Extend handwashing to the forearms?
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Biomedical subjects
Publications and source records attributed to M P Maley.
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Fifty burn patients who had central venous cannulations performed were randomly assigned to one of two groups. In group 1, the skin around the catheter insertion site was cleaned with 70% isopropyl alcohol prior to catheter removal. In group 2, the skin around the catheter insertion site was not cleaned prior to catheter removal. Twenty (40%) of the patients had negative cultures. The remaining 30 patients had positive cultures, 11 (37%) of which were positive for both skin and catheter tip specimens. All 11 of these cultures matched for the same organism. Six (55%) were from group 1 and five (45%) from group 2. Of the 14 patients with cultures positive for the catheter tips but not the skin, eight (57%) did not have the skin cleaned prior to catheter removal. Five skin cultures were positive, with no organism growth on the corresponding catheter tip; four (80%) of these were from group 2. Data from blood and intravenous (IV) catheter tip cultures performed from November 1982 through December 1985 demonstrated that of the 441 blood cultures obtained, 91 (21%) were positive. Twenty-seven (6%) were positive blood and IV catheter tip cultures; only ten (37%) of these matched for the same organism, accounting for only 2% of the total number of cultures obtained.
A total of 26 boxes of gloves were analyzed to determine if using nonsterile gloves for routine noninvasive procedures was sufficient for thermally injured patients and if the risk of infection increased. All of the study boxes had some organism present on or in the used box; the most common type found was Staphylococcus aureus. Eleven of the 13 subjects (85%) had specific antibiotic-resistant strains of S. aureus present on cultures obtained from open wounds. Seven (64%) of these corresponded to the glove boxes assigned to that patient. The remaining four boxes of gloves had no S. aureus present. In all of the boxes of gloves that had positive S. aureus cultures, 100% of the resistant strains occurred after it was first cultured from the patient. As a result, nonsterile gloves can be used safely for routine non-invasive procedures in the thermally injured patient. It is imperative to avoid using a common box of gloves for two or more patients to prevent the transfer of organisms between patients.
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The progression of autograft colonization to infection presents significant problems in the care of grafted burn wounds. To determine whether graft colonization arises from self-contamination or from some exogenous source, we characterized pregraft and graft Candida albicans isolates through serotyping and biotyping (Leicester system) and Pseudomonas aeruginosa isolates through serotyping (Japan Pseudomonas aeruginosa Society system). In 21 of 24 patients, the serotype/biotype of the graft isolate was the same as the serotype/biotype of a C. albicans strain previously isolated from the same patient. Fifteen of 16 P. aeruginosa graft contaminants also showed the same serotype as that in a pregraft isolate. Therefore, whereas it has long been surmised that the grafts of patients with burns are self-colonized, this study provides definite data showing that most C. albicans and P. aeruginosa autograft isolates are indeed self-contaminants.
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