Letters
to the Editor
125
References 1. Nelson R, Jenson C, Peterson C. et al. Effective use of prophylactic antibiotics in open heart surgery. Arch Surg 1965; 90: 731-736. 2. Hairston P, Lee WH. Jr. Mycotic (fungal) endocarditis after cardiovascular surgery. Am Surg 1969; 35: 135-140. 3. Newman WH, Cordell AR. Aspergillus endocarditis after open heart surgery. J Thorac Cardiovasc Surg 1964; 48: 652-660. 4. Conant FN, Smith TD, Baker DR, Callway LJ. Manual of Clinical Mycology. London: WB Saunders Co. 1971. 5. Koelle WA, Paster BH. Candida albicans endocarditis after aortic valvotomy. N Engl J Med 1956; 255: 997. 6. Jamshidi A, Pope RH, Friedman NHH. Fungal endocarditis complicating cardiac surgery. Arch Intern Med 1963; 12: 370. 7. Aslam PA, Gourley R, Eastridge GE, Pate JW. Aspergillus endocarditis after aortic valve replacement. Intern Surg 1970; 53: 91. 8. Ostermiller WE, Dye WS, Weinberg M. Fungal endocarditis following cardiovascular surgery. J ThoTac Cardiovas Surg 1971; 61: 670. 9. Gram J, Hall WJ, Penicillium endocarditis following open heart surgery and prosthetic valve insertion. Am Heart J 1976; 87: 501-506.
Sir,
Transmission
of chickenpox to two intensive care unit nurses from a liver transplant patient with zoster
A 41-year-old female patient developed zoster after an orthotopic liver transplant. She had a complicated postoperative course necessitating treatment in our intensive care ward. She developed a small cluster of vesicles on the right side of her chest 20 days after transplantation. This was initially thought to be an allergic reaction to adhesive tape which had been applied to this site. However, 18 h after the development of the rash, examination of vesicle fluid by electron microscopy revealed the presence of herpes type viruses. A diagnosis of herpes zoster was made and she was transferred to an isolation cubicle in the intensive care unit, and nursed by staff known to be immune to varicella-zoster virus (VZV; VZV antibody positive). Although the area of the vesicles had been covered by dressings during the development of the rash, all staff and patients in the unit were investigated for evidence of immunity to VZV. All four patients in the unit were VZV antibody positive. Of the 61 staff on the unit, most had been assessed for VZV history or antibody status previously. Two, who had not been tested, were screened for VZV antibody by ELISA (Biostat) and were antibody positive. Two, already known to be VZV antibody negative, were excluded from the unit from days lo-21 inclusive from the date of contact with the patient. Both had been involved in her intensive care. One had just returned to work having been excluded for the second time because of contact with other patients with VZV infection. Both of them developed chickenpox after incubation periods of 17 and 18 days and, as a result, were absent from work for 2 and 3 weeks respectively.
126
Letters
to the
Editor
This incident highlights the transmissibility of VZV and the value of excluding VZV antibody negative staff who have been in contact with chickenpox or zoster. The index case had only a few vesicles which were covered by dressings for most of the time and yet infection was transmitted to both of the susceptible staff members who were involved in her care.
Addenbrooke’s
T. G. Wreghitt P. J. Whipp J. Bagnall
Hospital, Cambridge, CBZ 2&W
Sir, Sterilization
of arthroscopes
and laparoscopes
We read with interest Dr Noone’s letter on sterilization of arthroscopes and laparoscopes.’ We too encounter this problem and have for many years routinely decontaminated arthroscopes with fresh 2% glutaraldehyde for 20 min. In 10 years of surveillance we have not related a single episode of infection following arthroscopy to spores surviving the decontamination procedure. We therefore take comfort from current Centers for Disease Control (CDC) and Association for Practitioners in Infection Control (APIC) guidelines2a3 which state that scopes entering normally sterile tissue should be sterilized and, if this is not feasible, they should receive at least high-level disinfection. However, with the advent of laparoscopic cholecystectomy we are concerned about the suitability of disinfection between cases. Is cholecystectomy, with the degree of damage to tissues and the likelihood of heavy bacterial contamination comparable to laparoscopic procedures in gynaecology? We would welcome readers’ comments.
