Control of Dust-borne Streptococcal Infection in Measles Wards

Abstract

Hospital trials on the control of dust-borne infection by oiling blankets, ward linen, garments, and floors were carried out in scarlet fever and measles wards in this hospital during the spring of 1942 and of 1943. The work in a scarlet fever ward, while on the whole encouraging, awaits the result of further tests before being recorded. The results of a controlled test in two measles wards are now reported.The haemolytic streptococcus has for many years been recognized as a predominant secondary invader in measles and as an important cause of its serious complications-e.g., otitis media, mastoiditis, and bronchopneumonia. The virus-damaged mucous membrane of the respiratory tract, the catarrhal nature of the primary infection, and the overcrowding of patients in hospital at epidemic times all combine to favour the acquisition and spread of streptococci. 1917and 1918(Michie and Lull, 1928. Its most serious consequences were pneumonia, empyema, and otitis media, which in the majority of cases were due to haemolytic streptococci. Cole and MacCallum (1918) found that a haemolytic streptococcal throat-carrier rate of 11.4% among measles patients on admission to hospital had risen to 38.6% after 3 to 5 days in the wards and to 56.8%,b after 8 to 16 days. They concluded that the chance of developing post-measles streptococcal infection was increased by residence in hospital, and that the high incidence of pneumonia, and the resulting high mortality, were due in part to infection occurring within the hospital. The sequence of events has become clearer since Griffith (1934) extended his method for the seiological typing of Str. pyogenes. Allison and Brown (1936) were thus enabled to make a survey in a measles ward. They took nose and throat swabs from 43 patients once weekly from admission to discharge, and appropriate swabs on the occurrence of any complication. By typing the strains of Str. pyogenes which they had isolated they showed that cross-infection with these organisms occurred in 22-i.e., 51.2%-of the 43 patients; and that of the patients thus cross-infected 13 developed complications as a result (7 otitis media ; 1 scarlet fever with otitis media ; 1 rhinitis; 4 rise of temperature only). In other words, 19% of the measles patients developed otitis media consequent upon crossinfection with streptococci. investigated possible measures for the control of dust-borne infection in wards. The dust-laying effect of spindle oil when applied to floors was tested in field trials by Thomas, who found that the method produced a prolonged and marked reduction in the number of bacteria in the air during sweeping. Since, however, the main source of the bacteriacarrying particles lay in the bed-clothes, van den Ende and co-workers devised methods for the -treatment of woollen and cotton materials with technical while oil, which reduced by 990% the number of micro-organisms liberated during bedmaking. The method of oiling ward articles by the use of oil-in-water emulsions (van den Ende and during the laundering process ...

Cross-infection in Measles Patients

“…They found that among 43 patients admitted to a measles ward 51% became cross-infected by haemolytic streptococci and that as a result 19% of the 43 patients developed otorrhoea. Wright, Cruickshank, and Gunn (1944) confirmed the findings of Allison and Brown andsuggested that dust particles derived from bed-clothes and garments are possibly the chief means by which streptococci spread in measles wards.…”

“…The method of Harwood, Powney, and Edwards (1944) is practicable in a well-conducted hospital laundry. This recommendation rests on the marked fall in cross-infection which followed the introduction of oil-treated articles into a highly contaminated measles ward, and on the inference that dust is an important means of streptococcal spread (Wright et al, 1944). If oiling of bed-clothes is not practicable, bed-making rounds should be abolished and the beds made individually as required, with the least possible disturbance.…”

“…The total percentage of patients who suffered from "early " middle-ear suppuration was 3.6 and from " late " 13.3, showing how much in excess over the early ear complications were the late ones, due to cross-infection in the wards. (Actually the latter figure would probably have proved to be I to 2/O higher if in one ward, for 9 weeks, dust-borne infection had not been controlled by means of oil-treated bed-clothes and garments (Wright et al, 1944).) The average hospital day on which late middle-ear suppuration developed was the 14th, with a range from the 6th to the 48th.…”

“…This ward served as a control in the experiment reported by Wright et al (1944). (B) An analysis of the case histories of all measles patients admitted to the North-Western Hospital from Dec.…”

Sterilization of Woollen Fabrics

“…Contact between and, while Rountree (1947) found that it brought no reduction in surgical cross-infection, Wright, Cruickshank, and Gunn (1944) were able to show a reduction in cross-infection in measles wards. The process, however, is not without disadvantages.…”