Sterility of Selected Operative Sites During Total Laparoscopic Hysterectomy
| Autor: | Marie E. Shockley, Stephen E. Zimberg, Katrin Arnolds, Benjamin Beran, M.L. Sprague, Heather Nutting |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Operating Rooms medicine.medical_specialty medicine.medical_treatment Uterus Hysterectomy Intraoperative Period 03 medical and health sciences 0302 clinical medicine Monitoring Intraoperative Humans Surgical Wound Infection Medicine Infection control 030212 general & internal medicine Antibiotic prophylaxis Laparoscopy Aged Aged 80 and over Infection Control 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Chlorhexidine Sterilization Obstetrics and Gynecology Antibiotic Prophylaxis Middle Aged Surgical Instruments Surgery medicine.anatomical_structure Vagina Abdomen Female business medicine.drug |
| Zdroj: | Journal of Minimally Invasive Gynecology. 24:990-997 |
| ISSN: | 1553-4650 |
| DOI: | 10.1016/j.jmig.2017.06.004 |
| Popis: | Study Objective To describe the type and quantity of bacteria found intraoperatively on the abdomen, vagina, surgical gloves, instrument tips, and uterus at distinct time points during total laparoscopic hysterectomy (TLH). Design Observational study (Canadian Task Force classification III). Setting Academic affiliated hospital. Patients Thirty-one women undergoing TLH for benign indications in 2016. Interventions After antibiotic prophylaxis and chlorhexidine preparation, swabs were collected from the vaginal fornices and abdomen. During subsequent TLH, additional swabs were collected from the following sites: surgeon's gloves after placement of the uterine manipulator, tips of instruments used to close the vaginal cuff, uterine fundus after extraction, and surgeon's gloves after removal of the uterus. A calibrated loop was used to inoculate each specimen onto 5% blood and chocolate agars for growth of aerobes and onto Brucella blood, phenylethyl alcohol, kanamycin vancomycin, and Bacteroides bile esculin agars for growth of anaerobes. Manual colony counts were tabulated for all positive cultures and reported in colony-forming units per milliliter (CFU/mL). Measurements and Main Results Anaerobic growth was not seen on the instrument tips, in the vagina, or on the abdomen of any patient. Aerobic bacterial growth was not seen in the vagina of any patient. On the surgeon's gloves after uterine manipulator placement, no patients demonstrated sufficient bacterial growth to potentially cause surgical site infection (≥5000 CFU/mL). On the surgeon's gloves following uterine extraction, 1 patient demonstrated sufficient growth to potentially cause infection. None of the patients developed surgical site infections postoperatively. Conclusion Cultures from multiple operative sites yielded bacterial growth, but the bacterial concentrations did not exceed the threshold for infection in 98.9% of cultures. Given absent growth from vaginal cultures and rare growth from abdominal cultures, chlorhexidine gluconate 4% is considered an appropriate surgical preparation for use in laparoscopic hysterectomy. |
| Databáze: | OpenAIRE |
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