Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-28T07:50:43.423Z Has data issue: false hasContentIssue false
  • English
  • Français

Routes and Sources of Staphylococcus aureus Transmitted to the Surgical Wound During Cardiothoracic Surgery Possibility of Preventing Wound Contamination by Use of Special Scrub Suits

Published online by Cambridge University Press:  02 January 2015

Ann Tammelin ,
Anna Hambræus  and
Elisabeth Ståhle
Ann Tammelin*
Affiliation:
Departments of Clinical Microbiology, University of Uppsala, Uppsala, Sweden
Anna Hambræus
Affiliation:
Departments of Clinical Microbiology, University of Uppsala, Uppsala, Sweden
Elisabeth Ståhle
Affiliation:
Departments of Clinical Microbiology, University of Uppsala, Uppsala, Sweden
*
Department of Clinical Microbiology, University Hospital of Uppsala, S-751 85 Uppsala, Sweden
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To trace the routes of transmission and sources of Staphylococcus aureus found in the surgical wound during cardiothoracic surgery and to investigate the possibility of reducing wound contamination, with regard to total counts of bacteria and S aureus, by wearing special scrub suits.

Methods:

A total of 65 elective operations for coronary artery bypass graft with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Bacteriological samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves and from the patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Bacteriological samples also were taken from the subcutaneous walls of the surgical wound just before closing the wound. Total counts of bacteria on sternal skin and wound walls (colony-forming units [CFUs//cm2) were calculated, as well as total counts of bacteria in the air (CFUs/m3). Strains of S aureus recovered from the different sampling sites were compared by pulsed-field gel electrophoresis (PFGE).

Results:

Special scrub suits significantly reduced total counts of bacteria in air compared to conventional scrub suits (P=.002). The number of air samples in which S aureus was found was significantly reduced by special scrub suits compared with conventional scrub suits (P=.016; relative risk, 4.4; 95% confidence interval [CI95], 1.3-14.9]). By use of PFGE, it was possible to identify two cases of possible airborne transmission of S aureus when wearing conventional scrub suits, whereas no case was found when wearing special scrub suits. When exposed to airborne S aureus, the concomitant sternal carriage of S aureus was a risk factor for having S aureus in the wound.

Conclusions:

