Intraoperative contamination of synthetic vascular grafts. Effect of glove change before graft implantation. A prospective randomised study.
OBJECTIVE
to investigate the incidence of intraoperative graft contamination, bacterial species and the influence of change of surgeon's gloves on contamination.


METHODS
a prospective randomised study.


METHODS
forty patients had implantation of synthetic vascular grafts. All patients received intraoperative cloxacillin (2.0 g) or clindamycin (0.6 g) intravenously. The procedures were randomised to two groups: Group 1 - surgeons changed the gloves before the first contact with the vascular prosthesis and Group 2 - operation without glove change. The growth of all bacterial species from graft segments and from the gloves was recorded. The susceptibility to antibiotics was tested.


RESULTS
the number of contaminated grafts was similar in the two groups. Growth of bacteria was recorded from 92.5% (37/40) of the graft segments and 33% (51/156) of glove imprints. Of the cultured species, 75% and 47%, respectively, were identified as coagulase-negative staphylococci (CNS). Twenty-eight per cent of CNS were resistant to cloxacillin, 15% to clindamycin, and 10% to cloxacillin and clindamycin. In all, 25% of the CNS strains were resistant to the prophylactic antibiotic used. In 50% of cases, the antibiogram of the CNS strain recovered from gloves agreed with that of the strain harvested from the graft.


CONCLUSIONS
a high incidence of graft contamination was found which was not reduced by changing gloves. However, changing gloves did seem to reduce the number of bacterial species.
Zdanowski
Z
Z
Department of Surgery, University of Lund, Sweden.
Danielsson
G
G
Jonung
T
T
Norgren
L
L
Ribbe
E
E
Thörne
J
J
Kamme
C
C
Schalén
C
C
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification / Q000254:growth & development; D001807:Blood Vessel Prosthesis / Q000382:microbiology*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D003023:Cloxacillin / Q000008:administration & dosage / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005932:Gloves, Surgical / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010403:Penicillin Resistance; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D013210:Staphylococcus / Q000145:classification / Q000254:growth & development; D013223:Statistics as Topic
D000900:Anti-Bacterial Agents; D010406:Penicillins; D002981:Clindamycin; D003023:Cloxacillin