title: An in vitro study assessing the infection risk of low-cost polyethylene mosquito net compared with commercial hernia prosthetics.
abstract: BACKGROUND
  The innovative use of sterilized mosquito net as a cheaper alternative to commercial mesh for hernia repair has gained increasing recognition. Developing health care systems have inherently higher surgical site infection rates, and concerns regarding the introduction of untested prosthetic hernia meshes have been raised. This in vitro study assesses the infection risk of polyethylene (PE) mosquito net mesh compared with commercial hernia prosthetics by assessing the essential (first) step in the pathogenesis of mesh infections.
  
  
  METHODS
  Individual meshes were inoculated with Staphylococcusepidermidis and Staphylococcusaureus with a bacterial inoculum of 10(2) bacteria. Inoculated meshes were incubated for 18 h in tryptone soy broth and then analyzed using scanning electron microcopy. The final fraction of the bacteria adherent to each of the meshes was compared. One-way analysis of variance was performed on the bacterial counts. The Tukey test was used to determine the difference between the different biomaterials in the event the one-way analysis of variance was significant.
  
  
  RESULTS
  There was no significant difference in the mean number of adherent bacteria to PE mosquito net compared with the monofilament polypropylene-based meshes (Prolene and Bard Soft Mesh). Multifilament Vypro mesh had significantly greater mean bacterial adherence compared with PE mosquito net (P < 0.001 with S aureus and P = 0.003 with S epidermidis).
  
  
  CONCLUSIONS
  In vitro infection risk of PE mosquito net is not significantly different from commonly used monofilament polypropylene commercial prosthetics and is in fact lower than a commonly used commercial multifilament mesh. This study adds to the growing body of evidence that indicates that these meshes can be safely deployed.
authors.affiliation: Peninsula College of Medicine and Dentistry, Plymouth, UK. dsanders@doctors.org.uk
authors.forename: David L
authors.initials: DL
authors.lastname: Sanders
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Kingsnorth
authors.forename: Roy
authors.initials: R
authors.lastname: Moate
authors.forename: Jane A
authors.initials: JA
authors.lastname: Steer
mesh_terms: D001422:Bacterial Adhesion / Q000502:physiology; D003362:Cost-Benefit Analysis; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D057147:Mosquito Nets / Q000009:adverse effects* / Q000191:economics / Q000382:microbiology; D020959:Polyethylene; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification / Q000502:physiology; D013526:Surgical Mesh / Q000009:adverse effects* / Q000191:economics / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology*
chemical_list: D020959:Polyethylene
keywords: Hernia; Infection; International; Mesh; Mosquito net; Rural