themselves would enact the responsibilities that composed their

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liberties’. Taking this cue, Bashford and Strange have noted that ‘isolation was not an aberration from liberal governance but central to its internal

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logic’. Put simply, ensuring the liberty of the many necessarily meant restricting the freedom of the few.
This chapter considers the isolation of patients with infectious disease in
Victorian Britain. It begins with a very brief summary of scholarship on citizenship and public health in the Victorian period. Just how far isolation hospitals really were ‘isolated’ is explored next, by taking into account both physical location of hospitals and the movement of people in and out of them. This is followed by an attempt to enumerate those features of isolation hospitals that acted as obstacles to their acceptance in the local community. In the fourth section, the forced separation of children from their families is identified as a bone of contention between parents and the state. Finally, the state’s shaping of visiting regulations comes under scrutiny as an important aspect of this separation. Here, the spotlight is on the families and friends of patients who were visitors to isolation hospitals. Public health authorities took the opportunity visiting presented to inculcate behaviours in families that limited the possible transmission of infection outside the hospital. The argument is that isolation hospital visiting regulations were part-and-parcel with the liberal state’s desire to shape those activities in the domestic sphere that qualified people as being fit for citizenship.
The consideration of visiting shifts the centre of attention away from diseased people – be they identified patients or carriers of disease as yet unidentified by a medical or state authority – towards those family members and friends who may be (or become) diseased, and spread disease, by the irresponsibility of their actions. In this way, the family – and not simply individuals with disease – comes into view as the locus of intervention. As one of the foremost authorities on the history of child welfare notes, one of the crucial questions for liberal democracies has been how the state relates to

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the private family in shaping ‘duties, responsibilities, rights and “needs”’. The ‘duties and responsibilities’ under investigation in this chapter are those imparted to family members who were visiting patients in isolation hospitals, while ‘rights and needs’ refer to the level of access that families

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were granted. The ‘costs to individual liberty and convenience’ families underwent because of isolation were transformed by the state into an opportunity to underline the dangers of infection and encourage behaviours that would prevent its spread beyond the walls of the hospital. The critique presented in this chapter therefore tends towards an interpretation that the

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state increasingly sought to govern ‘through’ the family, an interpretation that sits comfortably alongside studies that, in the realm of health, have examined domestic visiting, the infant welfare movement, child protection and school welfare.
To develop these lines of thought, three pivotal government inquiries are used, which were undertaken in the late 1870s and early 1880s. The first is

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a survey of hospital isolation facilities written by Richard Thorne Thorne (hereafter his surname will be truncated to just Thorne), an inspector of the medical department of the Local Government Board (LGB). In addition to distributing a questionnaire to all English and Welsh sanitary authorities, Thorne personally visited a total of 82 authorities and 67 hospitals. The second is a report by another LGB inspector, William Power, on the influence of the Fulham Smallpox Hospital as a focus of infection. The third is the Royal Commission on Smallpox and Fever Hospitals (RCSFH) which took evidence in 1881 and 1882 and was set up to consider the implications of Thorne’s and Power’s reports for the hospitals of the Metropolitan Asylums Board (MAB) in London. Interpretations of visiting that emerge from these central government documents are augmented by commentaries on the practices of local hospitals that can be found in Medical Officer of Health (MOH) reports, the archives of administrative bodies such as town council health committees, and accounts of isolation that occasionally surface in local newspapers written by the people who experienced it.

Citizenship and public health

The intersection of freedom, citizenship and health is proving to be fertile ground for historians of Great Britain. The production and maintenance of a healthy population in the twentieth century through primary health care, physical fitness, health education and army propaganda relates particularly well to the idea of ‘social’ citizenship put forward by T.H. Marshall in the

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mid-twentieth century. According to Peter Baldwin, the emphasis on individual responsibility and ‘internally accepted restrictions’ that was characteristic of some of the responses to the AIDS epidemic signified a ‘democratic public health’ in which the contract of health citizenship assumed that ‘individuals would curb harmful behaviour and develop

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healthy habits’. Isolation and exclusion are policies through which health and citizenship are seen to interact, notably in the leper colony and the

