Prevention of postoperative wound infections: to cover up?

Bacteriological evaluation of the cardiac surgery environment accompanying hospital relocation

PURPOSE

Airborne bacteria in the environment are thought to be a cause of postoperative infection. With the relocation of our hospital, the operating room we had used for 35 years was replaced, changing the surgical environment for cardiac operation completely. We conducted this study to evaluate the bacteriological change in the surgical environment between the new and old operating rooms.

METHODS

Airborne contaminants in the operating rooms were collected on blood agar plates, and samples of intraoperative salvaged blood from cardiac surgery were drawn from salvaged bags produced by Cell Saver 5 (Haemonetics, Braintree, MA, USA) in both the old (group O) and the new operating rooms (group N). These samples were cultured and evaluated bacteriologically.

RESULTS

We collected nine samples of airborne contaminants from both group O and group N. The mean number of isolated bacteria colonies was 5.0 +/- 1.2 in group O, and 2.0 +/- 0.94 in group N (P < 0.001). Bacterial growth was detected in 85% of the salvaged blood samples from group O (n = 20) versus 60% from group N (n = 15) (P = 0.09). The mean bacteria count was 1.9 +/- 2.7 colony-forming units (cfu)/ml in group O versus 0.4 +/- 0.5 cfu/ml in group N (P = 0.032).

CONCLUSION

Hospital relocation resulted in an improved operating room environment with less bacterial contamination of intraoperative salvaged blood.

Prevention of postsurgical infections: some like it hot

PURPOSE OF THE REVIEW

The present review covers the literature on prevention of surgical site infections published during 2001. Only papers that offer new insights or question current recommendations are included.

RECENT FINDINGS

The most interesting advances have been made in the preoperative preparation of the patient. In particular, the effects of preoperative warming of the patient, either generally or locally at the incision site, on the rate of surgical site infections are impressive and warrant further investigation. Also, the effects of strict control of perioperative blood glucose levels and of preoperative eradication of nasal carriage of Staphylococcus aureus should be studied in greater detail.

SUMMARY

The protective effect of local and systemic warming before surgical procedures has been described in two well designed studies. Although a final judgement regarding effectiveness can only be made after more extensive investigations have been conducted, there appear to be few arguments against application of this cheap and safe measure. Thus, implementation of preoperative warming can be justified in settings associated with high rates of surgical site infections.