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SUMMARYA standard hand-wash sampling technique was compared with a simple fingerstreak sampling method in assessing the relative effectiveness of a number of alternative preparations used for disinfecting the surgeon's hands (alcoholic 0-5 % chlorhexidine, alcoholic 041% tetrabrom-o-methyl phenol, a 4 % chlorhexidine detergent solution, aqueous 0 5 % chlorhexidine, 2 % 'Irgasan' detergent solution and, as control, bar soap). There was a fairly good correlation between the results of assessment by the two methods after a single disinfection and after six disinfections, three on one day and three on the next. Significant differences were shown in 21 comparisons between treatments when the hand-wash sampling test was used, and 16 of these comparisons also showed a significant difference by the finger-streak test.Staphylococcus aureus was found in hand samplings from 5 out of 8 nurses in the Burns Unit of Birmingham Accident Hospital by the hand-wash sampling method and from 2 of the same 8 nurses by the finger-streak method; the numbers were small, and no Staph. aureus were isolated from the same hands after 1 min. wash in 70 % ethyl alcohol. Similar sampling on 29 nurses in other wards showed Staph. aureus on 3 nurses (one in large numbers) by the hand-wash technique and on 1 nurse by the finger-streak test; in only 1 nurse whose hands showed Staph. aureus before disinfection was the organism found, by hand-wash sampling, after disinfection.Parallel sampling of nurses' hands after washing with soap and water and after disinfection with 95 % ethanol showed larger numbers of Staph. aureus in a hospital for skin diseases than in a general hospital, and a lower incidence and somewhat lower density of Staph. aureus after ethanol treatment than after washing with soap and water; Gram-negative bacilli, on the other hand, were commoner on hands in the general than in the skin hospital, and present in much smaller numbers after disinfection with ethanol than after washing with soap and water.Antibiotic sensitivity tests showed the frequent recurrence on the hands of some nurses of multi-resistant Staph. aureus with resistance patterns similar to those found in infective lesions in some of the patients; different sensitivity G. A. J. AYLIFFE AND OTHERS patternis were usually found in staphylococci isolated from the nose. Even in wards where many patients were infected, carriage by nurses' hands of a particular strain of Staph. aureus did not seem to last for more than a few days.

SUMMARY Topical chemoprophylaxis of extensive burns with silver sulphadiazine cream led to a large increase in the proportion of sulphadiazine-resistant Gram-negative bacilli in a bums unit. When all sulphonamide treatment in the ward was stopped, the incidence of sulphonamide-resistant strains fell back to levels similar to those recorded when silver sulphadiazine treatment was introduced. This was associated with a large reduction in the incidence of resistance of certain Gramnegative bacilli (especially Klebsiella sp) to several antibiotics.Transferable resistance to sulphadiazine, shown by conjugation experiments with Escherichia coli K12, was found in a majority of the strains of Klebsiella sp tested, and in some other species. A pattern of transferable resistance to tetracycline, cephaloridine, chloramphenicol, ampicillin, carbenicillin, and sulphadiazine (T Ce Cl A Ca S) was found in four of the 22 strains of Klebsiella tested, and closely related pattems were transferred by five other strains. These patterns of resistance were commonly found in Klebsiella sp isolated from bums in the period before the withdrawal of sulphonamides from the ward but were found in none of the Klebsiella strains isolated in the first six months after that period. Strains of Acinetobacter and Proteus, in which transferable resistance was not found, showed no appreciable fall or rise in sulphadiazine resistance; there was no fall in resistance of these organisms to tetracycline, cephaloridine, chloramphenicol, ampicillin or carbenicillin on withdrawal of sulphonamides from the ward, but there were substantial falls in resistance of Acinetobacter to kanamycin, gentamicin, trimethoprim, and tetracycline which were probably not caused by the withdrawal of sulphonamides.

BRITISH MEDICAL JOURNAL 28 FEBRUARY 1976 493 allergens in maltworkers with extrinsic allergic alveolitis than in the rest of the maltworker population, and (c) atopic maltworkers had a significantly lower rate of skin sensitivity to occupational allergens than non-atopic workers. The first observation is not surprising, since extrinsic allergic alveolitis is not due to a type 1 allergic reaction. The second is of interest, since it suggests that the type 3 allergic reaction responsible for the disease may be accompanied by a type 1 reaction to the same allergen. The third is difficult to explain except, perhaps, on the rather dubious hypothesis that skin sensitivity to common allergens in some way inhabits the development of skin sensitivity to occupational allergens. It would appear, however, that this phenomenon does not protect such patients from the type 3 antigen-antibody reaction believed to be responsible for extrinsic allergic alveolitis. With increasing mechanisation of the malting process the prevalence of this disease is likely to diminish rapidly, and there may never be another opportunity to confirm or refute the hypothesis that in most cases extrinsic allergic alveolitis is a pulmonary allergic reaction to inhaled spores of A clavatus.

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