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tuberculosis sanatoria. In the latter, patients were rehabilitated, educated and inculcated into behaviours that were ‘appropriate’ to functioning and

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productive members of the citizenry.
Rights are crucial in liberal democracies if individuals are to be free to pursue legitimate interests in the absence of interference from either other

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individuals or the state. Citizenship is an expression of the relationship between an individual in possession of rights, and the community, to which that individual has responsibilities, duties and obligations – and which, of course, grants those rights. Fluid and dynamic, citizenship is subject to constant redefinition as individuals find new ways of articulating their rights and obligations (in this case, as visitors) and as new institutions (in this case,

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isolation hospitals) are ‘constructed to give form to the changing needs and

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aspirations of the citizen and community’.
No discussion of citizenship in Victorian Britain can avoid the issue of

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nationhood as a crucial component of state formation. National identity was the concept through which the ‘improvement’ of individuals and thus

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citizenship was articulated. Pamela Gilbert has recently elaborated on this theme in relation to public health between the 1830s and 1860s. Franchise reform in this period focused increasingly on the ‘fitness’ of the electorate to contribute to the social well-being of the nation as a whole. As qualification for the vote shifted from property ownership in 1832 to property rental in 1867, ‘fitness’ came to mean not simply the ability to pay taxes, but the capacity of working-class individuals to ‘procure’ and maintain a home and demonstrate a degree of prudent household economy that resonated with

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middle-class norms.
At around about the same time, the rhetoric of sanitary reform was linking the physical degradation of urban places to the immorality of the

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inhabitants. While this seemingly ‘confirmed the vision of the poor as incapable of exercising citizenship’, Gilbert writes that ‘it also implied a remedy that might bring such creatures within the pale of those who could

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develop into citizens over time’. The ‘remedy’ was an environmentally based public health: cleaning up public space – the removal of sewage, the supply of water and so on – also secured the conditions under which individuals might achieve domestic propriety. As Mary Poovey points out, Edwin Chadwick’s sanitary report in the early years of Victoria’s reign

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concentrated on domestic as much as public space. Alongside the school, the home was the crucial site of liberal governance; the place where, through the agency of the family, moral character was built in order that individuals would behave rationally, as responsible citizens of a national community. Gilbert’s focus is on housing and the charitable efforts of Octavia Hill. In her book Bodily Matters, Nadja Durbach has revealed how citizenship was a crux of the debate over compulsory infant vaccination in England in the nineteenth century. Anti-vaccinationists argued for their rights as parents to withhold their children from vaccination; pro-vaccinationists saw vaccination as a way to ‘incorporate working people into the national community as citizens through participation in maintaining the public’s

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health’. Gilbert’s homes and Durbach’s infant bodies are both spaces of risk

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over which the role of family was contested. This chapter discusses yet another: isolation hospitals that were provided by local governments to sequestrate people with infectious disease.

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The isolation of isolation hospitals

Although the early years of the nineteenth century witnessed the founding of a small number of private isolation (fever) hospitals in England, it was not until the second half of the century that such institutions began to

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proliferate nationally. Both the 1866 Sanitary Act and the 1875 Public Health Act gave local government the power to build an isolation hospital, and allowed them to borrow money for the purpose. By the end of the 1870s, the LGB estimated that 296 local authorities made some form of provision for the reception of patients suffering from an infectious disease,

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representing about one quarter of all provincial sanitary authorities. The Isolation Hospitals Act of 1893 enabled County Councils to build an isolation hospital and, if necessary, force local authorities under their jurisdiction to do so. Between this date and the eve of the First World War, more than 300 local authority isolation hospitals were constructed; as a result almost 32,000 beds were available nationally for infectious diseases, and isolation hospitals (755) outnumbered both Poor Law infirmaries (700) and general hospitals (594). Local authorities were not compelled to provide a permanent isolation hospital and this might explain why a significant minority of these facilities – about one-fifth – were buildings that had been converted from other uses, such as Poor Law institutions, private houses and even factories. Under such conditions, much of the local provision for epidemic outbreaks was rudimentary at best, and often of a temporary nature. The LGB, of course, was instrumental in imposing a greater degree of uniformity. It issued model hospital plans on a regular basis and it also withheld loans for proposed hospital buildings considered to be

