title: Clinical correlation between irrigation bottle contamination and clinical outcomes in post-functional endoscopic sinus surgery patients.
abstract: BACKGROUND
  Sinonasal irrigation after endoscopic sinus surgery (ESS) is a common practice, but the role irrigation bottles play in iatrogenic contamination of the operated sinuses is unknown. Therefore, we investigated whether irrigation bottles used postoperatively become contaminated and have any potential association with immediate postsurgical infection and outcomes.
  
  
  METHODS
  Patients irrigated twice daily after ESS. Bottle cleaning was performed as recommended by the manufacturer. New bottles were distributed at the time of the operation and at each postoperative visit. During postoperative weeks 1, 2, and 4, bottles were cultured. Medical charts were reviewed for the presence of postsurgical infection and changes in management.
  
  
  RESULTS
  Twenty post-ESS patients were enrolled and examined at weeks 1, 2, and 4. A total of 51 bottles were collected and cultured. Overall, 15 of 51 (29%) bottles demonstrated bacterial growth when cultured. During the first two collection periods, 10 of 40 (25%) bottles demonstrated bacterial growth when cultured; however, five of 11 (45%) bottles collected at the last postoperative visit demonstrated bacterial growth when cultured. During the study, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were frequently recovered during the collection periods. Other organisms isolated included Escherichia coli and Enterobacter spp. Although positive bottle cultures were more common at weeks 2 and 4, no postoperative infections occurred.
  
  
  CONCLUSIONS
  Irrigation bottles used postoperatively have a measurable incidence of contamination. Contamination rate increases when bottles are used for longer than 1 week, but this does not appear to result in postsurgical infection.
authors: Loyola University Medical Center, Department of Otolaryngology-Head and Neck Surgery, Maywood, Illinois 60125, USA. kwelch1@lumc.edu
authors: Kevin C
authors: KC
authors: Welch
authors: Michael B
authors: MB
authors: Cohen
authors: Laurie L
authors: LL
authors: Doghramji
authors: Noam A
authors: NA
authors: Cohen
authors: Rakesh K
authors: RK
authors: Chandra
authors: James N
authors: JN
authors: Palmer
authors: Alexander G
authors: AG
authors: Chiu
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D004724:Endoscopy / Q000379:methods*; D004866:Equipment Contamination / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D012307:Risk Factors; D012852:Sinusitis / Q000188:drug therapy / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000295:instrumentation*