Determination of contamination of operation field in head and neck oncological surgery

Authors: Maciej Mazurek

Filip NowakowskiArtur Włodarczyk

Michał Głuski

Head and Neck Cancer Clinic of Marie Sklodowka Curie Memorial Cancer Centre – InstituteHead: Prof., Andrzej Kawecki Ph.D.

Tutors: Janusz Jaworowski M.D., Maciej Rysz M.D.

Students' Scientific Groupattached toHead and Neck Cancer Clinic

Background:• Surgical resections of head and neck cancer

with one-stage reconstructions are long procedures with high risk of microbial contamination;

• Determination of contaminating factors and efficacy of aseptic procedures is vital for reduction of possible surgical complications.

Aim:

Define possible complications

Determinate contaminating factor

Improvetreatment

Aim of this study is to determinate amount and type of the surgical field contamination factors and to define possible complications that can occur after resection of advanced tumour of head and neck.

Materials and Methods

• Swabs were taken from surgical field and surgical drapes every 2 hours (at 0h, 2h, 4h, 6h);

• Samples were delivered to the laboratory immediately;

• To analize our results we have used Statistica.

• The prospective study, which was approved by Bioethical Committee;

• The study was performed during long time surgical resections with one-stage reconstruction;

Materials and Methods

Microbial culturing methods:• Blood agar plate – preliminary

culturing (24-48 h, 37 Degrees Centigrade, CO2 enhanced atmosphere if needed);

• CPS agar, Chapman agar – differential culturing (24h, 37 Degrees Centigrade);

Final identification and antibiogram:

• ATB, • API, • VITEK

Culturing methods and microbial diagnostics:

Results:

Comparison of infected samples in time relevance:

39 out of 40 patients included to the research;

252 samples188 contaminated(74,6% contaminated).

Results: contaminated samples 4-6h and

over 6hSurgeries.

Results: contaminated samples 4-6h and

over 6hSurgeries.

Results: infected samples

Comparison of the most common pathogenes:

One sample could be infectedby more than one pathogeneThese pathogenes were the most popular outcome.

Results: antibiogram

Antibiotic Number of tested samples

Determinated resistancy

Amoxicillin and Clavulanic acid

22 1

Penicillin 11 0

Clindamicin 23 3

Vancomicin 16 0

Ciprofloxacin 20 1

Ceftriaxone 16 2

Tetracycline 19 7

Gentamicin 21 4

Results: complications

Complications after surgeries occured in 8 out of 40 cases (20%).

Conclusions: • The number of infected samples

from surgical field was not constantly increasing in time during surgeries;

• Peak of the contaminations was observed in 2nd hour, in timing of finishing tumour resection;

• Most common pathogenes were: Str. spp, Staph. Coagulasis(-) and Propionibacterium acnes;

• In spite of observing standard asepsis rules contamination of the surgical field occurs frequently.