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architecturally inferior.
Isolation hospitals came to be an integral component of the panoply of public health measures that Peter Baldwin has dubbed ‘neo-quarantine’ and

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Michael Worboys has characterised as ‘exclusive’. Focusing on the transmission of disease between people, leading lights of public health considered the institutional isolation of infectious patients as vital to the successful control of epidemics when used in combination with infectious

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disease notification, disinfection and domestic quarantine. Noting the amount of human traffic coming out of and going into these institutions, however, Logie Barrow recently lamented ‘how prematurely historians label

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these institutions as “isolation” hospitals’. The immediate rationale for isolation lay with the state of knowledge about the communicability of diseases. In general, the diseases that accounted for the largest proportion of cases admitted to fever hospitals – scarlet fever and, increasingly from the

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late 1880s, diphtheria – were acknowledged to be contagious. Smallpox came to be exceptional because of the controversy about whether the disease

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also could be carried in the air over long distances or not, a clear problem if

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the hospital was located amidst a populous district. This possibility sparked allegations that smallpox hospitals were foci for infection. Those for whom more proximate and intimate channels were required to pass on the disease rejected this. More crucial for them was the hospital’s endless traffic of people:

There are the milkman, the baker, the butcher, the greengrocer, and their assistants who call daily. To those who attend daily have to be added those who attend less frequently; contractors of various kinds, provision merchants, vendors of patents and disinfectants, the friends of the dead, inquirers after situations, the wine merchant, the brewer, the grocer, the cheesemonger, the oilman, the soap merchant, the crockery merchant, the

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brush man, &c., &c.

Notwithstanding omission of the candlestick maker, this remains an extensive list. It does not even begin to enumerate the movements of the nursing and medical staff, ambulances and visitors to patients. Indeed, in one six-day period in January 1881, LGB inspector William Power recorded that 439 interactions of the sort mentioned above took place at the Fulham

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smallpox hospital. In accepting the case for long-distance smallpox transmission, the RCSFH also admitted that ‘personal communication’ between patients and individuals entering the hospital was a significant factor in raising the incidence of smallpox in the immediate

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neighbourhood.
Following his extensive survey into isolation hospital provision, the
Commission heard from Thorne that disease might, on occasion, have spread as the result of ‘illicit’ visits to patients or when patients were ‘so

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placed’ as to be able ‘to communicate with others outside the hospital’. The Commission clearly felt the weight of evidence was heavy enough to tighten the authorities’ grip on all possible routes of transmission between people and it made a series of recommendations intended to minimise the risks involved with these interactions. Tradespeople and contractors were to use a separate entrance; nurses’ and attendants’ leave should be less frequent, though of a longer duration; the ambulance service should be more closely managed and under the complete control of the hospital authority; and, significant in the context of this chapter, regulations for visitors to patients

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should be ‘strictly enforced’.

The poor man’s spare bedroom?

Both the popular perception and the reality of exclusion that surrounded isolation hospitals presented a tricky problem to public health officialdom,

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since it militated against the isolation of all cases that, ideally, was required to arrest an epidemic. Local authorities used hospitalisation rates as a roughand-ready means of assessing community acceptance of, and satisfaction with, the isolation hospital. It is instructive that in 1891, Sheffield’s MOH regarded the city’s scarlet fever hospitalisation rate of twenty-nine per cent as

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a dismal figure. Although hospital accommodation in the city was ‘exceedingly well adapted to the requirements’, the MOH puzzled at parents’

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reluctance to utilise the city’s hospital at Winter Street. By the late 1880s and early 1890s, some other local authorities were hospitalising as many as

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eighty per cent of all scarlet fever cases that were notified to them. This intensification of isolation hospital provision in the final quarter of the nineteenth century must have represented a real, sometimes troubling, shift

