Acquisition of Staphylococcus aureus by Patients in Cubicles

Parker, M. T.; John, Madeleine; Emond, R. T. D.; Machacek, K. A.

doi:10.1136/bmj.1.5442.1101

Cited by 28 publications

(8 citation statements)

References 6 publications

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“…aureus not found on admission were later isolated from nose swabs of patients. In 4574 patient-weeks exposure (see Table 3) the rate of acquisition was 8-6 per 100 patient-weeks, a figure rather 537 P. N. EDMUNDS higher than the 6*4 found in patients in small cubicles by Parker et al (1965), and more than double the figure of 3-4 found in patients in the subdivided thoracic ward of Lidwell et al (1966). However, spurious acquisition of S and P strains due to failure to isolate an organism present on admission must be taken into account.…”

Section: Infection In Subdivided Wardsmentioning

confidence: 78%

“…Apparent acquisition of T strains is thought to be more significant than that of P and S strains and the present rate for T strains was 2-1 per 100 patient-weeks as against 1P4 for the cubicle patients and 1-3 for the thoracic subdivided ward patients. According to Parker et al (1965) comparable figures for multiple-resistant organisms in large open wards range from 3-7 to 12 per 100 patient-weeks. Recently, however, the unusually low figure of 3-2 per 100 patient-weeks has been reported by Whyte, Howie & Eakin (1969) for T strains in open general surgical wards.…”

Section: Infection In Subdivided Wardsmentioning

confidence: 99%

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Staphylococcal infection in subdivided general surgical wards

Edmunds¹

1970

Epidemiol. Infect.

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SUMMARYThe spread of Staphylococcus aureus was studied in three general surgical wards of identical design which consisted of a number of separate rooms, and the results were compared with those in the same unit previously studied, in subdivided wards elsewhere and in large open wards.The nasal carrier rate of Staph. aureus by patients rose during their stay in, the ward, but its peak rate was comparable with minimum rates reported in other subdivided wards and was lower than in open wards.Staphylococcal sepsis rates were lower than in most open wards and were also much lower than those found previously in the same unit when overcrowding was common and each sex had its own ward.

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Section: Infection In Subdivided Wardsmentioning

confidence: 78%

Section: Infection In Subdivided Wardsmentioning

confidence: 99%

Staphylococcal infection in subdivided general surgical wards

Edmunds¹

1970

Epidemiol. Infect.

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“…Acquisition of the nasal carrier state The rate of acquisition of S. aureus in the nose during hospital stay has frequently been documented and has been suggested as one index of the efficiency with which a hospital layout can protect patients from cross-infection (Parker, John, Emond & Machacek, 1965;Williams, 1966;Lidwell et al 1966). In our ward 6-2 % of I4-2 213 R. E. 0.…”

Section: Broadcasts Of Staphylococcimentioning

confidence: 99%

Airborne staphylococci in the surgical ward

Williams

1967

J. Hyg.

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The exposure of hospital patients to airborne staphylococci has commonly been estimated by collecting the bacteria from relatively large volumes of air over rather short periods with the use of one or other form of slit-sampler (Report, 1948). The design of the slit sampler was determined largely by the need to collect particles down to about 1-2 ,u in diameter, for which collection by sedimentation on to exposed culture plates is very inefficient (Bourdillon, Lidwell & Thomas, 1941), and it therefore employs a high velocity jet of air impinging on the culture plate. While the slit sampler is a very efficient instrument for collecting airborne particles, it has proved difficult to modify it to give really long-period sampling because of the drying effect of the air-stream on the agar plates. Recently it has been shown that only a very small proportion of the staphylococci in the air of hospital wards are associated with particles less than 4 ,t in diameter (Noble, Lidwell & Kingston, 1963) and that the median equivalent particle diameter for airborne staphylococci is about 14 ,t. For such particles the deficiency of sedimentation as a method of collection is small: the settling rate of 14 It particles is such that the number contained in 1 ft.3 of air is approximately equal to the number that settle on 1 ft.2 in 1 min. Since with settling plates it is simple to obtain an integrated sample over a considerable number of hours, it seemed worth exploring the use of this method to monitor the staphylococcal content of the air in hospital wards, as has also been reported by Alder & Gillespie (1964). This paper describes a study in a small surgical ward in which an attempt was made to recognize the sources of the airborne staphylococci and to use the method to study cross-contamination between the separate rooms of the ward. MATERIALS AND METHODSAlmost all the work reported here was done in a 14-bed surgical ward at St Mary's Hospital London between February 1964 and September 1965; the ward is divided into 4 rooms ( Fig. 1) and is used mainly for men and women undergoing thoracic and cardiac surgery. The ward has natural window ventilation; the corridor between the rooms leads to a stairway and the stack effect in this generates a flow of air along the corridor and out of the bedrooms in almost all weathers.A much shorter study was made in a 22-bed open 'Nightingale' ward, using 4 settling plates placed in the 4 quarters of the ward.

