Staphylococcal infection in thoracic surgery: experience in a subdivided ward

Lidwell, O. M.; Polakoff, Sheila; Jevons, M. P.; Parker, M. T.; Shooter, R. A.; French, Valentine I.; Dunkerley, D. R.

doi:10.1017/s0022172400040602

Cited by 32 publications

(24 citation statements)

References 7 publications

(13 reference statements)

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“…Our own results, here and in previous work (Shooter et at. 1958; (Lidwell et al 1966), have shown a low acquisition rate similar to ours. In both wards there was a fairly high usage of antibiotics, but, presumably because the subdivision has reduced the rate of transfer of the staphylococci in some way, this has not had the effect of increasing the carrier rate in the way that it did in the patients nursed in open wards (Noble et al 1964).…”

Section: Airborne Staphylococcisupporting

confidence: 85%

“…Acquisition of the nasal carrier state The rate of acquisition of S. aureus in the nose during hospital stay has frequently been documented and has been suggested as one index of the efficiency with which a hospital layout can protect patients from cross-infection (Parker, John, Emond & Machacek, 1965;Williams, 1966;Lidwell et al 1966). In our ward 6-2 % of I4-2 213 R. E. 0.…”

Section: Broadcasts Of Staphylococcimentioning

confidence: 99%

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Airborne staphylococci in the surgical ward

Williams

1967

J. Hyg.

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The exposure of hospital patients to airborne staphylococci has commonly been estimated by collecting the bacteria from relatively large volumes of air over rather short periods with the use of one or other form of slit-sampler (Report, 1948). The design of the slit sampler was determined largely by the need to collect particles down to about 1-2 ,u in diameter, for which collection by sedimentation on to exposed culture plates is very inefficient (Bourdillon, Lidwell & Thomas, 1941), and it therefore employs a high velocity jet of air impinging on the culture plate. While the slit sampler is a very efficient instrument for collecting airborne particles, it has proved difficult to modify it to give really long-period sampling because of the drying effect of the air-stream on the agar plates. Recently it has been shown that only a very small proportion of the staphylococci in the air of hospital wards are associated with particles less than 4 ,t in diameter (Noble, Lidwell & Kingston, 1963) and that the median equivalent particle diameter for airborne staphylococci is about 14 ,t. For such particles the deficiency of sedimentation as a method of collection is small: the settling rate of 14 It particles is such that the number contained in 1 ft.3 of air is approximately equal to the number that settle on 1 ft.2 in 1 min. Since with settling plates it is simple to obtain an integrated sample over a considerable number of hours, it seemed worth exploring the use of this method to monitor the staphylococcal content of the air in hospital wards, as has also been reported by Alder & Gillespie (1964). This paper describes a study in a small surgical ward in which an attempt was made to recognize the sources of the airborne staphylococci and to use the method to study cross-contamination between the separate rooms of the ward. MATERIALS AND METHODSAlmost all the work reported here was done in a 14-bed surgical ward at St Mary's Hospital London between February 1964 and September 1965; the ward is divided into 4 rooms ( Fig. 1) and is used mainly for men and women undergoing thoracic and cardiac surgery. The ward has natural window ventilation; the corridor between the rooms leads to a stairway and the stack effect in this generates a flow of air along the corridor and out of the bedrooms in almost all weathers.A much shorter study was made in a 22-bed open 'Nightingale' ward, using 4 settling plates placed in the 4 quarters of the ward.

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Section: Airborne Staphylococcisupporting

confidence: 85%

Section: Broadcasts Of Staphylococcimentioning

confidence: 99%

Airborne staphylococci in the surgical ward

Williams

1967

J. Hyg.

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“…A strain appearing which had not been found in previous swabs or which was different in resistance or phage-type from that found previously was assumed to have been 'acquired'. The conventions adopted for times of acquisition between swabbings were those of Lidwell et al (1966). The survey took place between November 1967 and April 1969.…”

Section: Bacteriological Examinationsmentioning

confidence: 99%

Staphylococcal infection in subdivided general surgical wards

Edmunds¹

1970

Epidemiol. Infect.

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SUMMARYThe spread of Staphylococcus aureus was studied in three general surgical wards of identical design which consisted of a number of separate rooms, and the results were compared with those in the same unit previously studied, in subdivided wards elsewhere and in large open wards.The nasal carrier rate of Staph. aureus by patients rose during their stay in, the ward, but its peak rate was comparable with minimum rates reported in other subdivided wards and was lower than in open wards.Staphylococcal sepsis rates were lower than in most open wards and were also much lower than those found previously in the same unit when overcrowding was common and each sex had its own ward.

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“…The enumeration of Staphylococcus aureus in the air of hospital wards may be of some value for routine monitoring in hospital hygiene (Alder & Gillespie, 1964) and also in the exploration of the hygienic consequences of particular sorts of hospital design or practice (Lidwell et al 1966;Williams, 1967). A truly selective medium for collection of S. aureus from the air would be a great advantage for either of these uses, but none of the selective media devised in the past has been found suitable.…”

Section: Commentmentioning

confidence: 99%

Selection ofStaphylococcus aureusin cultures from air samples

Harding

Williams

1969

J. Hyg.

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Although a good many selective culture media have been described for the isolation of Staphylococcus aureus, none of them has proved useful for the examination of cultures from air. This is partly because, in examining such cultures, one is trying to select the S. aureus from among a great variety of other members of the Micrococcaceae. Media depending on a high concentration of sodium chloride (e.g. Chapman, 1944), which are principally inhibitory for enterobacteria and similar Gram-negative bacilli, are not, therefore, of much use. Other media, such as those containing potassium tellurite (Zebovitz, Evans & Niven, 1955) or polymyxin B (Davis & Davis, 1965), though often satisfactory for examination of material from infected lesions or carrier sites, prove too inhibitory for the isolation of staphylococci from air. It has been a common experience that bacteria are often difficult to cultivate when collected from the airborne state. The recent studies on the taxonomy of staphylococci and micrococci published by Baird-Parker (1963, 1965) suggest a new approach, for he showed that S. aureus is able to grow at a higher temperature than most of the micrococci. Moreover members of the genus Staphylococcus are able to grow under anaerobic conditions, while those of the genus Micrococcus cannot, and other studies have shown that a substantial proportion of the airborne cocci fall into Micrococcus (Corse & Williams, 1968). We therefore explored the use of anaerobic culture at 41°C. as a selective method for the isolation of S. aureus. After a number of preliminary experiments with pure cultures, which need not be discussed here, all our studies were made by the exposure of culture plates containing the media under test in the wards of St Mary's Hospital. METHODS Air samplingCulture plates 14 cm. in diameter were exposed in hospital wards for periods varying between 8 and 16 hr. The plates were stacked in the holder illustrated in Plate 1, which provides about 5 cm. separation between plates. Preliminary experiments showed that there were no significant differences in the numbers of colonies developing on the four plates in the stack. The culture plates with the different media were placed at random on the four layers of the stack. One or more stacks of plates were exposed each day but each stack included at least one 'control' plate.The culture media used are listed in Table 1. 3-2

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Staphylococcal infection in thoracic surgery: experience in a subdivided ward

Cited by 32 publications

References 7 publications

Airborne staphylococci in the surgical ward

Airborne staphylococci in the surgical ward

Staphylococcal infection in subdivided general surgical wards

Selection ofStaphylococcus aureusin cultures from air samples

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