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in the community experience of institutionalisation.
The overwhelming impression is that isolation hospitals tended to serve the working classes and poorest members of the community. For the most part, this is undoubtedly true, since legislation that sanctioned compulsory removal to hospital – the 1866 Sanitary Act – stipulated that it need only take place in instances where domestic isolation was not feasible – that is, in homes that were overcrowded. This was achieved by reformulating the definition of a nuisance to embrace ‘any house, or part of a house so overcrowded as to be dangerous or prejudicial’ to the residents. The link between the lack of domestic space and hospitalisation is significant in the context of the mid-century formulation of citizenship: the criteria of ‘fitness’ included a family’s ability to secure a dwelling that would promote moral

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and physical wellbeing; since ‘overcrowding’ itself evaded official technical definition until the 1890s, there was considerable leeway in the

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interpretation of this term.
The opinions of public health officials, who tended to regard the working classes as either far too ignorant to understand the requirements of domestic isolation or unable to secure isolation of a patient in an overcrowded home, did much to foster the impression that isolation hospitals existed to serve primarily the needs of the poorer sections of society. The following quote from the Sheffield MOH indicates precisely why isolation hospitals came to be portrayed as the ‘poor man’s spare bedroom’:

It is quite impossible that proper isolation can be carried out in small houses where there are several members of a family, and where the room containing the patient is in close proximity to that used by others, or where the mother, no matter how careful in the use of disinfectants, has both to nurse the patient and superintend domestic arrangements. Efficient isolation consists in completely cutting off the sick room with all it contains, including the

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nurse, from the rest of the house and family, and, except in special cases, this

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is quite impossible in private houses.

The need to hospitalise all but the wealthiest patients created barriers to acceptance, particularly over the thorny issue of pauperisation. In London, where the MAB was a constituted authority of the Poor Law, those unable to secure domestic isolation and submitting to hospital admission were

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immediately pauperised – and thus disenfranchised. Though MAB hospitals could in fact admit any person without a relieving officer’s certificate if they were deemed to present a danger to the public, the legal status of pauperism was not removed until the Diseases Prevention

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(Metropolis) Act of 1883.
The spectre of pauperisation might have prejudiced the domestically overcrowded working classes against isolation hospitals in London; everywhere else, the spectre of paupers prejudiced the well-to-do. In the provinces around this time, some isolation hospitals contracted with the local guardians to admit paupers with an infectious disease, especially where separate accommodation did not exist in the workhouse infirmary. In the late 1870s, four per cent of Salford’s isolation hospital patients were drawn from the middle and upper classes (tradespeople, clerks, professionals) and fifty-four per cent from the ‘wage-earning classes’. The remainder – a little over forty per cent – were paupers, a figure similar to that in neighbouring Manchester’s Monsall Hospital in 1880. A minority of hospitals reported that no troubles were encountered with the admission of out-door paupers, particularly if their ragged or dirty clothing was replaced with hospital-issue

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uniform, as was the case in Salford. In Oldham, where the hospital outfits came in a variety of patterns ‘so as to avoid the appearance of a uniform’, newly arrived patients were also issued a numbered bag containing a clean brush and comb. Bathing, the cutting of hair and the sorting and

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disinfection of clothing became routine for patients everywhere. While these rituals of standardisation certainly can be interpreted as the inculcation of desirable hygienic behaviours, within the hospital itself they also aimed at dissolving the separation of the pauper ‘anti-citizen’ from the respectable

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working class. Despite this, securing the isolation of patients unwilling to co-habit wards with paupers was a recurring problem in places such as Blackpool, Carlisle, Manchester, Newcastle and Nottingham. Some local authorities administering isolation hospitals refused to admit paupers

