Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-28T15:17:55.832Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  15 May 2009

B. Moore  and
A. M. N. Gardner
B. Moore
Affiliation:
Public Health Laboratory, Exeter
A. M. N. Gardner
Affiliation:
Department of Surgery, Torbay Hospital, Torquay
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Type
Research Article
Information
Journal of Hygiene , Volume 61 , Issue 1 , March 1963 , pp. 95 - 113
Copyright
Copyright © Cambridge University Press 1963

References

Barber, M. & Burston, J. (1955). Antibiotic-resistant staphylococcal infection. Lancet, ii, 578.CrossRefGoogle Scholar
Barber, M. & Warren, S. (1962). Control of cross infection in a surgical ward. Lancet, ii, 374.CrossRefGoogle Scholar
Bassett, H. F. M., Ferguson, W. G., Hoffmen, E., Walton, M., Blowers, R. & Conn, C. A. (1963). Sources of staphylococcal infection in surgical wound sepsis. J. Hyg., Camb., 61, 83.CrossRefGoogle ScholarPubMed
Colbeck, J. C., Robertson, H. R., Sutherland, W. H. & Hartley, F. C. (1959). The importance of endogenous staphylococcal infections in surgical patients. Med. Serv. J. Can. 15, 326.Google ScholarPubMed
Davies, D. M. (1960). Staphylococcal infection in nurses. Lancet, i, 644.CrossRefGoogle Scholar
Elek, S. D. & Conen, P. E. (1957). The virulence of Staphylococcus pyogenes for man. A study of the problems of wound infection. Brit. J. exp. Path. 38, 573.Google Scholar
Gardner, A. M. N., Stamp, M., Bowgen, J. A. & Moore, B. (1962). The infection control sister, a new member of the control of infection team in general hospitals. Lancet, ii, 710.CrossRefGoogle Scholar
Gillespie, W. A. (1958). Hospital cross-infection. Med. J. South-West, 73, 56.Google ScholarPubMed
Gillespie, W. A., Alder, V. G., Ayliffe, G. A. J., Bradbeer, J. W. & Wyprema, W. (1959). Staphylocococcal cross-infection in surgery. Lancet, ii, 781.CrossRefGoogle Scholar
Gillespie, W. A., Alder, V. G., Ayliffe, C. A. J., Powell, D. E. B. & Wypkema, W. (1961). Control of staphylococcal cross-infection in surgical wards. Lancet, i, 1299.CrossRefGoogle Scholar
Hare, B. & Cooke, E. M. (1961). Self-contamination of patients with staphylococcal infections. Brit. med. J. ii, 333.CrossRefGoogle Scholar
Henderson, R. J. & Williams, R. E. O. (1961). Nasal disinfection in prevention of post-operative staphvloeoccal infection of wounds. Brit. med. J. ii, 330.CrossRefGoogle Scholar
Howe, C. W. (1956). Prevention and control of postoperative wound infections owing to Staphylococcus aureus. New Engi. J. med. 255, 787.CrossRefGoogle ScholarPubMed
Lidwell, O. M. (1961). Sepsis in surgical wounds. Multiple regression analysis applied to records of post-operative hospital sepsis. J. Hyg., Gamb., 59, 259.CrossRefGoogle ScholarPubMed
McNeill, I. F., Porter, I. A. & Green, C. A. (1961). Staphylococcal infection in a surgical ward. Brit. med. J. ii, 798.CrossRefGoogle Scholar
Moore, B. (1960). A new screen test and selective medium for the rapid detection of epidemic strains of Staph aureus. Lancet, ii, 453.CrossRefGoogle Scholar
Public Health Laboratory Service (1960). Incidence of surgical wound infection in England and Wales. Lancet, ii, 659.Google Scholar
Rountree, P. M. & Barbour, R. G. H. (1951). Nasal carrier rates of Staphylococcus pygenes in hospital nurses. J. Path. Beet. 63, 313.CrossRefGoogle Scholar
Rountree, P. M. & Beard, M. A. (1962). Observations on the distribution of Staphylococcvs aureus in the atmosphere of a surgical ward. J. Hyg., Camb., 60, 387.CrossRefGoogle ScholarPubMed
Rountree, P. M., Harrington, M., Loewenthal, J. & Gye, R. (1960). Staphylococeal wound infection in a surgical unit. Lancet, ii, 1.CrossRefGoogle Scholar
Rubbo, S. D., Stratford, B. C. & Dixson, S. (1962). Spread of a marker organism in a hospital ward. Brit. med. J. ii, 282.CrossRefGoogle Scholar
Sandys, G. H. (1960). A new method of preventing swarming of Proteus sp. with a description of a new medium suitable for use in routine laboratory practice. J. med. Lab. Technol. 17, 224.Google ScholarPubMed
Shooter, B. A., Smith, M. A., Griffiths, J. D., Brown, M. E. A., Williams, R. E. O., Rippon, J. E. & Jevons, M. P. (1958). Spread of staphylococci in a surgical ward. Brit. med. J. i, 607.CrossRefGoogle Scholar
Stokes, E. J. & Milne, S. E. (1962). Effect of Naseptin cream prophylaxis on stapbylococcal infection in adult surgical wards and infant nurseries. J. Hyg., Cainb., 60, 209.CrossRefGoogle Scholar
Thomas, M. (1961). The sticky film method of detecting skin staphylococci. Mon. Bull. Minist. Hit/i Lab. Serv. 20, 37.Google ScholarPubMed
Weinstein, H. J. (1959). The relation between the nasal staphylococcal carrier state and the incidence of postoperative complications. New. Engi. J. Med. 260, 1303.CrossRefGoogle ScholarPubMed
Williams, J. R. B., Talbot, E. C. S. & Maughan, E. (1959). Hospital outbreak of cross-infection due to Staphylococcus pyogenes phage type 80. Brit. med. j. i, 1374.CrossRefGoogle Scholar
Williams, R. E. O. (1947). Cited by Elek, S. D. (1959) in Staphylococcus pyogenes and its Relation to Disease, p. 154. Edinburgh and London: E. & S. Livingstone Ltd.Google Scholar
Williams, R. E. O., Blowers, R., Garrod, L. P. & Shooter, R. A. (1960). Hospital Infection—Causes and Prevention. London: Lloyd-Luke.Google Scholar
Williams, R. E. O., Jevons, M. P., Shooter, R. A., Hunter, C. J. W., Girling, J. A., Griffiths, J. D. & Taylor, G. W. (1959). Nasal staphylococci and sepsis in hospital patients. Brit. med. J. ii, 658.CrossRefGoogle Scholar
Williams, R. E. O. & Miles, A. A. (1949). Infection and Sepsis in Industrial Wounds of the Hand. Spec. Rep. Series M.R.C. No. 266. London: H.M.S.O.Google Scholar
Williams, R. E. O., Noble, W. C., Jevons, M. P., Lidwell, O. M., Shooter, R. A., White, R. G., Thom, B. T. & Taylor, G. W. (1962). Isolation for the control of staphylococcal infection in surgical wards. Brit. med. J. ii, 275.CrossRefGoogle Scholar
Williams, R. E. O. & Rippon, J. (1952). Bacteriophage typing of Staphylococcus aureus. J. Hyg., Camb., 50, 320.CrossRefGoogle ScholarPubMed