The effect of thorough preoperative disinfection on the incidence of postoperative mediastinitis

This study was conducted to evaluate the effectiveness of scrubbing the ski n of patients scheduled to undergo elective cardiac surgery with disinfecta nt solutions in an attempt to reduce the incidence of the potentially fatal postoperative complication of mediastinitis, Since April 1991, we have rou tinely disinfected the skin of all such patients three times preoperatively , A retrospective comparison of the incidence of mediastinitis before and a fter April 1991 was carried out. Microbiological examinations of the anteri or chest were conducted in ten patients admitted for elective operations, a nd in four patients admitted for emergency surgery. Specimens were obtained before each scrubbing, before the operation, and just after skin closure. There was a significant decrease in the general incidence of mediastinitis after April 1991 (P < 0.01). Microbiologically, significant decreases in co lony counts were also observed after the first (P < 0.05) and second scrubb ing (P < 0.05) in the ten patients specifically studied before elective sur gery. No colonies grew in the postoperative specimens from any of these pat ients, but colony formations were observed in two of the four patients who underwent emergency surgery (P = 0.066), Thus, we conclude that our thoroug h disinfection method effectively achieves adequate, prolonged suppression of the skin flora, which explains the marked decrease in the incidence of m ediastinitis in our hospital since its institution.