The purpose of the study was to determine the normal skin flora on 30 orthopaedic patients preoperatively and to ascertain whether it changed during the patient’s stay in hospital.

After ethical committee approval of the trial, on admission a swab sample was taken of the limb upon which surgery was to be performed. A postoperative swab was taken in the ward on the day of surgery.

Preoperatively Staphylococcus epidermidis was cultured in 24 cases, Staphylococcus aureus in three and Enterococcus faecalis in three. Postoperatively S. epidermidis was cultured in 25 cases and Enterococcus in four. All preoperative S. epidermidis cultures were sensitive to Cloxacillin, Kefzol, Augmentin, Oflaxin and Ciprobay. Ten cases of postoperative S. epidermidis were resistant to Cloxacillin and five to Augmentin.

Within 48 hours of admission, the bacterial flora with which patients were admitted changed to one that was more resistant to first-line antibiotics. We believe ‘simple’ antibiotics can be used prophylactically if the patient undergoes surgery the day of admission.