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Bacterial recolonization of the skin under a polyurethane drape in hip surgery
W Fleischmann1, H Meyer, A von Baer
1Department of Traumatology, University of Ulm, Germany.
Abstract:
This study investigated the proliferation of skin flora under polyurethane (PU) wound dressings following surgical interventions. In vitro the film proved to be impermeable to staphylococci. However, bacteria migrated under the film, showing a preference for the adhesive rather than the adhesive-free areas. The skin of 43 patients with incisions of the proximal thigh was covered postoperatively with a transparent PU-dressing. This was examined bacteriologically preoperatively and at the third and seventh postoperative days. The use of an antiseptic (povidone iodine) reduced the number of colony forming units in the postoperative skin but at the same time there was a significant reduction of bacteria under the film in comparison with the uncovered skin. The numbers and species of bacteria in different areas under the film did not suggest a spread of organisms from the uncovered skin to the skin under the film, but rather that there was a multifocal microbial regeneration.
Insights
Polyurethane (PU) wound dressings allowed bacterial migration under the film, particularly in adhesive areas. Postoperative antiseptic use reduced bacteria on skin and under dressings, suggesting multifocal microbial regeneration rather than spread.
Area of Science:
- Microbiology
- Wound Healing
- Biomaterials
Background:
- Polyurethane (PU) films are used as wound dressings.
- Understanding microbial behavior under these dressings is crucial for surgical site infection prevention.
Purpose of the Study:
- To investigate skin flora proliferation under PU wound dressings post-surgery.
- To assess bacterial migration patterns and the effect of antiseptics.
Main Methods:
- In vitro testing of PU film impermeability to staphylococci.
- Bacteriological examination of proximal thigh incisions in 43 patients, preoperatively and on postoperative days 3 and 7.
- Comparison of bacterial counts in adhesive vs. adhesive-free areas under the dressing and on uncovered skin.
Main Results:
- In vitro, PU film was impermeable to staphylococci, but in vivo, bacteria migrated under the film.
- Bacteria showed a preference for adhesive areas under the PU dressing.
- Povidone-iodine antiseptic reduced bacterial counts on the skin and significantly reduced bacteria under the dressing.
- Bacterial species under the film suggested multifocal regeneration, not spread from uncovered skin.
Conclusions:
- Polyurethane wound dressings can permit bacterial migration, especially in adhesive zones.
- Antiseptic application can reduce bacterial load both on the skin and beneath PU dressings.
- Multifocal microbial regeneration, rather than external spread, appears to be the primary source of bacteria under these dressings.