Control of Cross-Infection in a Surgical Ward

Barber, Mary; Warren, Sheila

doi:10.1016/s0140-6736(62)90230-1

Cited by 10 publications

(6 citation statements)

References 10 publications

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“…It seems probable, therefore, that in the foregoing studies, as in others described in the literature, e.g. by Barber & Warren (1962), environmental contamination at any one time tended to be caused by one phage type of epidemic staphylococcus that was widely disseminated in the ward. If this was so, it would again increase the likelihood that the wound and nose of a given patient acquired the same strain of epidemic staphylococcus, independently, from the contaminated environment.…”

Section: Discussionmentioning

confidence: 50%

“…First, several reports (e.g. Shooter et al 1958;Barber & Warren, 1962;Rountree & Beard, 1962) have indicated that, in surgical wards, very large numbers of epidemic types of staphylococcus may be disseminated from time to time, probably from patients with heavy skin or wound contamination or with staphylococcal lung or urinary tract infection. Rountree & Beard mention unpublished evidence suggesting that these strains can persist for long periods on various types of textile.…”

Section: Discussionmentioning

confidence: 99%

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A study of post-operative wound infection in a provincial general hospital

Moore

Gardner

1963

J. Hyg.

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1. A survey of post-operative wound infection was done in 1959–60 on 559 surgical patients admitted to a provincial general hospital.2. Clinical evidence of post-operative wound sepsis was observed in 71(12·7 %), suppuration in 51(9·1 %) and staphyloccocal wound sepsis in 48 (8·6 %).3. Seventeen of the patients died in hospital. Although 5 of these had septic wounds, the sepsis did not appear to have been the cause of death.4. Contrary to some reported findings, the post-operative wound sepsis rate was considerably lower in patients who were staphylococcal nasal carriers on admission to hospital than in non-carriers. Nine out of 153 carriers (5·9 %) developed wound sepsis and 36 out of 385 non-carriers (9·4 %). When allowance is made for 3 highly probable self-infections, the incidence of wound cross-infection was 3 % in carriers and 9 % in non-carriers.5. The excess of sepsis in non-carriers could not be explained in terms of different age or sex distribution in carrier and non-carrier groups, nor by differences in the types of operation undergone or in degree of exposure to staphylococcal contamination.6. The excess of sepsis in non-carriers was accounted for by the patients whose wounds had drains rather than by clean-stitched wounds.7. Those carriers who harboured a staphylococcus of the 80/81 group in the nose on admission to hospital had a higher incidence of wound sepsis than carriers of other phage types or staphylococcus.8. Three probable instances of wound self-infection occurred, and in the early stages of the survey at least 5 wound infections were probably directly caused by two members of the theatre staff carrying staphylococci of the 80/81 group in the nose and with existing skin sepsis or a recent history.9. The survey findings and a study of the literature suggested: (a) that the acquisition of a nasal staphylococcus in hospital was probably, as a rule, evidence of exposure to staphylococeal contamination and not a determinant of wound sepsis, unless the patient also became a skin carrier; (b) that a small proportion of patients are self-infected, some are directly infected by theatre personnel, and the wounds of other patients are directly or indirectly contaminated by staphylococci from the ward environment; (c) that wool or cotton fluff contaminated with staphyloccoci may cause wound sepsis by falling into open wounds and as foreign bodies induce a significant reduction in the minimum pus-forming dose of staphylococci; (d) that before ascribing high or low sepsis rates to factors such as the nasal carrier state, the relevant groups should be shown not to differ materially in respect of other factors known to influence the incidence of wound sepsis.We gratefully acknowledge the help and encouragement of our surgical colleagues Mr H. P. Guerrier, Mr P. J. W. Monks, Mr J. Macpherson and Mr C. C. Jeffery; and of Dr C. P. Warren, consultant pathologist to the Torbay Hospital, Mrs M. Stamp, Matron, Sister E. M. Cottrell, first Infection Control Sister at the Torbay Hospital, and her successor Mr H. Street.Acknowledgement is also due to the South Western Regional Hospital Board for its encouragement and for a research grant for technical aid, without which the surveys described would not have been possible.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

A study of post-operative wound infection in a provincial general hospital

Moore

Gardner

1963

J. Hyg.

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“…It is suggested, therefore, that topical framycetin is a more effective method of treating mucosal carriage of staphylococci than of treating carriage of these organisms on the squamous epithelium of the nasal vestibule. Other studies on the effects of topical framycetin, such as those of Barber and Warren (1962) and Jarvis and Wigley (1961), confirm the persistence of vestibular staphylococci during framycetin treatment. As staphylococcal contamination of the environment can follow superficial nasal carriage as well as deep nasal carriage it is concluded that the assessment of the effective carrier rate during framycetin treatment is more accurately determined by superficial swabbing.…”

Section: A Comparison Of the Data Included Inmentioning

confidence: 66%

“…Other studies on the effectiveness of framycetin, such as that of Barber and Warren (1962), have shown that not all patients carrying staphylococci ceased to do so under treatment with framycetin, and although in many cases the staphylococci disappeared from the nares they subsequently returned despite continuation of treatment.…”

mentioning

confidence: 95%

Effect of Topical Framycetin on Staphylococcal Nasal Carriage

Porter¹,

McNeill²,

Miller³

et al. 1963

BMJ

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“…The same approach was used later by means of an individual antibiotic spray by Stratford, Rubbo. Christie, and Dixson (1960) and Barber and Warren (1962) Laboratory Investigations.-Nasal swabs were taken from each patient on admission and thereafter once a week; a swab was also taken the day before operation. The same procedure applied to sputa.…”

mentioning

confidence: 99%

Abolition of Staphylococcal Cross-Infection in a Thoracic Surgical Ward

1963

JAMA

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Control of Cross-Infection in a Surgical Ward

Cited by 10 publications

References 10 publications

A study of post-operative wound infection in a provincial general hospital

A study of post-operative wound infection in a provincial general hospital

Effect of Topical Framycetin on Staphylococcal Nasal Carriage

Abolition of Staphylococcal Cross-Infection in a Thoracic Surgical Ward

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