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Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.ORCID iD: 0000-0001-5939-2932
Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Region Örebro County, Örebro, Sweden.ORCID iD: 0000-0001-5403-4183
2013 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 84, no 2, p. 151-158Article in journal (Refereed) Published
Abstract [en]

Background: Sternal wound infection after cardiac surgery is a serious complication. Various perioperative strategies, including plastic adhesive drapes, are used to reduce bacterial contamination of surgical wounds.

Aim: To compare plastic adhesive drape to bare skin regarding bacterial growth in wound and time to recolonization of the adjacent skin intraoperatively, in cardiac surgery patients.

Methods: This single-blinded randomized controlled trial (May 2010 to May 2011) included 140 patients scheduled for cardiac surgery via median sternotomy. The patients were randomly allocated to the adhesive drape (chest covered with plastic adhesive drape) or bare skin group. Bacterial samples were taken preoperatively and intraoperatively every hour during surgery until skin closure.

Results: Disinfection with 0.5% chlorhexidine solution in 70% alcohol decreased coagulase-negative staphylococci (CoNS), while the proportion colonized with Propionibacterium acnes was not significantly reduced and was still present in more than 50% of skin samples. P. acnes was significantly more common in men than in women. Progressive bacterial recolonization of the skin occurred within 2-3 h. At 120 min there were significantly more positive cultures in the adhesive drape group versus bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs 24%; P = 0.013). The only statistically significant difference in bacterial growth in the surgical wound was higher proportion of CoNS at the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).

Conclusion: Plastic adhesive drape does not reduce bacterial recolonization. P. acnes colonized men more frequently, and was not decreased by disinfection with chlorhexidine solution in alcohol.

Place, publisher, year, edition, pages
London, United Kingdom: Saunders Elsevier, 2013. Vol. 84, no 2, p. 151-158
Keywords [en]
Coagulase-negative staphylococci, Contamination, Plastic adhesive drape, Propionibacterium acnes, Recolonization, Sex differences
National Category
Medical and Health Sciences Surgery Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-29852DOI: 10.1016/j.jhin.2013.02.011ISI: 000319213200010PubMedID: 23623487Scopus ID: 2-s2.0-84878121765OAI: oai:DiVA.org:oru-29852DiVA, id: diva2:634079
Note

Funding Agencies:

Research Committee of Örebro County Council 

Nyckelfonden at Örebro University Hospital 

Available from: 2013-06-28 Created: 2013-06-28 Last updated: 2018-09-11Bibliographically approved
In thesis
1. The effect  of peroperative skin preparation on bacterial growth during cardiac surgery
Open this publication in new window or tab >>The effect  of peroperative skin preparation on bacterial growth during cardiac surgery
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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 preparation before cardiac surgery.

In study I, 10 healthy volunteers were compared in time to recolonization 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 microbial 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 intraoperative.

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 disinfection are sensitive tochlorhexidine.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 99
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 50
Keywords
OR, plastic adhesive drape, microbial skin sealent, chlorhexidine
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-31039 (URN)978-91-7668-978-3 (ISBN)
Public defence
2013-12-16, Wilandersalen, Universitetssjukhuset i Örebro, S. Grev Rosengatan 18, 703 62 Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-09-30 Created: 2013-09-30 Last updated: 2017-09-15Bibliographically approved

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Falk-Brynhildsen, KarinSöderquist, BoNilsson, Ulrica

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