Staphylococcal infections following childbirth

Abstract

An investigation is reported into sepsis due toStaphylococcus aureusin the maternity unit of a provincial hospital and in domiciliary midwifery in the same town.In the hospitalStaph. aureusinfections of mother or infant occurred 123 times per 1000 live births in one ward and 116 per 1000 in another, but the use of hexachlorophane powder on the infants in one ward reduced the sepsis rate in that ward to 34 cases per 1000 live births, thus confirming the reports by two teams in Bristol hospitals. Sepsis was more frequent in both mothers and infants after Caesarean delivery than after normal labour. Reasons are given for thinking that ‘sticky eyes’ are usually not caused by the bacteria isolated when the eyes are swabbed.The rate of infection in domiciliary cases was 39 per 1000 live births. As all these were normal deliveries the sepsis rate cannot be directly compared with that occurring among complicated cases in hospital.No evidence was found that hospitalStaph. aureusstrains carried home by newly born infants were causing a significant amount of sepsis among their home contacts within 28 days of delivery.The importance of nurses as sources of infecting strains ofStaph. aureusin maternity work is discussed. The infant-to-infant route of transmission has been stressed in the literature but reasons are given for believing that nurse-to-infant infection in the labour room may also be important under certain circumstances.I am greatly indebted to Dr V. P. Randall Martin, formerly Senior Medical Officer in the Hampshire County Health Department, who organized the follow-up of patients after leaving hospital and after home delivery, and also to the County Medical Officer Dr I. A. MacDougall for his help.I am also grateful to Messrs P. R. Mitchell and G. T. Hammond for permission to investigate their wards and to Sister D. M. Carter and her staff, and to the County midwives and Health Visitors, for their co-operation.Dr G. J. G. King kindly undertook the phage-typing of a large number of strains ofStaph. aureusat the Bournemouth Public Health Laboratory, for which I am most grateful.I am also grateful to Dr W. A. Gillespie for information in advance of publication, and for advice, about the hexachlorophane regimen of which he and his Bristol colleagues were the pioneers.