Identification of Bacteria from Skin Swab in Pre-operative Closed Fracture Orthopedic Surgery Patients at Dr. Hasan Sadikin General Hospital

Ghita Bengtissen, Sunarjati Sudigdoadi, Yoyos Dias Ismiarto, Isa Ridwan


Background: Surgical site infection (SSI) is the most frequent site of health care- associated infections (HAIs). Surgical incision breaks the protective barrier of the skin and causes bacteria to enter; therefore, pre-operative procedure is very important to reduce the risk of SSI. This study aimed to identify any bacteria in skin swab of pre-operative closed fracture during elective orthopedic surgery patients.

Methods: This was a descriptive laboratory study, conducted in the Department of Microbiology, Faculty of Medicine, Universitas Padjadjaran in October to November 2012. Samples were taken from skin swab of patients with closed fracture taken before elective orthopedic surgery. Samples were cultured on blood agar, then incubated in an aerobic condition for 24 hours at 37°C. The bacteria were then identified, including the type and the number of the bacteria colonies, using microscopic gram staining and by biochemistry testing using coagulase, novobiocin, and catalase test. The bacteria colonies formed on blood agar were counted using CFU/mL.

Results: Of 24 samples taken, 14 (58.3%) were positive for bacteria, 7 negative and 3 were excluded due to dead bacteria. The bacteria identified in the samples were all staphylococcus species and the colony counting was lower than 10⁵ CFU/mL.

Conclusions: Bacteria staphylococcus are detected from more than half of skin swab during pre-operative closed fracture orthopedic surgery patients. Thus, it is important to apply a proper antiseptic procedure before making a surgical incision to reduce the risk of SSI.


bacteria; pre-operative patient’s skin; Staphylococcus

Full Text:



Bagnall NM, Vig S, Trivedi P. Surgical-site infection. Surgery (Oxford). 2009;27(10):426−30.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection 1999. Center for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97−132.

Zinn J, Jenkins JB, Swofford V, Harrelson B, McCarter S. Intraoperative patient skin preparation agents: is there a difference ? AORN J. 2010;92(6):662−74.

Afifi IK, Baghagho EA. Three months study of orthopaedic surgical site infections in an Egyptian University hospital. Int J Infect Control. 2010;6(1):1–6.

Brooks GF, Carroll KC, Butel JS, Morse SA. Jawetz, Melnick, & Adelberg’s Medical Microbiology. 24th ed. Michigan US: Mc Graw Hill; 2004.

Humphreys H, Cunney R, Devitt E, Crowe M, Hayes B, O’Connor M, et al. Guidelines for hand hygiene in Irish healthcare settings. Ireland: SARI by HSE, Health Protection Surveillance Centre; 2004.

Greene LR. Guide to the elimination of orthopedic surgery surgical site infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide. Am J Infect Control. 2012:40(4);384–6.

New South Wales Nurses Association. Expert panel review of elective surgery and emergency access targets under the national partnership agreement on improving public hospital. The Lamp [Online Journal] 2012; Oct 1 [cited 2013 January 23]. Available from:

Royal Australasian College of Surgeons. The case for the separation of elective and emergency surgery. Melbourne: Royal Australasian College of Surgeons; 2011. [cited 2013 January 23]. Available from:

OrthoInfo. Diseases & condition: open fractures. American Academy Of The Orthopedic Surgeons; 2012 [cited 2012 April 2]; Available from:

World Health Organization. WHO guidelines for safe surgery 2009: safe surgery saves lives. Geneva: WHO Press; 2009 [cited 2012 April 20]; Available from:;jsessionid=25ED3F5B06FE8F3C0E1D8156911CC48F?sequence=1

Johnson J. Pre-operative hygiene. HygieneExpert [Online] 2010 [cited 2012 April 3]. Available from:

Seal LA, Paul-Cheadle D. A systems approach to preoperative surgical patient skin preparation. Am J Infect Control. 2004;32(2):57–62.

Rauk PN. Educational intervention, revised instrument sterilization methods, and comprehensive preoperative skin preparation protocol reduce cesarean section surgical site infections. Am J Infect Control. 2010;38(4):319–23.

Napolitano LM. Decolonization of the skin of the patient and surgeon. Surgical infections. Surgical Infections. 2006;7(Suppl 3):S3-15.

Parks PJ. Patient preoperative skin preparations to reduce surgical site infections. Future Direction in Surgery. 2006;1:84─7

Ridwan I, Ismono D, Ismiarto YD, Hidajat NN. Comparison of effectiveness in decreasing bacterial counts between povidone iodine 10% painted with and without alcohol 70% wiping off preoperative skin preparation in orthopaedic surgery patients [Thesis]. Bandung: Universitas Padjadjaran; 2012.

Virtual Amrita Laboratories Universalizing Education. Catalase and coagulase test. Amrita Vishwa Vidyapeetham [Online] 2011 [cited 2012 April 15]. Available from:∼=703&cnt=2.

Hardy Diagnostics. Novobiocin differentiation disks. Santa Maria: Hardy Diagnostic [Online Article] 1996 [cited 2012 April 15]. Available from :


Article Metrics

Abstract view : 473 times
PDF - 318 times

 This Journal indexed by




Creative Commons License
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License


View My Stats