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    Thorax: first published as 10.1136/thx.42.9.705 on 1 September 1987. Downloaded from Thorax 1987;42:705-752 Proceedings of the British Thoracic Society, Scottish Thoracic Society and Thoracic Society of Australia The 1987 summer meeting held on 1-3 July in the University of Edinburgh. Bronchoscopy in the elderly: helpful or hazardous? mg (two). Bronchoscopists completed questionnaires immediately afterwards, and patients the next day, AJ KNOX, BH MASCIE-TAYLOR, RL PAGE Respiratory returning them promptly by stamped addressed envelope. Medicine Unit, St. James's Hospital, Leeds Recently, After midazolam, fewer patients remembered the nasal doubt has been cast on the safety and desirability of spray (15% vs 36%, p<0.05) or bronchoscope insertion fibreoptic bronchoscopy in the elderly (Grant IBW, Br Med (9% vs 38%, p<0.01); complaints fell from 48% J 1986;293:286-7). To answer this question, we looked at previously to 7%o. Fewer patients were difficult to the safety and acceptability of the procedure in 60 patients, bronchoscope or found it unpleasant after midazolam, aged 80-92 over the four year period May 1982-May 1986. though more needed extra lignocaine; these differences Thirty-four patients were male. Sedation was with atropine, were not significant. Overall, the commonest complaint fentanyl, and diazepam, 2% lignocaine being instilled (32%) was of apprehension about the procedure or results locally over the cords. There was no serious morbidity and but 97%to would have another bronchoscopy, and 74%o no mortality. The diagnostic yield was similar to younger found it better than expected, though 93% appreciated age groups.
  • ESCMID Online Lecture Library © by Author

    ESCMID Online Lecture Library © by Author

    Library Lecture D J M Wright Imperialauthor College, London Onlineby © ESCMID Smallpox : 17th Century yVariola not an infection ‐ Library Sydenham Lecture yNot a problem: Disease author of the poor (despite Mary II and LouisOnline XVby dying of the disease) © yEstablished smallpox ((p+pla gue ) houses. FirstESCMID house in Windmill St. off Tottenham Court Road Hospital Movement for the Poor 17th Century y General (Teaching) Hosp ital Library referral by letter of recommendation, GLGovernors Lay Lecture y Specialist Hospital medical author Onlineby referral, Governors medical© y New Fever //pSmallpox HospitalESCMID referral parish/medical, Governors medica l and l ay Febrile illnesses y SSllmallpox y Scarlet fever Library y Epidemic fever y Relapsing fever Lecture y Endemic fever y enteric ,typhus, chhloleraauthor ((dand perhaps oth er form of febrileOnline gastroby ‐enteritis) y Continued Fever © y Camp or goal fever ((g),meningitis), p,pneumonia, ESCMIDsepticaemia and erysipelas. y Unknown cause y Visitation of God Admissions to London Fever Hospital (1869) y Typhus* 1260 (half the previous y)year) Library 18.6% died [70 from same street] y Enteric 368 Lecture y Relapsing fever* 769 y Scarlet fever 641 author y Undiagnosed Onlineby dyspepsia 36, starvation© 10, hysteria 1, melancholia 1,balance undiagnosed y TotalESCMID 3411 *These were mainly destitutes or tramps Smallpox Library 1796 Nelmes inoculated by Jenner 1798 J’Jenner’s IIinquiry iLecturento SSllmall pox 1853 Vaccination Act [paymentauthor of doctor for vaccinatingOnline a childby

  • Statistics of the Barony Parish Fever Hospital of Glasgow in 1847-48

    Art. VI.?-Statistics of the Barony Parish Fever Hospital of Glasgow in 1847-48. By James Paterson, House-Sur- v geon and Superintendent of the Hospital. During the year 1847, fever, which had for several months of the previous year assumed, in most parts of the country, an epidemic form, prevailed so much as to raise in the minds of all very considerable alarm. In Glasgow, the first noted increase of the disease was in autumn 1846, from which time it became more and more pre- valent, till it reached its maximum in the summer of the follow- ing year. The only public accommodation in this city, previous to 1847, was that afforded by the wards of the Royal Infir- mary, and in these the number of beds scarcely exceeded 200. As might have been expected, this amount of accommodation was found, even before the close of 1846, to be insufficient, accordingly, the managers of the Infirmary rented the Lock Hospital, then recently erected, and capable of affording ac- commodation to seventy or eighty persons. But as this auxi- liary hospital was too inconsiderable to render very efficient service in an increasing epidemic, the managers resolved that they should themselves build another on ground already in their possession; but so strong was the opposition of the neigh- bouring inhabitants and proprietors to this proceeding, that the design was relinquished. They then purchased a building in Bridgeton, one of the eastern suburbs of the city, but before it could be furnished to receive patients, opposition, as in the for- mer instance, was brought forward, and in such a way as to de- lay the employment of the building in the manner contemplated.
  • The Relationship Among Workload, Teamwork, and Missed Nursing Care at Intensive Care Units Abstract

