بررسی ارتباط بین پاتوژنهای موجود در دست جراح و کمک جراح و محل عمل با ارگانیسمهای محل عفونت زخم جراحی در بیمارانی که در بیمارستان رسول اکرم و شهیداکبرآبادی تهران سزارین شده و با عفونت زخم بعد از عمل مراجعه کرده اند

Introduction: Some previous studies have shown that in the surgical site infection, sterility of the surgeon’s hands is not so effective, while the other studies have shown the other way. Also some studies believe that most infections come either from pathogens of the patient’s skin or from the pathogens of the environment. This study is designed to compare the pathogens of the surgeon’s hands and surgical site for each patient with the same patient’s pathogens of the wound infection, and recognize the possible infection factor. However, there are some altering factors that make the final conclusion, difficult. Some of these factors are unknown. It is tried to match the conditions for all patients, to reduce the chance of biased results. However, some of them could not be prevented. Methods and Materials: The current study is designed in the form of prospective cohort. In this study, 122 patients which have undergone cesarean operation in the two hospitals of Rasool Akram and Shahid Akbarabadi in the city of Tehran, are considered for the study. The method of sampling was that after washing the surgeon’s and surgeon assistant’s hands with sterile soap, a culture is taken from the grooves of their hand palms on the sheep blood agar, and after preparation of the operation site and before cutting, a culture is taken from the operation site. After 5 to 7 days, the patients are called by phone to the hospital, and their operation site is investigated. If any sign of infection including stiffness, erythma, and discharge is seen, once more a culture is taken from the operation site, and the type of pathogen of operation site and the surgeon’s and surgeon assistant’s hands and that of the wound site are compared and their relation are investigated. To reduce the chance of biased results, the type of operations are matched and all the known infectious factors, such as immune deficiency, diabetes, history of using immunosuppressor drugs, Corton, and rupture of membrane, are excluded from the study. Results: In this study, 122 patients have participated, which have undergone cesarean operation in Rasool Akram and Shahid Akbarabadi hospitals in Tehran. From these patients, 57% were from Akbarabadi hospital, 39% were above age of 30, 58% had urgent operation, 57% had repeated cesarean operation, 69% were obese, 9% were illiterate, 14% had hypertension or pre-eclampsy, 12% faced with tearing of operation gloves during operation, for %62 of them povidine iodine is used for washing the surgeon’s hands. The results were that in the 4.9% of cases, the surgeon’s hands culture results were positive, in 16.4% of the cases, the surgical site culture results were positive, and finally, in 6.6% of the cases, the wound infection culture results were positive. For investigation of the relation between the wound infection culture result and the other recorded parameters of the operation, the mean and standard deviation of the different parameters in the presence or absence of the wound infection are measured and compared with each other. Then, the significance of the relation is investigated with the calculation of the P Value, and with the calculation of the Odds Ratio for different parameters, their effects as a risk factor for wound infection positive culture is examined. Conclusions: This study shows that the wound infection culture result has significant and direct relation with the surgeon’s hand culture result, but it rejects the significant relation between wound infection culture result and the surgical site culture result, that requires more samples and investigations for confirmation, and requires that all the samples are taken from a single hospital to reduce the chance of altering factors. This study also shows that for the wound infection culture result, these are some risk factors: age above 30, being an urgent operation, being a repeated operation, obesity, illiteracy, past medical history, hypertension or pre-eclampsy, type of washing solution (povidine iodine), and surgeon’s hands positive culture result. This study shows, as well, that for the surgeon’s hands positive culture result, being an urgent operation, and type of washing solution (povidine iodine) are some risk factors.