BREAST ABSCESS AND STAPHYLOCOCCAL DISEASE IN A MATERNITY HOSPITAL

Breast, milk and microbes: a complex relationship that does not end with lactation

Until relatively recently, the extent of microbiota presence in the human breast was under-appreciated. A high-throughput sequencing study and culture-based studies have demonstrated the extensive presence of microbes in human milk, with their origin believed to be from the skin, oral cavity and via gut translocation. Since formula milk substitutes do not contain these bacteria, what benefits are denied to these infants? The addition of probiotic bacteria to some infant formula is meant to provide some benefits, but these only contain one species and the dose is relatively high compared with breast milk. Many questions of importance to women's health arise from these findings. When, how and what types of microbes colonize the breast at different stages of a woman's life, including postlactation, and what effect do they have on the host in the short and long term? This article discusses some aspects of these questions.

Hexachlorophene in the newborn nursery. A risk-benefit analysis and review

A critical review of the available data on the risks and benefits of hexachlorophene suggests that there is ample evidence fror the toxic potential; whereas there is no substantial evidence of its benefit in life-threatening staph 80/81 epidemics, and effective less toxic alternatives are available. In view of its limited usefulness and definite toxicity, the routine use of hexachlorphene is unjustified;

An evaluation of antiseptics used for hand disinfection in wards

The antibacterial effectiveness of hand antiseptics commonly used in wards was studied by laboratory and in-use tests and their acceptability assessed by means of a questionnaire passed to hospital staff. To determine the immediate and long-term antibacterial effects of the preparations the in-use tests were performed by groups of students. The greatest immediate reduction in bacterial counts on hands was obtained by products containing chlorhexidine. The long-term antibacterial effect was recorded with emulsions containing 3% hexachlorophane, 2% Irgasan CF3R or 4% chlorhexidine when used constantly on several consecutive days. Considerable discrepancies were recorded in the antibacterial effectiveness of some preparations when comparing laboratory and in-use test results. Therefore it is suggested that antiseptics should be tested by in-use tests which more closely resemble practical conditions before their use, or further trial, in hospital.

Absorption of hexachlorophane from dusting powder on newborn infant's skin

In a maternity hospital in which the umbilicus and trunk of healthy newborn infants were treated with 0.33% hexachlorophane dusting powder, the hexachlorophane content of blood was measured in mothers before delivery, in infants' umbilical samples at birth, and at 8 days of age in capillary blood samples. One mother and her baby had rather high blood concentrations of hexachlorophane, probably derived from a toilet preparation used before admission to hospital. Hexachlorophane was absent or barely detectable in the other mothers' blood and in the infants' umbilical blood. The hexachlorophane concentrations in the blood of 8-day-old infants ranged from nil to 0.166 mug./ml. (mean 0.066 mug./ml.). These were much less than the concentrations reported to be toxic in animals.In a previous trial now reported here, a dusting powder containing chlorhexidine instead of hexachlorophane was found to delay the separation of the umbilical cord.

A prospective study of staphylococcal infection and its prevention among infants and mothers after childbirth in hospital and at home

Staphylococcal colonization and infection were studied prospectively in infants, mothers and households after childbirth at home and in hospital. Infants were treated prophylactically with frequent applications of ‘Ster-zac’ hexachlorophane dusting powder. Some were treated in addition with ‘Naseptin’ nasal disinfectant cream.

The incidence of staphylococcal sepsis in infants was much less than before the adoption of hexachlorophane prophylaxis. The sepsis rate was further reduced when ‘Naseptin’ was used in addition to hexachlorophane. Of the two prophylactic agents, hexachlorophane was the more convenient and probably the more effective. ‘Naseptin’ was difficult to employ correctly and unsuitable for routine use.

The treatment of infants with disinfectants reduced nasal carriage markedly in infants and to a smaller extent in mothers. Both agents contributed to the reductions which persisted for some weeks after treatment ceased.

Breast abscesses were almost entirely confined to mothers of infants who became nasal carriers by the second week of life.

Staphylococcal colonization of infant's skin was greater when they wore impervious garments, probably because skin moisture increased.