Assessing the risk of irrigation bottle and fluid contamination after endoscopic sinus surgery.

BACKGROUND: Saline nasal irrigation has become an important aspect of post-operative care following endoscopic sinus surgery. The objective of this study was to identify the risks of contamination of both the nasal irrigation bottle and fluid following endoscopic sinus surgery. METHODS: This was a prospective study of consecutive patients undergoing endoscopic sinus surgery for chronic sinusitis. All patients were given nasal irrigation bottles with detailed cleaning instructions preoperatively. Nasal irrigation bottles were collected and cultured at 1 and 2 weeks postoperatively. During the same visit, 5-ml of sterile normal saline was mixed into the irrigation bottle and then cultured separately. RESULTS: A total of 20 patients agreed to participate in the study. At 1 week postoperatively, 50% of the bottles had positive cultures with 40% of the irrigation samples testing positive for bacteria. At two weeks, the contamination in the irrigation bottle and fluid decreased to 26.7% and 20%, respectively. The most common bacteria cultured was Pseudomonas aeruginosa. There were no cases of postoperative infection. CONCLUSION: Despite detailed cleaning instructions, there is a relatively high risk of bacterial contamination in nasal irrigation bottles and fluid following endoscopic sinus surgery. Although these risks did not translate into higher infection rates postsurgery, it may be important for physicians to emphasize regular cleaning techniques to minimize a potential source of bacterial contaminant exposure.

The effects of serum and urinary cortisol levels of topical intranasal irrigations with budesonide added to saline in patients with recurrent polyposis after endoscopic sinus surgery.

BACKGROUND: The delivery of topical intranasal corticosteroid sprays has traditionally been the primary method of treating recurrent nasal polyposis. An emerging treatment for polyposis is budesonide nasal irrigations. Delivered at concentrations nearly 100 times greater than found in prescription nasal sprays, there have been little studies on the effects of budesonide irrigation on the adrenal axis. Therefore, we investigated whether irrigation with budesonide solution was associated with any increase in serum cortisol and 24-hour urinary cortisol levels. METHODS: Patients who previously had undergone endoscopic sinus surgery and were not taking prednisone for 3 months were prospectively enrolled in this study. Patients irrigated twice daily with 0.5 mg/2 mL of budesonide mixed with 240 mL of saline solution. Serum cortisol and 24-hour urinary cortisol were collected before drug administration and 6 weeks after continuous use. RESULTS: Ten patients completed this study. The average serum cortisol and 24-hour urinary cortisol before drug administration were 9.8 +/- 5.4 microg/dL and 28.1 +/- 15.1 microg/24 hours, respectively. After 6-week follow-up, the average serum cortisol and 24-hour urinary cortisol were 12.8 +/- 3.5 microg/dL and 16.5 +/- 5.6 microg/24 hours, respectively. Normal ranges for serum cortisol and 24-hour urinary cortisol are 5-25 microg/dL and 4-50 microg/24 hours, respectively. CONCLUSIONS: Irrigation with budesonide, 0.5 mg/2 mL, in 250 mL of saline solution does not result in decreases of serum cortisol and 24-hour urinary cortisol levels. Based on this, we feel irrigation with budesonide solution is safe to perform in patients as an alternative to traditional aerosolized steroid sprays or systemic corticosteroids.

Clinical correlation between irrigation bottle contamination and clinical outcomes in post-functional endoscopic sinus surgery patients.

BACKGROUND: Sinonasal irrigation after endoscopic sinus surgery (ESS) is a common practice, but the role irrigation bottles play in iatrogenic contamination of the operated sinuses is unknown. Therefore, we investigated whether irrigation bottles used postoperatively become contaminated and have any potential association with immediate postsurgical infection and outcomes. METHODS: Patients irrigated twice daily after ESS. Bottle cleaning was performed as recommended by the manufacturer. New bottles were distributed at the time of the operation and at each postoperative visit. During postoperative weeks 1, 2, and 4, bottles were cultured. Medical charts were reviewed for the presence of postsurgical infection and changes in management. RESULTS: Twenty post-ESS patients were enrolled and examined at weeks 1, 2, and 4. A total of 51 bottles were collected and cultured. Overall, 15 of 51 (29%) bottles demonstrated bacterial growth when cultured. During the first two collection periods, 10 of 40 (25%) bottles demonstrated bacterial growth when cultured; however, five of 11 (45%) bottles collected at the last postoperative visit demonstrated bacterial growth when cultured. During the study, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were frequently recovered during the collection periods. Other organisms isolated included Escherichia coli and Enterobacter spp. Although positive bottle cultures were more common at weeks 2 and 4, no postoperative infections occurred. CONCLUSIONS: Irrigation bottles used postoperatively have a measurable incidence of contamination. Contamination rate increases when bottles are used for longer than 1 week, but this does not appear to result in postsurgical infection.