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In an attempt to assess the importance of different aspects of the immediate wound environment during an operation, detailed bacteriological data were obtained in the operating theatre from 1000 patients operated upon in two different theatres.Nasal and skin carriage of Staphylococcus pyogenes were found to be associated with a small number of autogenous infections, but no significant increase in the staphylococcal wound infection incidence could be shown in these groups. Skin carriage of other pathogens seemed to be of no importance with the disinfection methods used in the present study.Settle-plate studies showed no apparent difference in the bacteriological hazard of the two operating theatre environments, neither appearing to constitute any real danger. Samples at the end of operation confirmed the importance of endogenous contamination with intestinal organisms during potentially dirty operations. Apart from the few autogenous infections, there was little evidence of staphylococcal wound sepsis arising as a result of contamination in the operating theatre. Hands and masks of members of the operating team could not be demonstrated as sources of contamination during operation.There was no apparent difference in the bacteriological findings as they related to the different operating theatre environments.POSTOPERATIVE wound infection still exists as an important aspect of general surgical practice. Although seldom a cause of mortality, wound sepsis frequently leads to an increased morbidity and a prolonged hospital stay after an otherwise uncomplicated operation. Much work has been done to attempt to assess the relative importance of the many different factors believed to be involved in the aetiology of this common complication.Infection in a surgical wound can be the result of contamination arising either in the operating theatre or in the ward. Many attempts have been made to evaluate which is the more important. A consideration of the conditions at operation and the bacteriology of the infected wound can often suggest the probable origin of the responsible organisms (Davidson, Smylie, Macdonald, and Smith, 1971). In the recent past, workers have been concerned mainly with the problem of infection by Stuphylococcus pyogenes. Not so well recognized has been the almost equally serious occurrence of wound sepsis associated with 'faecal' or 'intestinal' organisms such as Escherichia coli, Bacillus proteus, and Streptococcus faecalzs.In the numerous publications dealing with the incidence of wound infection under different conditions, the sepsis rates vary to a striking degree. Retrospective studies, although interesting, must be regarded with suspicion, information collected from hospital records tending to depend so much on the varying diligence of different generations of junior doctors. The present study attempted to obtain information about the immediate bacteriological hazards to a wound during operation. MATERIALS AND METHODSA total of 1070 patients was studied in the operating theatre. Data were incomplete...

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SummaryThe incidence of postoperative wound infection in a general surgical unit is reported both before and after transfer from a "Nightingale" type multibed ward to a new "race-track" type of surgical ward with controlled ventilation and with 40% of its beds in single rooms. Following transfer postoperative wound infection was reduced by about 55%.With the use of certain types of staphylococcal infection as an index of cross-infection it was shown that transfer was followed by a 72% reduction in cross-infection of wounds.A case is made for control of hospital cross-infection in surgical wards. The principal change in ward architecture resulting from the transfer was the extensive division of ward space into separate compartments (40% of single-bed rooms), which make controlled ventilation easier.

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