The epidemiology of infection withPseudomonas pyocyaneain a burns unit

Abstract

A bacteriological study of burned patients and of the staff and environment in a burns unit was made with the purpose of discovering the principal reservoirs and routes of transfer ofPs. pyocyanea.Infected burns appeared to be the most important reservoirs. About 3 % of the stools of normal subjects and of patients with intestinal symptoms carried the organism, which was also isolated from the nose, throat, nasopharynx, skin and ear of a small proportion of patients and staff in the burns wards.The hands of nurses in the wards were often contaminated withPs. pyocyanea, and presented a likely vector in the transfer of the organism by contact—e.g. from the bandages of infected patients, and from furniture and other objects near to their beds.It was shown by slide agglutination that a new type ofPs. pyocyaneaadmitted to one of the wards spread freely in that ward but hardly at all to the other ward. Since patients from both wards used the same dressing station and operating theatres, it seemed from this finding that a large proportion of the cross-infection occurred in the wards.Polymyxin dusting powder was shown in a controlled trial to protect exposed burns against contamination byPs. pyocyanea.These results are discussed in relation to the mechanism of transfer of the organism and the methods of preventing cross-infection. The need to use several methods concurrently is emphasized, since none of those which have been investigated contributes more than a partial effect. Cubicle wards are advocated, since much cross-infection is shown to occur in open wards.We are much indebted to Dr G. T. Cook for kindly letting us use results obtained by him at the Oxford Public Health Laboratory. We also wish to thank Prof. J. F. D. Shrewsbury of Birmingham University and our colleagues at the Birmingham Accident Hospital for their valuable co-operation, and Dr A. C. Cunliffe of King's College Hospital for information on the typing ofProteusfrom patients in our wards.

Microbial contamination of topical medicaments used in the treatment and prevention of pressure sores

“…aeruginosa, like other gramnegative organisms, is not generally found on normal skin, although it may appear as a transient organism in moist areas (Lowbury, 1969;Grogan, 1966). The establishment of this organism on the skin is, however, affected by the presence of tissue damage (Lowbury & Fox, 1954;Harris & Gray, 1974). Results from the present study appear to support this in that most of the bedsores were infected with Ps.…”

Hand carriage of aerobic Gram-negative rods by health care personnel

“…Of the control subjects 4 % had Enterobacteriaceae on their hands compared to 1-5 % of nurses. There are many reports of hand carriage of aerobic Gram-negative rods by health care workers; however, the vast majority of these have been carried out during the investigation of outbreaks of nosocomial infection (Buxton et al 1978;Knittle, Eitzman & Baer, 1975;Lowbury & Fox, 1954;Mayhall et al 1979;Parry et al 1980;Selwyn, 1965;Shulman, Terry & Hough, 1971). In the studies carried out in the endemic situation (Ayliffe et al 1979;Brown & Baublis, 1977;Bruun & Solberg, 1973;Casewell & Phillips, 1977;Larson, Strom & Evans, 1980;McBride et al 1972McBride et al , 1974Polk & Lopex, 1972;Salzman, Clark & Klemm, 1968) sampling techniques have varied and often speciation of the bacteria isolated was not performed.…”

Survival of wound pathogens under different environmental conditions

“…aeruginosa is not commonly found in air samples, it is usually found in the dust of burn wards, and dust-borne or air-borne Ps. aeruginosa can be an important source of infection in burns (Lowbury & Fox, 1954;Lowbury, 1954;Hurst & Sutter, 1966).…”