Sources of staphylococcal infection in surgical wound sepsis

SUMMARYThe relationship of pre-operative nasal and skin carriage of Staphylococcus aureus to wound colonization and sepsis was studied in 269 patients. Thirty-seven per cent of 96 carriers developed wound colonization as compared to 16 % among non-carriers (a statistically significant difference). The wound sepsis rates were 17 % and 9 % respectively. The combination of nasal and skin carriage was an important factor, since the sepsis rate among skin carriers (most of whom were nasal carriers as well) was 22%. Among carriers, the homologous strain was recovered from the majority of wound colonizations and from all instances of wound sepsis. A carrier strain also was recovered from 52% of the wounds colonized and from 50% of septic wounds in the entire study group. Profuse nasal carriage resulted in a significantly greater number of septic wounds (31%) than sparse carriage (9%). Wound cultures before closure, and skin from the initial incision site only once yielded a patient's carrier strain or a strain of Staph. aureus that was later recovered from the wound. The results indicate that measures designed to control the carrier state or to isolate the wound from the external environment should reduce wound sepsis by approximately one half.Excellent technical aid was furnished by Eleanor Ford, R. N., Edith E. Silverman, Adrienne Marus, M. S., and Patricia Welch.

Section: Discussionmentioning

confidence: 96%

Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis

Calia

Wolinsky

Mortimer

et al. 1969

“…aureus isolated from the anterior nares, the main depot, closely resemble strains isolated from other skin sites (Williams et al 1959). In the case of sepsis, however, there is conflicting information as to whether the strains are derived from self-infection or crossinfection (Williams et al 1959;Bassett et al 1963). In the present study it would seem that both occurred and were responsible for the high isolation rate from skin sites.…”

Section: Discussionmentioning

confidence: 55%

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

Baird

Farwell

Sturgiss

et al. 1979

“…The findings of the Torbay Hospital survey, as discussed in the foregoing pages, and of Bassett et al (1963), are in sharp contrast to those of the St Bartholomew's Hospital group (Williams et al 1962). In the Torbay Hospital study, the presence of a staphylococcus in the nose on admission to hospital was almost a guarantee of freedom from wound sepsis rather than a predisposing cause, and Bassett and his colleagues also report a lower incidence of wound sepsis in nasal carriers than in non-carriers.…”

Section: Discussionmentioning

confidence: 78%

“…Bassett et al (1963) interpret the findings of their two hospital surveys as indicating that self-infection of wounds was of minor importance, but that crossinfection probably occurred with equal frequency in carriers and non-carriers, the apparent excess of cross-infection in non-carriers being due to the impracticability of demonstrating cross-infection in carriers whose noses and wounds harboured the same phage type of staphylococcus. In the Torquay survey, however, the total incidence of sepsis in those who were staphylococcal nasal carriers on admission to hospital was so low that the existence of an increased resistance to sepsis in this group seems a reasonable inference.…”

Section: Discussionmentioning

confidence: 98%

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

Moore

Gardner

1963

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.