Hostname: page-component-77c89778f8-gq7q9 Total loading time: 0 Render date: 2024-07-20T10:23:29.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Skin as a Source of Nosocomial Infection: Directions for Future Research

Published online by Cambridge University Press:  02 January 2015

Dennis G. Maki
Dennis G. Maki*
Affiliation:
Infection Control Department, University of Wisconsin Hospital and Clinics, and the Section of the Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin
*
University of Wisconsin Hospital and Clinics—H4/574, 600 Highland Avenue, Madison, WI53792
Get access Rights & Permissions [Opens in a new window]

Extract

Whereas infections of the skin per se comprise only a fraction of all institutionally-acquired infections, the skin has become one of the most important reservoirs of nosocomial pathogens in the hospital. Professor Noble has provided a scholarly review of the increasing importance of the major constituents of the cutaneous microflora as nosocomial pathogens and what we know of their epidemiology. Unfortunately, the empiricism and limited scientific data which underlie essential infection control measures in this area, particularly in regard to cutaneous antisepsis and handwashing, is almost incongruous in an era in which controlled clinical trials have dominated most other areas of medicine. The numerous outbreaks traced to contaminated antiseptics and disinfectants over the past two decades, stand as mute testimony to the inadequate investigative attention this area has received.

Type
Research Article
Information
Infection Control & Hospital Epidemiology , Volume 7 , supplement S2: Proceedings of the Second ICI/Stuart Workshop , February 1986 , pp. 113 - 117
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Wenzel, RP: The re-emergence of gram-positive cocci as significant nosocomial pathogens. Infect Control, to be published.Google Scholar
2.Dixon, RE, Kaslow, RA, Mackel, DC, et al: Aqueous quaternary ammonium antiseptics and disinfectants: Use and misuse. JAMA 1976; 236:2415–2417.CrossRefGoogle ScholarPubMed
3.Craven, DE, Moody, B, Connolly, MG, et al: Pseudobacteremia caused by povidone-iodine solution contaminated with Pseudomonas cepacia. N Engl J Med 1981; 305:621–623.Google Scholar
4.Noble, WR: Skin as a source of hospital infection. Infect Control 1986; 7(2)(suppl):111–112.Google Scholar
5.Archer, GL, Armstrong, BC: Alteration of Staphylococcal flora in cardiac surgery patients receiving antibiotic prophylaxis. J Infect Dis 1983; 147:642–649.Google Scholar
6.Maki, DG, Stevens, JA: Nosocomial colonization of cardiac surgery and cardiology patients by methicillin-resistant coagulase-negative staphylococci. Proceedings and Abstracts of the Twenty-fourth Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, October 1984.Google Scholar
7.Maki, DG, Alvarado, C, Hassemer, C: Comparison of organisms carried on the hands of hospital personnel and nonmedical control personnel: Methicillin-resistant coagulase-negative Staphylococcus is a hospital organism. Proceedings and Abstracts of the Twenty-fourth Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, D.C., October 1984.Google Scholar
8.Maki, DG, Zilz, MA, Alvarado, C, et al: Multiply-resistant epidermidis surgical wound infections linked to a chronic carrier. Proceedings and Abstracts of the Twenty-second Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami Beach, October 1982.Google Scholar
9.Fox, B, Maki, DG, Belzer, F, et al: Trimethoprim-sulfamethoxazole prophylaxis in renal transplantation. I. Efficacy and effect on colonization. Proceedings and Abstracts of the Twenty-fifth Interscience Conference on Antimicrobial Agents and Chemotherapy, Minneapolis, MN, September 30-October 2, 1985.Google Scholar
