title: Antiseptic wound ventilation with a gas diffuser: a new intraoperative method to prevent surgical wound infection?
abstract: Postoperative wound infections are often a result of peri-operative contamination by Staphylococcus aureus. With a new insufflation device, a gas diffuser, it has become possible to establish a local micro-environment of almost 100% carbon dioxide in an open surgical wound. The device enables ventilation of the wound with an antiseptic agent, which in gaseous form can be delivered as a low uniform dose to all parts of the wound. The use of carbon dioxide (CO2) as a carrier gas eliminates possible inflammability of an antiseptic agent and helps to concentrate it to the site of interest by gravity. Using the above delivery system we have demonstrated the antibacterial effect of gaseous ethanol on S. aureus inoculated on sterile filter disks and blood agar plates, respectively. Ethanol is a very potent antiseptic agent with known properties, which makes it suitable for testing the maximal decontamination level. On filter disks, CO2 carrying vapour from a 95% ethanol solution decreased the number of colony-forming units after 5 min of exposure (P=0.04), and killed all bacteria within 10-15 min (P<0.001). In the presence of organic material, i.e. on exposed blood agar plates, the colony size decreased with exposure time, and no colonies were detected after 60 min of exposure (P<0.001). Antiseptic gas derived from 70% ethanol solution was less effective than that from 95% ethanol (P<0.001). CO2 humidified with water did not have a significant effect on number or size of the colonies. Our findings suggest that intraoperative wound antisepsis with a gas mixture of CO2 and an antiseptic agent delivered with a gas diffuser, may be a simple method to reduce the risk of postoperative wound infection.
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institute, Huddinge University Hospital, SE-141 86 Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Persson
authors.forename: J-I
authors.initials: JI
authors.lastname: Flock
authors.forename: J
authors.initials: J
authors.lastname: van der Linden
mesh_terms: D000279:Administration, Cutaneous; D000336:Aerosols; D000704:Analysis of Variance; D000985:Antisepsis / Q000379:methods*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D015169:Colony Count, Microbial; D004058:Diffusion; D004337:Drug Carriers; D004867:Equipment Design; D000431:Ethanol / Q000008:administration & dosage*; D006112:Gravitation; D006801:Humans; D007327:Insufflation / Q000295:instrumentation / Q000379:methods*; D007430:Intraoperative Care / Q000379:methods*; D009330:Nebulizers and Vaporizers / Q000592:standards*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000336:Aerosols; D004337:Drug Carriers; D002245:Carbon Dioxide; D000431:Ethanol