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Investigations of the bacteriological factors in clean neurosurgical wounds
S I Savitz1, E J Bottone, M H Savitz
1Department of Neurosurgery, Mount Sinai Hospital, New York, New York.
Abstract:
A number of questions remained unanswered by the empirical success of antimicrobial prophylaxis for neurosurgical patients at The Mount Sinai Hospital during a 15-year period. Vancomycin (1 g intravenously) and tobramycin (80 mg intramuscularly) were administered in the induction room. Streptomycin (50 mg) was mixed into each liter of saline used to irrigate the surgical incision. A series of 45 consecutive clean neurosurgical operations were investigated. The potential sources of random contamination of the surgical wound that were studied included the following: 1) the patient's skin; 2) the flora of the skin and nares of the operating team; 3) the surgical apparel; 4) the surgeons' gloves; and 5) the airborne organisms in the operating theater. No wound infections were documented during a 4-month period between June and September of 1991. A remarkable 98% of the intraoperative cultures of the surgical wounds were free of bacteria. Positive cultures of glove imprints were found in 29% of the operations, and the bacterial source was traced to four different surgeons in four operations (9%). The surgeons' gloves were also a source of potential pathogens (Staphylococcus aureus) in two instances, but the bacterial species were also recovered from cultures of the environment. Based on individual biotyping of bacteria and antibiotic susceptibility testing, no consistent source or pattern could be uncovered for the bacteria in the surgical wound or the operating room air.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Antimicrobial prophylaxis in neurosurgery showed high success, with 98% of surgical wounds bacteria-free. However, glove contamination occurred in 29% of operations, highlighting potential pathogen transmission risks.
Area of Science:
- Neurosurgery
- Infectious Disease
- Hospital Epidemiology
Background:
- Antimicrobial prophylaxis is empirically successful in neurosurgery.
- Potential sources of surgical wound contamination require investigation.
Purpose of the Study:
- To investigate sources of surgical wound contamination in neurosurgical patients.
- To assess the efficacy of established antimicrobial prophylaxis protocols.
Main Methods:
- Studied 45 consecutive clean neurosurgical operations.
- Collected intraoperative wound cultures and environmental/personnel samples.
- Analyzed bacterial contamination from patient skin, operating team flora, apparel, gloves, and airborne organisms.
Main Results:
- No wound infections were documented in a 4-month period.
- 98% of intraoperative surgical wound cultures were sterile.
- Surgeons' gloves showed contamination in 29% of operations, with Staphylococcus aureus identified in 2 instances.
Conclusions:
- Established antimicrobial prophylaxis protocols demonstrate high efficacy in preventing neurosurgical wound infections.
- Surgeons' gloves represent a potential source of bacterial contamination.
- No consistent source or pattern of contamination was identified for surgical wounds or operating room air.