Infection of Burns

Lowbury, E. J. L.

doi:10.1136/bmj.1.5178.994

Cited by 70 publications

(21 citation statements)

References 32 publications

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“…The ease with which infection develops is probably shared only by the comparable lesions of burns (Lowbury, 1960). Thus, 109 of the 233 patients to whom anti-bacterial measures were not applied developed infected lesions after admission to hospital.…”

Section: Discussionmentioning

confidence: 99%

The mechanism and prevention of cross-infection in dermatological wards

Selwyn

1965

J. Hyg.

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Much of the extensive work on hospital cross-infection has of necessity been opportunist associated with the occurrence of sporadic outbreaks of infection. Investigations concentrated on such outbreaks cannot give a true picture of the general problem, and the value of any counter-measures which may have been introduced is not easily assessed.A pilot study, carried out in a large dermatology department, revealed an ideal model for the planned, long-term investigation of hospital infection (Selwyn, 1963). An endemic situation was uncovered in which the extensive skin lesions of in-patients were readily colonized by the abundant pathogenic bacteria present in the environment. Many of the infected patients became in their turn prolific dispersers of pathogens. A detailed study of these processes was facilitated by the long periods of hospital treatment which many patients with skin diseases require. Further work was therefore carried out in this neglected field to investigate the dynamic relationship which exists between the bacterial flora of these patients and that of their environment. The effect of simple anti-bacterial measures upon this relationship was also studied during two of the four stages of the investigation. The principal aim here was to assess the relative importance of nasal carriers and patients with infected lesions in the aetiology of hospital infection. MATERIALS AND METHODS Sampling proceduresThe investigation was carried out over a 2-year period in three dermatological wards. These are housed in a relatively modern pavilion, within a large teaching hospital. The two main wards, situated on different floors, are 68 ft. long, 28 ft. wide and 12 ft. high; each contains sixteen beds. The third ward, containing eight beds, is 32 ft. long; the width and height are as in the main wards.The degree of bacterial contamination was measured on two days of the week at representative sites in each ward, and in the adjacent day-room and bathroom. Air counts were performed with pairs of 3-5 in. Petri dishes containing blood agar and 7 5 % salt-milk agar respectively. These were exposed for 2 hr. periods as 'settle plates' and during each period similar plates were exposed in a 'Casella' slit sampler (but this could not be operated in the bathrooms). Solid surfaces were examined by contact-transfer using self-adhesive cellulose tape in a similar manner to that used by Thomas (1961) for swabbing skin. Direct impressions

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Section: Discussionmentioning

confidence: 99%

The mechanism and prevention of cross-infection in dermatological wards

Selwyn

1965

J. Hyg.

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“…Staphylococcus aureus is isolated more often than other pathogens from burn lesions (Lowbury, 1960(Lowbury, , 1972Wickman, 1970;Thomsen, 1970), but in this Unit it has usually caused less clinical infection than Pseudomonas aeruginosa and other opportunistic gram-negative bacilli. In this respect burns differ from clean operation wounds, in which Staph.…”

Section: Introductionmentioning

confidence: 94%

Staphylococcal sepsis in a burns unit

Lilly

Lowbury

Wilkins

et al. 1979

J. Hyg.

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SUMMARYAn outbreak of staphylococcal sepsis in a burns unit occurred between January 1976 and May 1978. Many patients and members of staff had boils, and a number of patients also developed septicaemia. Most of the boils in the early period of the trial and a large proportion of boils in patients during the later period yielded Staphylococcus aureus resistant to penicillin, tetracycline and erythromycin only (PTE), and were shown to be of phage type 95 in the early period while strains were phage typed. From blood cultures, most strains in the early period were of resistance pattern PTE and phage type 95, but in the later period other resistance patterns were predominant. Strains from burns were usually multiresistant (PTEKNML) and of the phage pattern 29/77, which had been endemic in the Unit, but during the early period of the outbreak there was an increased proportion of strains in burns with the resistance pattern PTE and of phage type 95.Staphylococcal sepsis has for many years been very infrequent in the burns unit. This outbreak seems to have been initiated by a strain of phage type 95 and resistance pattern PTE, but during the course of the outbreak the endemic strain of type 29/77 and some other staphylococci seem to have developed enhanced ability to cause clinical infections, conceivably by transduction from the epidemic strain of phage type 95.

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“…The turbid 6 plaque was of particular interest and the subject of more detailed study because it 6 The term is used here to describe the centeral lytic area of the plaque and does not refer to the peripheral zones of partial lysis, such as those shown in Figures 4 and 5. was frequently employed, under special conditions, in the typing of strains of pseudomonas, as already noted.…”

Section: Resultsmentioning

confidence: 99%