10.Hansen, BG: The occurrence of Staphylococcus epidermidis in a department of the thoracic and cardiovascular surgery. A clinical and epidemiological investigation. Scandinavian Journal of Cardiovascular Surgery 1982; 16:269–273.Google Scholar
11.Berry, AR, Watt, B, Goldacre, MJ, et al: A comparison of the use of povidone-iodine and Chlorhexidine in the prophylaxis of postoperative wound infection. J Hosp Infect 1982; 3:55–63.Google Scholar
12.Ayliffe, GAY, Noy, MF, Babb, JR, et al: A comparison of pre-operative bathing with chlorhexidine-detergent and non-medicated soap in the prevention of wound infection. J Hosp infect 1983; 4:237–244.CrossRefGoogle ScholarPubMed
13.Maki, DG: Infections associated with intravascular lines. Current Topics in Clinical Infectious Disease, Swartz, M, Remington, J (eds). New York, McGraw-Hill, Inc., 1982, pp 309–363.Google Scholar
14.Champagne, S, Fussell, S, Scheifele, D: Evaluation of skin antisepsis prior to blood culture in neonates. Infect Control 1985; 5:489–491.Google Scholar
15.Goldblum, SE, Ulrich, JA, Goldman, RS, et al: Comparison of 4% Chlorhexidine gluconate in the detergent base (Hibiclens) and povidone-iodine (Betadine) for the skin preparation of hemodialysis patients and personnel. Am J Kidney Dis 1983; II:Google Scholar
16.Steere, AC, Mallison, GF: Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975; 83:683–690.Google Scholar
17.Maki, DG: Control of colonization and transmission of pathogenic bacteria in the hospital. Ann Intern Med 1978; 89(Part 2):777–780.Google Scholar
18.Larson, E: Handwashing and skin physiologic and bacteriologie aspects. Infect Control 1985; 6:14–23.Google Scholar
19.Dineen, P, Hildick-Smith, G: Antiseptic care of hands, in Maiback, HI, Hildick-Smith, G (eds): Skin Bacteria and Their Role in Infection New York, McGraw Hill, 1965, pp 291–310.Google Scholar
20.Lowbury, EJL, Lilly, HA: Use of 4% Chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection. Br Med J 1973; 1:510–515.Google Scholar
21.Maki, DG, Zilz, MA, Alvarado, CJ: Evaluation of the antibacterial efficacy of four agents for handwashing. Current Chemotherapy and Infectious Disease Proceedings of the 11th International Congress on Chemotherapy and the 19th ICAAC, Nelson, JC, Grassi, C (eds), Washington, D.C., American Society for Microbiology, 1980; pp 1089–1090.Google Scholar
22.Meers, PD, Yeo, GA: Shedding of bacteria and skin squames after handwashing. J Hyg 1978; 81:99–105.Google Scholar
23.Ayliffe, GAJ, Babb, JR, Quoraishi, AH: A test for ‘hygienic’ hand disinfection. J Clin Pathol 1978; 31:923–928.Google Scholar
24.Lilly, HA, Lowburry, EJL: Transient skin flora. J Clin Pathol 1978; 31:919–922.Google Scholar
25.Rotter, M, Koller, W, Wewalka, G: Povidone-iodine and Chlorhexidine gluco-nate-containing detergents for disinfection of hands. J Hosp Infect 1980; 1:149–158.CrossRefGoogle ScholarPubMed
26.Aly, R, Maibach, HI: A comparison of the antimicrobial effect of 0.5% Chlorhexidine (Hibistat) and 70% isopropyl alcohol on hands contaminated with Serratia marcescens. Clin Exp Dermatol 1980; 5:197–201.Google Scholar
27.Bruun, JN, Solberg, CO: Hand carriage of gram-negative bacilli and Staphylococcus aureus. Br Med J 1973; 9:580–582.Google Scholar
28.Ojajavi, J, Makela, P, Rantasalo, I: Failure of hand disinfection with frequent hand washing: A need for prolonged field studies. J Hyg 1977; 79:107–119.CrossRefGoogle Scholar
29.Parry, MF, Hutchinson, JH, Brown, NA, et al: Gram-negative sepsis in neonates: A nursery outbreak due to hand carriage of Citobacterdiversus. Pediatrics 1980; 65:1105–1109.Google Scholar
30.Kaslow, RA, Dixon, RE, Martin, SM, et al: Staphylococcal disease related to hospital nursery bathing practices—A nationwide epidemiologic investigation. Pediatrics 1973; 51:418–425.Google Scholar
31.Casewell, M, Phillips, I: Hands as route of transmission for Klebsiella species. Br Med J 1977; 2:1315–1317.Google Scholar