Use of tightly woven special scrub suits reduces the dispersal of total counts of bacteria and of S aureus from staff in the operating room, thus possibly reducing the risk of airborne contamination of surgical wounds. The importance of careful preoperative disinfection of the patient's skin should be stressed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 6 , June 2001 , pp. 338 - 346
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Lidwell, OM, Lowbury, EJ, Whyte, W, Blowers, R, Stanley, SJ, Lowe, D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed) 1982;285(6334):104.Google Scholar
2.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR, the Hospital Infection Control Practice Advisory Committee. CDC Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 1999;4:247–280.CrossRefGoogle Scholar
3.Wong, ES. Surgical site infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins;1996:154–175.Google Scholar
4.Ståhle, E, Tammelin, A, Bergström, R, Hambræus, A, Nyström, SO, Hansson, HE. Sternal wound complications—incidence, microbiology and risk factors. Eur J Cardiothorac Surg 1997;11:1146–1153.Google Scholar
5.Loop, FD, Lytle, BW, Cosgrove, DM, Mahfood, S, McHenry, MC, Goormastic, M, et al. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity and cost of care. Ann Thorac Surg 1990;49:179–187.CrossRefGoogle Scholar
6.Rodriguez-Hernandez, MJ, de Alarcon, A, Cisneros, JM, Moreno-Maqueda, I, Marrero-Calvo, S, Leal, R, et al. Suppurative mediastinitis after open-heart surgery: a comparison between cases caused by gram-negative rods and by gram-positive cocci. Clinical Microbiology and Infection 1997;3:523–530.Google Scholar
7.Tammelin, A, Domicel, P, Hambræus, A, Ståhle, E. Dispersal of methicillin-resistant Staphylococcus epidermidis by staff in an operating suite for thoracic and cardiovascular surgery: relation to skin carriage and clothing. J Hosp Infect 2000;44:119–126.Google Scholar
8.Allander, C, Abel, E. Investigation of a new ventilating system for clean rooms. Med Res Eng 1968;7:28–38.Google ScholarPubMed
9.Hambræus, A, Hoborn, J, Whyte, W. Skin sampling—validation of a pad method and comparison with commonly used methods. J Hosp Infect 1990;16:19–27.Google Scholar
10.Benediktsdóttir, E, Hambraeus, A. Isolation of anaerobic and aerobic bacteria from clean surgical wounds: an experimental and clinical study. J Hosp Infect 1983;4:141–148.CrossRefGoogle ScholarPubMed
11.Miranda, AG, Singh, KV, Murray, BE. DNA fingerprinting of Enterococcus faecium by pulsed-field gel electrophoresis may be a useful epidemiologic tool. J Clin Microbiol 1991;29:2752–2757.Google Scholar
12.Tenover, FC, Arbeit, RD, Goeing, RV, Mickelsen, PA, Murray, BE, Persing, DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
13.Lidwell, OM. Air, antibiotics and sepsis in replacement joints. J Hosp Infect 1988;11(suppl C):18–40.Google Scholar
14.Blomgren, G, Hambraeus, A, Malmborg, AS. The influence of the total body exhaust suit on air and wound contamination in elective hip-operations. J Hosp Infect 1983;4:257–268.Google Scholar
15.Rodriguez-Hernandez, MJ, de Alarcon, A, Cisneros, JM, Moreno-Maqueda, I, Marrero-Calvo, S, Leal, R, et al. Suppurative mediastinitis after open-heart surgery: a comparison between cases caused by gram-negative rods and by gram-positive cocci. Clinical Microbiology and Infection 1997;3:523–530.Google Scholar
16.Whyte, W, Hodgson, R, Tinkler, J. The importance of airborne bacterial contamination of wounds. J Hosp Infect 1982;3:123–135.Google Scholar
17.Whyte, W, Hambraeus, A, Laurell, G, Hoborn, J. The relative importance of routes and sources of wound contamination during general surgery, I: non-airborne. J Hosp Infect 1991;18:93–107.Google Scholar
18.Lidwell, OM, Lowbury, EJL, Whyte, W, Blowers, R, Stanley, SJ, Lowe, D. Bacteria isolated from deep joint sepsis after operation for total hip or knee replacement and the sources of the infection with Staphylococcus aureus. J Hosp Infect 1983;4:19–29.Google Scholar
19.Scheibel, JH, Jensen, I, Pedersen, S. Bacterial contamination of air and surgical wounds during joint replacement operations. Comparison of two different types of staff clothing. J Hosp Infect 1991;19:167–174.Google Scholar
20.Ayliffe, GAJ, Babb, JR, Collins, BJ. Dispersal and skin carriage of Staphylococci in healthy male and female subjects and patients with skin disease. In: Hers, JFP, Winkler, KC, eds. Airborne Transmission and Airborne Infection. Utrecht, The Netherlands: Oosthoek Publishing; 1973.Google Scholar
21.Hare, R, Ridley, M. Further studies on the transmission of Staph, aureus. BMJ 1958;Jan 11:69–73.CrossRefGoogle Scholar
22.Hambraeus, A, Laurell, G, Nybacka, O, Whyte, W. Biliary tract surgery: a bacteriologic and epidemiologic study. Acta Chir Scand 1990;156:155–162.Google ScholarPubMed
23.Hambraeus, A. A microbiologist's view on perioperative hygiene and prophylactic antibiotic treatment. Acta Chir Scand 1987;538:96–100.Google Scholar
24.Noble, WC, Valkenburg, HA, Wolters, CH. Carriage of Staphylococcus aureus in random samples of a normal population. J Hyg (London) 1967;65:567–573.Google Scholar
25.Blowers, R, Hill, J, Howell, A. Shedding of Staphylococcus aureus by human carriers. In: Hers, I, Winkler, KC, eds. Dispersal of Bacteria From the Human Body Surface. New York, NY: Halsted Press;1972:432–434.Google Scholar