Assessment of Vaginal Preparation Solutions to Prevent Microbial Contamination at Key Surgical Sites in Laparoscopic Hysterectomy

Abstract

<h3>Study Objective</h3> The goal of our study is to determine which solution is the best for maintaining a sterile vaginal field during surgery. <h3>Design</h3> The primary objective was to determine a difference in microbial growth from two sites after randomization to one of three vaginal preparation solutions (povidone-iodine, 2% chlorhexidine gluconate, or 4% chlorhexidine gluconate) by obtaining bacterial cultures of the vaginal fornix and uterine manipulator handle. The secondary objective was to determine any difference in patient reported vaginal itching or burning between the three vaginal preparation solutions. <h3>Setting</h3> Hospital operating room with patients in dorsal lithotomy position. <h3>Patients or Participants</h3> All patients undergoing laparoscopic hysterectomy by either of two participating surgeons and who met inclusion criteria were invited to participate in this study. A total of 50 participants were included. <h3>Interventions</h3> After preparation with the assigned solution and before beginning the surgery, a baseline vaginal culture was taken. Prior to completing the hysterectomy, a second vaginal culture and a culture from the uterine manipulator handle were taken. The swabs were processed as aerobic and anaerobic cultures. <h3>Measurements and Main Results</h3> There was no difference in microbial growth from the baseline vaginal culture across the three groups (p=1.00). There was a significant difference in the presence of microbial growth from the second vaginal culture, with the PI group exhibiting more positive cultures compared to the 2% CHG and 4% CHG groups (93.8% vs. 47.4% and 20.0% respectively, p=<0.001). The 2% CHG group had more positive cultures on the uterine manipulator handle compared to the PI and 4% CHG groups (21.1% vs. 6.3% and 6.7%, p=0.35). <h3>Conclusion</h3> Our study demonstrates decreased microbial growth at the vaginal field during laparoscopic hysterectomy when using 4% CHG for vaginal preparation compared to 2% CHG and PI.