The Role of the Laboratory in Control of Nosocomial Infection

Post-surgical nasal cellulitis outbreak due to Mycobacterium chelonae

An outbreak of post-rhinoplasty nasal cellulitis due to Mycobacterium chelonae in a secondary care centre is described. A case-control study demonstrated that the use of inadequately sterilized surgical equipment in the Otorhinolaryngology Department was a risk factor. The causal organism was cultured from the equipment, from the surface of the operating theatre lamp, adhesive tape and from two of the hospital's general water tanks. Introduction of effective instrument sterilization methods, monitored with biological controls, the use of new air filters and cleansing and disinfection of hospital water tanks, were sufficient to control the outbreak. The antimicrobial susceptibilities of the causal organism were consistently different from those previously reported in M. chelonae.

Antibiotic pressure and nosocomial disease

Nosocomial infection control programs of various types have been implemented in human hospitals since the staphylococcal pandemic of the 1950s. The prevalence of hospital infections is expected to increase in veterinary medicine with the advent of sophisticated invasive monitoring techniques, lengthier patient hospital stays, and the widespread use of antimicrobial agents. In order to monitor and control nosocomial infection outbreaks, the hospital staff must make strategic measures a priority. We propose the establishment of a nosocomial infection control committee, especially at the larger teaching and referral centers, to oversee such activities as hospital and personnel hygiene protocols, patient handling, antisepsis of surgical and critical care instruments, and surveillance. We have described a hospital pharmacy antibiotic restriction policy similar to those used with success in several human hospitals. It is apparent that the careless use of antibiotics adds significantly to the emergence of resistant hospital microflora and predisposes hospitalized patients to nosocomial infections. Judicious use of antibiotics not only helps to curtail such risks and lower health costs but encourages the clinician to fully evaluate his or her therapeutic rationale. As with any new program, continued staff education is the paramount requirement for its success.