The effect of preoperative skin preparation
on bacterial growth during cardiac surgery
av
Karin Falk-Brynhildsen
Akademisk avhandling
Avhandling för medicine doktorsexamen i medicinsk vetenskap, med inriktning hälso- och vårdvetenskap,
som kommer att försvaras offentligt fredag den 6 december 2013 kl. 09.00, Wilandersalen, Universitetssjukhuset, Örebro
Opponent: docent Tor Monsen
Institutionen för klinisk mikrobiologi, Umeå universitet
Örebro universitet
Institutionen för hälsovetenskap och medicin 701 82 ÖREBRO
Abstract
Karin Falk-Brynhildsen (2013): The effect of preoperative skin preparation on bacterial growth during cardiac surgery. Örebro Studies in Care Sciences 50.
Routine products are used and procedures are followed in order to prevent and minimize the bacterial contamination of the surgical wound, and thus reduce the risk of postoperative wound infections. The overall aim of this thesis was to investigate the effect of different preoperative skin prepara-tion before cardiac surgery.
In study I, 10 healthy volunteers were compared in time to recoloniza-tion of the skin and bacterial growth with or without plastic adhesive drape. Bacterial samples were taken as paired samples on both side of the sternum. Plastic drape on disinfected skin seems to hasten recolonization compared with bare skin. In study II, 135 cardiac surgery patients were comparing plastic adhesive drape versus bare skin on the chest regarding intra-operative bacterial growth. Plastic adhesive drape did not reduce the bacterial recolonization or wound contamination, P. acnes colonizes males more often than females and P. acnes is not affected by disinfection with 0.5% chlorhexidine in ethanol. Study III, compared the leg harvesting site with or without microbal skin sealant in 135 CABG patients regarding intraoperative bacterial growth and postoperative wound infection. Almost no bacterial growth was found during surgery regardless of the use of mi-crobial skin sealant and bare skin. A high incidence of postoperative wound infections (16.8%) in 2 month follow up was present and SSI was largely caused by S. aureus, i.e. other bacterial species than observed in-traoperative. Study IV, a descriptive study using phenotypic and genotypic methods investigate susceptibility to chlorhexidine among S. epidermidis indicating that S. epidermidis isolates following preoperative skin disinfec-tion are sensitive to chlorhexidine.
Keywords: OR, plastic adhesive drape, microbial skin sealent, chlorhexidine Karin Falk-Brynhildsen, Institutionen för hälsovetenskap och medicin, Örebro University, SE-70182 Örebro, Sweden, karin.falk-brynhildsen@orebroll.se