    The Relationship Among Workload, Teamwork, and Missed Nursing Care at Intensive Care Units Abstract

    Original Article Egyptian Journal of Health Care, 2020 EJHC Vol.11 No.3 The Relationship among Workload, Teamwork, and Missed Nursing Care at Intensive Care Units Sanaa Mohammed Soliman1, Nashwa Mahmoud Eldeep2 (1) Lecturer of nursing administration, Faculty of Nursing, Fayoum University, Egypt Email: [email protected] (2) Lecturer of nursing administration, Faculty of Nursing, Damanhour University, Egypt Email: [email protected] Abstract Background: Nurses are vital to the delivery of safe and effective care at critical units, but improper team work and high patient workloads may cause missed nursing care. Research Aims: To examine the relationship among workload, teamwork, and missed nursing care at intensive care units Methodology: Correlational research design was conducted at Intensive Care Units (ICU) at Fayoum university hospitals. Intensive care units at Kom Hamada central hospital, Damanhour fever hospital and Damanhour chest hospital. The subjects were 207 nurses. A self-administered questionnaire containing four parts; (Part I: Demographic characteristics of the subjects such as age, gender, marital status, nurse role, qualifications, experience, shift worked, nurse to patient ratio, length of shift time, Part II: Miss care Survey was developed to measure the frequency with which nursing care activities are omitted or delayed, and to identify the factors that contribute to these missed activities as perceived by nursing staff in the acute care setting,Part III: Workload Subscale was used to measure the nursing staff’s perception of workload. This subscale was designed to measure “the extent to which feelings of pressure and urgency dominate the work environment”, Part IV: Nursing Teamwork Survey, This 33-item instrument was designed to measure teamwork among nurses in the acute care setting, but the items generically address teamwork activities across nursing care settings.) Results: The present study showed that less than half of studied nurses had moderate missed care and moderate team work.
  • An Observational Study: Health Care Providers' Knowledge and Its Relationship to Compliance with Standard Infection Control Pr

    An Observational Study: Health Care Providers' Knowledge and Its Relationship to Compliance with Standard Infection Control Pr

    ISSN 2394-7330 International Journal of Novel Research in Healthcare and Nursing Vol. 6, Issue 2, pp: (1686-1699), Month: May - August 2019, Available at: www.noveltyjournals.com An Observational Study: Health Care Providers’ Knowledge and Its Relationship to Compliance with Standard Infection Control Precautions at Damanhour Fever hospital Shaimaa Shawky Abdel Wahab1, Nora Ahmed Bassiouni2, Yaldez K. Zein Eldin3 1 Teacher of Nursing, School of Nursing, Damanhour Governorate. 2 Professor of Nursing Administration, Faculty of Nursing, Alexandria University 3 Assistant Professor of Nursing Administration, Faculty of Nursing, Damanhour University Abstract: Health care providers (HCPs) are exposed to blood-borne infections from different pathogens. Standard Precautions (SP) practices are designed to protect healthcare providers (HCPs) and prevent them from spreading infections among patients. Design: descriptive correlational design. Aim: identify the relationship between health care providers' knowledge of and compliance with Standard infection control precautions at Damanhour fever hospital. Setting: Nine inpatient units at Damanhour Fever Hospital. Subjects: 56 nurses, 16 Physicians, 7 Technicians and 5 auxiliary personnel who were available during data collection and agreed to participate in the study. Tools: two tools were developed by the researchers, tool (1): Standard Infection Control Precautions Knowledge Questionnaire to assess Health Care Providers' (HCPs) level of knowledge; tool (2): Standard Infection Control Precautions Observation Checklist developed to observe HCPs compliance with Standard Infection Control Precautions. Results: The study findings were (89.3% ) of nurses, (81.3% ) of physicians, (85.7% ) of technicians, (60.0% ) of auxiliaries had high level of knowledge about Standard Precautions (SP) general information. As for overall compliance with SP, 57.1% of nurses, 60% of auxiliaries complied fairly while 87.5% of physicians and 100% of technicians complied poorly to the overall SP.