Control of infection in the hospital: problems in surgery and the management of burns.

Three aspects of hospital infection control are discussed: disinfection of skin, antimicrobial prophylaxis of burns, and methods of preventing the emergence of antibiotic-resistant bacteria. The relative values and limitations of alternative methods of reducing resident and transient skin flora are evaluated on the basis of laboratory studies of volunteers; the special value of alcohol, rubbed to dryness, against both resident and transient flora is illustrated. In prophylaxis against infection of burns, first-and second-line defenses, i.e., against contamination of the burn wound and against invasion from the colonized burn wound, respectively, are illustrated by results of controlled trials of various topical preparations of antimicrobial agents and of a pseudomonas vaccine. Ways of preventing the emergence of antibiotic-resistant bacteria and of eliminating them from wards in which they have become endemic are illustrated. Methods effective in dealing with resistance to one antibiotic or group of antibiotics do not necessarily have similar value for resistance to other antibiotics; e.g., in a burns unit, Pseudomonas aeruginosa resistant to carbenicillin due to a plasmid determining resistance to five antibiotics was eliminated by withdrawal of all five of these antibiotics, but in the same unit gentamicin-resistant P. aeruginosa was eliminated only when all patients with P. aeruginosa were segregated in one ward to which no new patients were admitted until those whose burns had carried gentamicin-resistant P. aeruginosa had been discharged.