Intraoperative contamination of synthetic vascular grafts. Effect of glovechange before graft implantation. A prospective randomised study

Objectives: to investigate the incidence of intraoperative graft contaminat ion, bacterial species and the influence of change of surgeon's gloves on c ontamination. Design: a prospective randomised study. Materials and methods: forty patients had implantation of synthetic vascula r grafts. All patients received intraoperative cloxacillin (2.0g) or clinda mycin (0.6g) intravenously. The procedures were randomised to two groups: G roup 1 - surgeons changed the gloves before the first contact with the vasc ular prosthesis and Group 2 - operation without glove change. The growth of all bacterial species from graft segments and from the gloves was recorded . The susceptibility to antibiotics was tested. Results: the number of contaminated grafts was similar in the two groups. G rowth of bacteria was recorded from 92.5% (37/40) of the graft segments and 33% (51/156) of glove imprints. Of the cultured species, 75% and 47%, resp ectively, were identified as coagulase-negative staphylococci (CNS). Twenty -eight per cent of CNS were resistant to cloxacillin, 15% to clindamycin, a nd 10% to cloxacillin and clindamycin. In all, 25% of the CNS strains were resistant to the prophylactic antibiotic used. In 50% of cases, the antibio gram of the CNS strain recovered from gloves agreed with that of the strain harvested from the graft. Conclusions: a high incidence of graft contamination was found which was no t reduced by changing gloves. However, changing gloves did seem to reduce t he number of bacterial species.