Vaginal scrub prophylaxis in abdominal hysterectomy

This study was aimed at reducing postoperative infection after abdominal hysterectomy in Chon Buri Hospital. Thirty patients scheduled for total abdominal hysterectomy were randomly divided equally into two groups of 15 patients each and received different preoperative preparation procedures. Group I patients received the procedure routinely used at Chon Buri Hospital comprising vaginal scrubbing in the evening before the operation day followed by abdominal scrubbing in operating room, whereas group II patients received the same treatment as Group I with additional vaginal scrubbing with 10% povidone-iodine immediately prior to the operation. All patients were given routinely antibiotics prophylaxis. After removal of the uterus, the discharge from the vaginal cuff was taken before and after closing the vaginal stump for aerobic and anaerobic cultures. Only 3 of group II patients (20%) were culture-positive before closure of vaginal cuff compared with 11 (73%) of group I patients (p < 0.01). After closure of the vaginal cuff, the positive bacterial culture declined to 5 (33%) in group I and 2 (13%) in group II (p > 0.05). Most of isolated organisms were vaginal normal flora. Postoperative infection with E. coli occurred in 2 patients of group I and none of group II (p > 0.05). Our results suggested that additional prophylactic vaginal scrubbing reduced postoperative bacterial infections, but this observed reduction did not reach a statistically significant level. Thus a larger sample size is needed to substantiate whether vaginal scrubbing could be advocated in a routine practice.