Pre-operative bladder irrigation with Povidone Iodine in reducing open prostatectomy surgical site infection(SSI) at University Teaching Hospital, Lusaka

Abstract

Objective:The study investigated the efficacy of using 1% povidone-iodine pre-operative bladder irrigation in reducing open prostatectomy surgical site infections at the University Teaching Hospital, Department of Surgery, Lusaka. Patients and Methods:One hundred and thirty patients were recruited from the waiting list of Urology unit II in the department of surgery during the period between July 2011 to December 2012. The patients were randomly allocated to each of the two groups using a non-probability convenient sampling method. Each group had 65 patients. Patients in the study group had their bladder irrigated with 1% 50cc povidone-iodine which was drained upon opening the bladder and open prostatectomy performed as per standard technique. In the control group povidone-iodine was not used. Both groups received pre-operative antibiotics 30 minutes before incision and post-operative for 5 days. Pre-operative, intraoperative and post-operative data were collected on a standardised data collection forms.Post-operative irrigation was done for 24 to 48 hours. After 9 to 12 days the catheter was removed as an out patient. Patients were followed up in the urological clinic at 1 week, 2 weeks and at 4 weeks post-operatively to assess whether they had developed surgical site infections according to CDC guidelines. Data were analysed using SPSS version 16.Results :The patients mean age was 71.1 in the control group and 71.4 in the study group with no statistically significant difference (t=0.318; p=0.75; df =126.89). The overall surgical infection rate was 16.2%. In the control group 15 out of 65 patients (23.1%) developed SSIs. While in the study group 6 out of 65 patients (9.2%) developed SSIs. The difference in the rates of SSI between the two groups was statistically significant (χ²; p<0.05; df=126.89) Escherichia coli was the most predominant organism 13/37 (35%), Streptococcus 7/37 (18.9%), Citrobacter koseri 5/37 (13.5%), Klebsiella sp 4/37 (10.8%). Escherichia coli, Streptococcus and Citrobacter were sensitive to ciprofloxacin; Pantoea agglomerans was sensitive to ceftazidime, while Staphylococcus coagulase was sensitive to imipenem. Enterobacter cloace was resistant to all antibiotics used.Conclusion:Irrigating the bladder with 1% povidone-iodine resulted in a significant lower rate of surgical site infections, reduced morbidity and post-operative hospital stay.