Isolation care of infection-prone burn patients.

An experimental and clinical study of spread of colonisation between burn patients, and their susceptibility to infection, was performed. Burn patients' polymorphonuclear neutrophil granulocytes (PMN) functioned poorly, particularly during the second week after injury which coincided with maximum growth of bacteria in the burn wound. Patients with large burns often dispersed S. aureus and Ps. aeruginosa but also beta-hemolytic Streptococcus to the air of their rooms. Airborne transfer of these bacteria was practically eliminated by nursing in single isolation rooms with plenum ventilation. In such rooms, cross-contamination was carried mainly via clothes. Patients with small burns sometimes were important sources of such contamination although they dispersed little bacteria to the air. A thorough change of barrier dress after close contact nursing delayed the first exogenous S. aureus colonisation until after the time of greatest impairment in PMN functions. A further reduction in cross-contamination would be possible with barrier garments impermeable to fluids and bacteria on points of contact, as shown in experiments with plastic apron as protective dress. Measurements of penetration through fabrics of particles suspended in air, commercially used, did not correlate to the performance of garments made from the fabrics in experimental nursing and clinical use. Bacteria were shown to penetrate fabrics through rubbing, particularly when wet where the microcolonies present on the cloth were separated into smaller units. An instrument was designed which measured such penetration, and was used to select fabrics for barrier garments. Tightly fitting barrier garments increased the disperal of bacteria from clothes worn underneath them. The wearing of barrier garments should therefore be restricted to close contact nursing. An open-roofed plastic patient isolator was designed and built. It did not appreciably reduce cross-contamination and gave psychological and practical problems. It seemed not to be a realistic alternative to better protective garments in isolation rooms.