E. E. R. E.
Microbiology Department Beaumont Hospital, Dublin 9, Ireland
G. Smyth Creamer J. Cunney M. McNamara
References 1. Noone M. Sterilization of arthroscopes and laparoscopes. r Hosp Infect 1991; 17: 317. 2. Garner JS, Favero MS. Guideline for handwashing and hospital environmental control. 1985. AmJ Infect Control 1986; 14: 110-126. 3. Rutala WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1990: 18: 99-117.
to the Editor
125
References 1. Nelson R, Jenson C, Peterson C. et al. Effective use of prophylactic antibiotics in open heart surgery. Arch Surg 1965; 90: 731-736. 2. Hairston P, Lee WH. Jr. Mycotic (fungal) endocarditis after cardiovascular surgery. Am Surg 1969; 35: 135-140. 3. Newman WH, Cordell AR. Aspergillus endocarditis after open heart surgery. J Thorac Cardiovasc Surg 1964; 48: 652-660. 4. Conant FN, Smith TD, Baker DR, Callway LJ. Manual of Clinical Mycology. London: WB Saunders Co. 1971. 5. Koelle WA, Paster BH. Candida albicans endocarditis after aortic valvotomy. N Engl J Med 1956; 255: 997. 6. Jamshidi A, Pope RH, Friedman NHH. Fungal endocarditis complicating cardiac surgery. Arch Intern Med 1963; 12: 370. 7. Aslam PA, Gourley R, Eastridge GE, Pate JW. Aspergillus endocarditis after aortic valve replacement. Intern Surg 1970; 53: 91. 8. Ostermiller WE, Dye WS, Weinberg M. Fungal endocarditis following cardiovascular surgery. J ThoTac Cardiovas Surg 1971; 61: 670. 9. Gram J, Hall WJ, Penicillium endocarditis following open heart surgery and prosthetic valve insertion. Am Heart J 1976; 87: 501-506.
Sir,
Transmission
of chickenpox to two intensive care unit nurses from a liver transplant patient with zoster
A 41-year-old female patient developed zoster after an orthotopic liver transplant. She had a complicated postoperative course necessitating treatment in our intensive care ward. She developed a small cluster of vesicles on the right side of her chest 20 days after transplantation. This was initially thought to be an allergic reaction to adhesive tape which had been applied to this site. However, 18 h after the development of the rash, examination of vesicle fluid by electron microscopy revealed the presence of herpes type viruses. A diagnosis of herpes zoster was made and she was transferred to an isolation cubicle in the intensive care unit, and nursed by staff known to be immune to varicella-zoster virus (VZV; VZV antibody positive). Although the area of the vesicles had been covered by dressings during the development of the rash, all staff and patients in the unit were investigated for evidence of immunity to VZV. All four patients in the unit were VZV antibody positive. Of the 61 staff on the unit, most had been assessed for VZV history or antibody status previously. Two, who had not been tested, were screened for VZV antibody by ELISA (Biostat) and were antibody positive. Two, already known to be VZV antibody negative, were excluded from the unit from days lo-21 inclusive from the date of contact with the patient. Both had been involved in her intensive care. One had just returned to work having been excluded for the second time because of contact with other patients with VZV infection. Both of them developed chickenpox after incubation periods of 17 and 18 days and, as a result, were absent from work for 2 and 3 weeks respectively.
126
Letters
to the
Editor
This incident highlights the transmissibility of VZV and the value of excluding VZV antibody negative staff who have been in contact with chickenpox or zoster. The index case had only a few vesicles which were covered by dressings for most of the time and yet infection was transmitted to both of the susceptible staff members who were involved in her care.
Addenbrooke’s
T. G. Wreghitt P. J. Whipp J. Bagnall
Hospital, Cambridge, CBZ 2&W
Sir, Sterilization
of arthroscopes
and laparoscopes
We read with interest Dr Noone’s letter on sterilization of arthroscopes and laparoscopes.’ We too encounter this problem and have for many years routinely decontaminated arthroscopes with fresh 2% glutaraldehyde for 20 min. In 10 years of surveillance we have not related a single episode of infection following arthroscopy to spores surviving the decontamination procedure. We therefore take comfort from current Centers for Disease Control (CDC) and Association for Practitioners in Infection Control (APIC) guidelines2a3 which state that scopes entering normally sterile tissue should be sterilized and, if this is not feasible, they should receive at least high-level disinfection. However, with the advent of laparoscopic cholecystectomy we are concerned about the suitability of disinfection between cases. Is cholecystectomy, with the degree of damage to tissues and the likelihood of heavy bacterial contamination comparable to laparoscopic procedures in gynaecology? We would welcome readers’ comments.
E. E. R. E.
Microbiology Department Beaumont Hospital, Dublin 9, Ireland
G. Smyth Creamer J. Cunney M. McNamara
References 1. Noone M. Sterilization of arthroscopes and laparoscopes. r Hosp Infect 1991; 17: 317. 2. Garner JS, Favero MS. Guideline for handwashing and hospital environmental control. 1985. AmJ Infect Control 1986; 14: 110-126. 3. Rutala WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1990: 18: 99-117.
