The mechanism and prevention of cross-infection in dermatological wards

Abstract

Over a 2-year period a dermatology department was shown to be a valid model for the long-term study of hospital cross-infection. In the absence of specific anti-bacterial measures, consistently high levels of Staph. aureus and Gram-negative bacilli were found throughout the environment. ‘Broadcasts’ of Staph. aureus were particularly evident in the bathrooms, and notable sites of heavy, cumulative contamination were the communal baths, bedding, settled dust, and the hands of the staff.Cross-infection of lesions occurred in ninety-four of the 233 ‘uncontrolled’ patients—15 cases being due to Gram-negative bacilli. Autogenous infection occurred in another fifteen cases. Nasal carriage of Staph. aureus developed in fifty-one patients after admission.In one of the two main wards nasal disinfection (with ‘Soframycin’ nebulizers) was used for 4 months, and was effective in the treatment and prevention of nasal carriage; but it produced no change in the level of environmental contamination or in the incidence of cross-infection—even though efficient cleansing of the baths was also instituted. In contrast, during two separate periods of the work disinfection of skin lesions (with ‘Rikospray Antibiotic’) markedly reduced the counts of pathogens in the environment, and virtually abolished both cross-infection and the development of nasal carriage.