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Introduction from the chairman
Journal of Hospital Infection (1985) 6 (Supplement B), 1
I n t r o d u c t i o n f r o m the C h a i r m a n
Opinions about burn infection and about measures to prevent it have undergone some t u m u l t u o u s changes in recent decades. In the late 1940s, when I started work in this field, infection of burns and (with the exception of Streptococcus pyogenes) the role of bacteria that caused it, did not attract the interest of surgeons and bacteriologists. T h i s was paradoxical because burns, unlike other wounds, had not been f o u n d amenable to Listerian antisepsis, nor were they effectively screened against bacterial contamination by standard aseptic procedures. Surgeons had known for a long time that patients with severe burns who survived the early phase of hypovolaemic shock were apt to develop fatal septic complications. T h e s e were not unlike those discribed in pre-Listerian surgery as 'hospital gangrene'; but helplessness against this menace seems to have diverted attention from the problems of sepsis (which had increased since the introduction of effective measures for preventing death from shock) and p r o m p t e d a wave of interest in hypothetical non-infective toxaemias. In the 1950s and 1960s, infection came to be recognized as the major cause of death in patients with extensive burns. Bacteria such as Pseudomonas aeruginosa, which had formerly been dismissed by m a n y as 'harmless commensals' ('green for safety'), were now recognized as potential major pathogens in such patients. M e t h o d s for prevention of infection of burns were developed and tested. T h e .first line of defence (against contamination of the burn) consisted of topical application of antimicrobial agents, patient isolation, and other m e t h o d s of preventing cross-infection--including excision and grafting and (paradoxically) both occlusive dressings and exposure method. T h e second line of defenee (against invasion of tissues and blood stream from already infected burns) consisted of i m m u n o p r o p h y l a x i s , selective chemotherapy, and various m e t h o d s of supporting the natural defences, e.g. control of diabetes and maintenance of other physiological norms. We are lucky to have in this S y m p o s i u m a team of clinical and scientific experts well-known for their studies in this field. I am sure they will give us a valuable picture of current knowledge and practice, and some glimpses of future developments in the war against microbial invaders. T h e field is large--the topics included in this p r o g r a m m e do not, in fact, cover all aspects of burn infection c o n t r o l - - a n d it keeps c h a n g i n g - - b e c a u s e microbes, too, keep improving their defences.
E. J. L. Lowbury 0195-5701/85/06B001 4 02 $03.00/0
(~ 1985 The Hospital Infection Society
I n t r o d u c t i o n f r o m the C h a i r m a n
Opinions about burn infection and about measures to prevent it have undergone some t u m u l t u o u s changes in recent decades. In the late 1940s, when I started work in this field, infection of burns and (with the exception of Streptococcus pyogenes) the role of bacteria that caused it, did not attract the interest of surgeons and bacteriologists. T h i s was paradoxical because burns, unlike other wounds, had not been f o u n d amenable to Listerian antisepsis, nor were they effectively screened against bacterial contamination by standard aseptic procedures. Surgeons had known for a long time that patients with severe burns who survived the early phase of hypovolaemic shock were apt to develop fatal septic complications. T h e s e were not unlike those discribed in pre-Listerian surgery as 'hospital gangrene'; but helplessness against this menace seems to have diverted attention from the problems of sepsis (which had increased since the introduction of effective measures for preventing death from shock) and p r o m p t e d a wave of interest in hypothetical non-infective toxaemias. In the 1950s and 1960s, infection came to be recognized as the major cause of death in patients with extensive burns. Bacteria such as Pseudomonas aeruginosa, which had formerly been dismissed by m a n y as 'harmless commensals' ('green for safety'), were now recognized as potential major pathogens in such patients. M e t h o d s for prevention of infection of burns were developed and tested. T h e .first line of defence (against contamination of the burn) consisted of topical application of antimicrobial agents, patient isolation, and other m e t h o d s of preventing cross-infection--including excision and grafting and (paradoxically) both occlusive dressings and exposure method. T h e second line of defenee (against invasion of tissues and blood stream from already infected burns) consisted of i m m u n o p r o p h y l a x i s , selective chemotherapy, and various m e t h o d s of supporting the natural defences, e.g. control of diabetes and maintenance of other physiological norms. We are lucky to have in this S y m p o s i u m a team of clinical and scientific experts well-known for their studies in this field. I am sure they will give us a valuable picture of current knowledge and practice, and some glimpses of future developments in the war against microbial invaders. T h e field is large--the topics included in this p r o g r a m m e do not, in fact, cover all aspects of burn infection c o n t r o l - - a n d it keeps c h a n g i n g - - b e c a u s e microbes, too, keep improving their defences.
E. J. L. Lowbury 0195-5701/85/06B001 4 02 $03.00/0
(~ 1985 The Hospital Infection Society