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[Reducing vaginal flora by preoperative disinfection]
1St.-Marien-Hospital, Frauenklinik, Lünen.
Abstract:
In 70 gynaecological patients vaginal disinfection by povidone-iodine and chlorhexidine solution (LEC) was investigated. The preoperative bacterial spectrum corresponded to the specifications in literature. Only lactobacilli were found in fewer cases than expected, an effect, which was explained by the povidone-iodine sanitation of the vagina a day before the operation. In cases of disturbed lactobacilli flora, facultative pathogen species were found in high concentrations up to 10(6) CFU/ml. Germ reduction achieved more than 3.4 log CFU/ml in the three groups of antiseptics. Povidone-iodine left a residue of other bacteria species in one-fifth of the cases, one of the LEC-solutions only in one-tenth of the cases. B-Streptococcus, Streptococcus viridans (mitis) and Candida glabrata were found in concentrations up to 10(3) CFU/ml in the residues. In these cases, a disturbed ecology of the vagina had already existed previously. It is concluded, not to disturb normal vaginal flora needlessly before preoperative disinfection and to restore it as soon as possible after operation. The LEC solutions appeared to be a competent alternative to povidone-iodine solution in vaginal disinfection.
Insights
Povidone-iodine and chlorhexidine solution (LEC) effectively reduced vaginal bacteria before surgery. LEC solutions are a viable alternative to povidone-iodine, but avoid disturbing normal vaginal flora unnecessarily.
Area of Science:
- Gynecology
- Microbiology
- Infectious Disease Prevention
Background:
- Vaginal disinfection is crucial for preventing surgical site infections in gynecological procedures.
- The impact of preoperative vaginal disinfection on the natural vaginal flora and its implications for pathogen growth require further investigation.
- Povidone-iodine is a common antiseptic, but alternatives with potentially better flora preservation are sought.
Purpose of the Study:
- To compare the efficacy of povidone-iodine and a novel povidone-iodine and chlorhexidine solution (LEC) in vaginal disinfection prior to gynecological surgery.
- To assess the impact of these antiseptics on the native vaginal microflora, particularly lactobacilli.
- To evaluate the residual bacterial presence after disinfection and identify potential pathogens.
Main Methods:
- A study involving 70 gynecological patients undergoing preoperative vaginal disinfection.
- Comparison of bacterial spectrum and reduction efficacy between povidone-iodine and LEC solutions.
- Analysis of residual bacterial species and concentrations post-disinfection.
Main Results:
- Both povidone-iodine and LEC achieved significant germ reduction (>3.4 log CFU/ml).
- LEC solutions showed a lower incidence of residual bacteria (1/10 cases) compared to povidone-iodine (1/5 cases).
- Disturbed vaginal flora prior to disinfection was associated with the presence of facultative pathogens and specific residual bacteria like B-Streptococcus and Candida glabrata.
Conclusions:
- Preoperative vaginal disinfection should aim to minimize disruption of the normal vaginal flora.
- LEC solutions represent a competent alternative to povidone-iodine for vaginal disinfection.
- Restoring vaginal flora post-operation is recommended, especially in cases of pre-existing flora disturbance.