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Abstract:
Of four cases of postoperative gas gangrene in three hospitals three followed amputation of legs with gangrenous lesions, and one followed gastrectomy. Clostridium welchii was isolated from the wounds and the faeces of each patient; small numbers of Cl. welchii were found on the floors of the theatres where the operations had been performed.Two infections occurred in one hospital on successive days. Typing of strains of Cl. welchii from these patients showed that they were serologically distinct. Further studies suggested that in each of the four cases infection was probably acquired from the patients' intestinal flora, probably through faecal contamination of skin.In 76 patients sampling of the skin with surface contact plates showed occasional heavy contamination of the thighs, groins, and buttocks with Cl. welchii, most of which were present as spores or sporing bacilli; Cl. welchii was more commonly found in patients with incontinence of faeces. Compresses of povidone-iodine applied for 30 minutes were found greatly to reduce the numbers of Cl. welchii, and swabbing with 70% alcohol was effective in some cases; washing with soap and water had no effect on the numbers of Cl. welchii on the skin.
Insights
Postoperative gas gangrene, caused by Clostridium welchii, can originate from a patient's own intestinal flora. Skin decontamination with povidone-iodine effectively reduced bacterial presence, unlike soap and water.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Surgical Site Infections
Background:
- Postoperative gas gangrene is a severe complication.
- Clostridium welchii is a known causative agent.
- Understanding transmission routes is crucial for prevention.
Purpose of the Study:
- Investigate the source and transmission of Clostridium welchii in postoperative gas gangrene cases.
- Evaluate the effectiveness of different skin decontamination methods.
Main Methods:
- Case study analysis of four gas gangrene patients.
- Bacteriological isolation of Clostridium welchii from wounds, feces, and operating room floors.
- Skin surface sampling on 76 patients using contact plates.
- Assessment of povidone-iodine, alcohol, and soap/water for skin decontamination.
Main Results:
- Clostridium welchii was isolated from all four patients' wounds and feces.
- Low levels of Cl. welchii were detected on operating room floors.
- Patient intestinal flora was identified as the likely source of infection.
- Heavy skin contamination with Cl. welchii, particularly spores, was observed in 76 patients, especially those with fecal incontinence.
- Povidone-iodine compresses significantly reduced Cl. welchii; alcohol showed some efficacy; soap and water were ineffective.
Conclusions:
- Clostridium welchii infections in these cases likely originated from patients' endogenous intestinal flora via fecal contamination.
- Effective skin decontamination strategies are essential for preventing surgical site infections.
- Povidone-iodine is a highly effective agent for reducing Cl. welchii on the skin.