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“…Drawsheet samples and perineal swabs As in previous analyses of this type, a substantial proportion of apparent acquisitions could not be related to any known source in the ward. Some of these acquisitions were certainly spurious, since examination of repeated nasal swabbings of the same individual shows that intermittent recovery is not uncommon (Parker, John, Emond & Machacek, 1965). There are also more antibiotic sensitive strains among these 'acquisitions' without apparent source than among acquisitions from known sources, a fact which correlates with the greater frequency of sensitive strains in nasal swabs taken from patients on admission compared with those from patients who have been in hospital for some time.…”

Section: Airborne Staphylococcus Aureusmentioning

confidence: 99%

Nasal acquisition of Staphylococcus aureus in a subdivided and mechanically ventilated ward: endemic prevalence of a single staphylococcal strain

Lidwell¹,

Polakoff²,

Davies³

et al. 1970

J. Hyg.

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SUMMARYAn investigation was made of nasal acquisition of Staphylococcus aureus and of staphylococcal wound sepsis in a hospital ward divided into two sections and provided with mechanical ventilation, so that there was no transfer of air from one of the sections to the other. Although the strains of S. aureus found in the air, and those colonizing the noses of patients, in the protected section could seldom be related to patients nursed elsewhere in the ward, the mechanical ventilation did not lead to any significant reduction in the degree of contamination of the air or in the rate of nasal acquisition of S. aureus.Even in the protected section, nearly 20 % of the strains of S. aureus recovered from the air could not be related to known nasal carriers. Since this proportion was nearly as great as that found in the absence of directed air-flow, it seems probable that these strains were derived either from undetected sources within the section or were dispersed from the clothes of persons who entered it.Nearly one-third of the nasal acquisitions in the ward could not be related to known nasal carriers, but about one-half of these (16 %) were probably 'spurious' and half of the remainder (8 %) could be related to strains recovered from patients' lesions or drawsheets, leaving no more than 8 % unaccounted for. A short investigation in which both drawsheet and perineal samples were examined showed that drawsheet samples did not give a reliable indication of perineal carriage unassociated with nasal carriage. During the period of the investigation, a single strain of S. aureus that was resistant to a wide range of antibiotics established itself in the ward. The most notable character of this strain was the profuse dispersion of it by carriers. As a consequence, staphylococcal wound sepsis increased, with nearly three-quarters of 0. M. LIDWELL AND OTHERS the infections attributable to this strain, and nasal carrier rates increased with length of stay in the ward, over 20 % of patients who stayed 5-6 weeks acquiring the strain.

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Acquisition of Staphylococcus aureus by Patients in Cubicles

Cited by 28 publications

References 6 publications

Staphylococcal infection in subdivided general surgical wards

Staphylococcal infection in subdivided general surgical wards

Airborne staphylococci in the surgical ward

Nasal acquisition of Staphylococcus aureus in a subdivided and mechanically ventilated ward: endemic prevalence of a single staphylococcal strain

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