32.Maki, DG, Hecht, J: Antiseptic-containing handwashing agents reduce nosocomial infections—A prospective study. Proceedings of the Twenty-second Interscience Conference on Antimicrobial Agentsand Chemotherapy, Miami Beach, October, 1982.Google Scholar
33.Massanari, RM, Hierholzer, WJ: A crossover comparison of antiseptic soaps on nosocomial infection rates in intensive care units. Am J Infect Control 1984; 12:247–248.Google Scholar
34.Bjornson, HS, Colley, R, Bower, RH, et al: Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery 1982; 92:720–727.Google Scholar
35.Snydman, DR, Pober, BR. Murray, SA, et al: Predictive value of surveillance skin cultures in total-parenteral-nutrition-related infection. Lancet 1982; 2:1385–1388.Google Scholar
36.Jarrard, MM, Olson, CM, Freeman, JF: Daily dressing change effects on skin flora beneath subclavian catheter dressing during total parenteral nutrition. JPEN 1980; 4:391–392.Google Scholar
37.Craven, DE, Lichtenberg, DA, Kunches, LM, et al: A randomized study comparing a transparent polyurethane dressing to a dry gauze dressing for peripheral intravenous catheter sites. Infect Control 1985; 6:361–366.Google Scholar
38.Maki, DG, Will, L: Colonization and infection associated with transparent dressings for central venous, arterial, and Hickman catheters—A comparative trial. Abstract, Twenty-fourth Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, D.C., October, 1984.Google Scholar
39.Kelsey, MC, Gosling, M: A comparison of the morbidity associated with occlusive and non-occlusive dressings applied to peripheral intravenous devices. J Hosp Infect 1984; 5:313–321.Google Scholar
40.Maki, DG, Coll, M, Hassemer, C.et al: Safety and cost-effectiveness of 4 dressing regimens for peripheral IV catheters, including indefinite gauze and a povidone-iodine impregnated transparent dressing. Proceedings of the Annual Meeting of the Midwest Section of the American Federation for Clinical Research, Chicago, IL, November 6-8, 1985. Clinical Research, 1985; 33:8458.Google Scholar
41.Maki, DG, Band, JD: A comparative study of polyantibiotic and iodophor ointments in prevention of vascular catheter-related infection. Am J Med 1981; 70:739–744.Google Scholar
42.Prager, RL, Silva, J: Colonization of central venous catheters. South Med J 1984; 77:458–461.Google Scholar
43.Broviac, JW, Cole, JJ, Scribner, BH: A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 1973; 136:1–5.Google ScholarPubMed
44.Hickman, RO, Buckner, CD, Clift, RA, et al: A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 1979; 148:871–875.Google Scholar
45.Fuchs, PC, Gustafson, ME, King, JT, et al: Assessment of catheter-associated infection risk with the Hickman right atrial catheter. Infect Control 1984; 5:226–230.Google Scholar
46.Stillman, RM, Soliman, F, Garcia, L, et al: Etiology of catheter-associated sepsis: Correlation with thrombogeniciry. Arch Surg 1977; 112:1497–1502.Google Scholar
47.Christensen, GD, Simpson, WA, Bisno, AL, et al: Adherence of slime-producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun 1982; 37:318–326.Google Scholar
48.Peters, G, Locci, R, Pulverer, G: Adherence and growth of coagulase-negative staphylococci on surfaces of intravenous catheters. J Infect Dis 1982; 146:479–482.Google Scholar
49.Sheth, NK, Rose, HD, Franson, TR, et al: In vitro quantitative adherence of bacteria to intravascular catheters. J Surg Res 1983; 34:213–218.CrossRefGoogle ScholarPubMed
50.Sheth, NK, Franson, TR, Rose, HD, et al: Colonization of bacteria on polyvinyl chloride and teflon intravenous catheters in hospitalized patients. J Clin Microbiol 1983; 18:1061–1063.Google Scholar
51.Trooskin, SZ, Donetz, AP, Harvey, RA, et al: Prevention of catheter sepsis by antibiotic bonding. Surgery 1985; 97:548–551.Google Scholar