Perioperative antimicrobials at cesarean section: Lavage versus three intravenous doses

Abstract

worm-like segmented forms with an internal tubular structure-“adults,” and numerous intermediate forms-“larvae.” All of these structures stained distinctly and demonstrated reddish purple granules. Many of the elongated forms appeared to us to be of vegetable origin, and their internal structure showed blue and red birefringence under polarized light. All of the smears containing cotton wool clippings showed vast numbers of “worms,” and those from gauze-filtered serum showed abundant spheres and intermediate forms. These inclusions were indistinguishable microscopically from those seen in blood films made directly from patient’s blood. We concluded that “Hydatoxi luulba” is a common laboratory contaminant, cellulose fibers, especially cotton wool. The worm-like appearance of cotton fibers when sulfated and stained with toluidine blue-0 can be explained by their molecular structure. Cotton fibers are composed of almost pure strands of cellulose fibrils which in turn are composed of chains of n-glucose units, each of which contains three free hydroxl groups.’ When cotton fibers are exposed to the sulfuric acid-ether sulfation reagent, the hydroxyl groups are esterified and react with toluidine blue-0 to assume a reddish purple appearance.3 The inner structures of the artifacts are the visible cellulose macrofibrils of the cotton fibers, and the outer segmented portion is an envelope of cellulose microfibrils attached in a bottlebrush fashion to the macrofibrils. The microfibrils are about 10 nm wide and thus are invisible by light microscopy unless stained.’ The spheres, or “eggs,” are small particles of cellulose and globules of microfibrils which have sloughed off from the main cotton fiber. We believe that the objects described by Lueck et al. are artifacts created bv cotton or other cellulose fibers and are unrelated to disease. The sources of fibers are legion-laboratory coats, clothing, bandages, alcohol swabs-and are ubiquitous in a hospital environment. Careful examination of a scrupulously cleaned microscope slide will show contamination by dust particles from atmospheric sources.