BACKGROUND:The pathogenic role of nasal carriage as a source for cutaneous and soft-tissue Staphylococcus aureus (SA) infections, and Staphylococcal scalded skin syndrome (SSSS) in particular, is unclear.OBSERVATION:We herein describe a nosocomial outbreak of SSSS in three orthopaedic patients who received intra-articular injections by a single orthopaedic surgeon. Bacteriological samples from the index patients and medical personnel involved in their care were assessed by phage typing, polymerase chain reaction for exfoliative toxin genes, SmaI macro-restriction analysis and molecular spa-typing. These studies first revealed SA cultural growth in synovial fluid of all three patients as well as nasal mucosa of one medical assistant. Moreover, all SA isolates had the same phage typing and antibiotic susceptibilities and were positive for exfoliative toxin ETa by polymerase chain reaction. SmaI macro-restriction and spa-typing further confirmed all proband isolates to be identical.CONCLUSION:These findings provide evidence that SA nasal colonization of otherwise healthy carriers is a risk factor for SA infections, including SSSS, in predisposed individuals.

In recent years and decades increasingly more emphasis has been placed on alcohol-based solutions for hygienic and surgical hand disinfection. Traditional handwashing with soap and water has been largely replaced in the everyday clinical setting, as has the use of disinfectant soap-based solutions for surgical hand disinfection. It has been possible in recent years to reduce the exposure time for alcohol-based hand disinfection in surgery from 5 to 3 minutes, and there are plans to reduce this even further. The growing awareness of the tolerability issues has also given rise to favorable developments here. There have also been dramatic changes in preoperative skin disinfection. The non-alcoholic solutions with a slow onset of action (e.g. iodophors) have been virtually replaced by alcohol-based solutions of demonstrated efficacy. Non-alcoholic solutions continue to be used for disinfection of mucous membranes, but iodine-based products are being phased out here. The term "instrument disinfection" has been largely supplanted now by the expression "instrument reprocessing or medical device decontamination" (which is also underpinned by legislation) and it takes account of the trend towards thermal disinfection. Meticulous cleaning is thus an indispensable precondition for sterilization, which normally follows disinfection. The greatest lack of consensus at European level relates to surface disinfection. Routine, parallel cleaning and disinfection of all surfaces close to and remote from the patient is being increasingly replaced by selective disinfection, whenever warranted, of surfaces close to the patient. The problem here is that medical personnel continue to view cleaning and disinfection as interchangeable tasks. This situation is further compounded by the fact that hospitals are finding it increasingly more difficult to assure adequately successful cleaning and disinfection outcomes. To ensure effective infection control, cleaning and disinfection of surfaces in special situations must also be assured whenever warranted outside the regular working hours. Disinfection and decontamination of highly complex medical devices that pose special challenges (heat-sensitive devices with an intricate design and, correspondingly, with surfaces that are difficult to access, e.g. flexible endoscopes) will present the main challenge in the future. There is still much to be accomplished here to assure the hygienic safety of the patient.

ABSTRACT The expression of the mRNA encoding galanin message-associated peptide (GMAP) in human keratinocytes is upregulated by lipopolysaccharides and exposure to Candida albicans. GMAP has growth-inhibiting activity against C. albicans and inhibits the budded-to-hyphal-form transition, establishing GMAP as a possible new component of the innate immune system.

ABSTRACT Broad-range PCR has proven to be useful for the detection of bacteria. A set of broad-range PCR primers directed against conserved regions in the 16S rRNA gene was designed to specifically amplify either gram-positive or gram-negative bacteria. The gram type-specific broad-range PCR correctly classified all 62 pathogenic species tested.