June 09-41-2.indd - Kma.org.kw

106Comparative Efficacy of Two Methods of Skin Preparation of the Perineal and Genital Skin ...June 2009Table 3: The bacteria isolates from all patients in Groups 1 and 2(N = 231).Micro-organisms No. of patients (N = 231) %Gram -veE. coliKlebs. pneumoniaeProteus mirabilisPseudomonas sppE. faecalis *Sub TotalGram +veS. haemolyticusS. epidermidisS. hominisS. warneriOthersSub TotalGross TotalGoup - 1n = 63513121028104295363Goup - 2n = 76Gross Totaln = 139DISCUSSIONThe ideal antiseptic is one that is rapidly lethalto all forms of bacteria and their spores, capableof bactericidal activity for a prolonged period,has no injurious effects on wound tissues or skin,delineates the operation site and is easily applied andremoved [15] . The antiseptic used in skin preparationsand the sequence in which they are used is a matterof individual surgeon’s preference with variationsfrom unit to unit and even within the same surgicalunit as shown by McGrath and McCory [16] in asurvey of pre-operative skin preparation practicesin surgical units and among surgeons in NorthernIreland. The outcome of our current study seemsto justify our unit’s policy of using Savlon® as theantiseptic of choice for perineal skin disinfectionprior to endoscopic procedures as its use wasassociated with significant reduction in the numberof patients with culture-positive bacteria as well as inthe quantity of the bacterial isolates as demonstratedin specimens B compared with samples A in bothgroups of patients. Our study further demonstratedthat instead of using Savlon® alone to clean threetimes, the addition of an iodine-based antisepticagent like Betadine® appears to guarantee betterand more efficient disinfection. The use of Savlon®twice followed by further disinfection with Betadinereduced positive microbiological culture rate to 2.6%in swab C of group-2 patients, compared to 11.4% ingroup-1 (p < 0.001). This is because iodine containingantiseptics like Betadine®, in addition to havingstrong bacteriostatic activity are also known to kill040105281546871765532215563588171241393.63.62.21.41.410.840.325.25.85.812.289.2100Over all positive culture 139/231 (60.2%) patients* Two patients had E. faecalis + E.coli isolated from the perinealswab. Both patients were on urethral catheter for more than 28days before surgeryTable 4: Distribution of bacterial isolates before and after skinpreparation with antisepticsBacterial isolatesGram +veS. haemolyticusS. epidermidisS. hominisS. warneriOthersGram –veE. coli *Klebsiella sppProteus mirabilisPsuedomonas sppE. faecalis*Total no.of patientsTotal (%)No. of patients with positive culture in specimensGroup - 1 (n = 114) Group - 2 (n = 117)A B C A B C1783155020243(35.1)10012011107(7.1)bacteria, fungi, viruses and spores [17,18] . The bacteriaisolation rates from the specimens of the two patientgroups were significantly reduced (p < 0.001) postdisinfectionof the perineum and genitalia.In this study, our patients had about six-foldhigher isolation rates of Gram-positive bacteriathan the Gram-negative bacteria, a finding that wasstatistically significant (p < 0.001). Of these Grampositivebacteria, S.haemolyticus was by far the isolatemost frequently present in the perineum of thesepatients, including those with or without underlyingco-morbidity. This finding is essentially similar to thereports of Magera et al [1] and Larson et a l[19] which alsofound S.haemolyticus as the commonest isolate in theirpatients compared with S. hominis in controls. The nextfairly common isolate was S.epidermidis but we did notisolate S. hominis or S.aureus from any of the patientswhich essentially also supports earlier report [19] . Ofparticular concern are the high isolation rates of thecoagulase-negative staphylococci (CoNS) whichare increasingly becoming important in nosocomialinfections and infections in immunosuppressedindividuals.Post-operative septicemia occurred in morepatients in group-1 compared to group-2, althoughthe difference was not statistically significant. Allthe patients had endoscopic procedures; thereforethey would be expected to have a low septicemiarate. Importantly, the efficacy of adding Betadineto the perineal skin antiseptic preparation regimenis demonstrated by the drastic reduction in thenumber of patients with positive perineal cultureand the bacterial load post-disinfection as well as thesignificant lower septicemia rate in group B patients.1021000000013(11.4)281546190401076(63)32001000006(5.1)11001000003(2.6)*E. faecalis and E. coli isolated from the perineal swabs of twopatients who were on indwelling urethral catheter for more than28 days prior to surgery