Attempts to control clothes-borne infection in a burn unit, 2. Clothing routines in clinical use and the epidemiology of cross-colonization

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Abstract
SUMMARY: Previous investigations have shown that cross-contamination in a burn unit is mainly clothes-borne. New barrier garments have been designed and tried experimentally. The aim of the present study was to investigate the effects of different clothing routines on cross-contamination. In a long-term study, the rates and routes of colonizations withStaphylococcus aureus, Streptococcusgroups A, B, C, F, and G andPseudomonas aeruginosawere examined. The exogenous colonization rates were, withS. aureus77%, withStreptococcusspecies 52% and withPs. aeruginosa32%. The colonization rate withPs. aeruginosawas higher in patients with larger burns. Patients dispersedStreptococcusandPs. aeruginosaas well asS. aureusinto the air of their rooms in considerable amounts, but dispersers were not more important as sources of cross-colonization than non-dispersers. In comparison of clothing routines, there was no difference in overall colonization rates. The newly designed barrier garment that was made from apparently particle-tight material did not reduce the transfer of bacteria from patient to patient. A less rigid routine than that previously used did not increase the risk of cross-contamination. A thorough change of barrier dress after close contact nursing delayed the first exogenousS. aureuscolonization from day 6 to day 14 after admission. This routine might be recommended for clinical use. Otherwise, methods must be developed for adequate selection of materials intended for barrier garments.