AAOS 2014：手术贴膜前再次消毒可减少切口感染

AAOS 2014：手术贴膜前再次消毒可减少切口感染

背景：全关节置换术后切口感染（SSI）对患者来说是毁灭性的，而因为内植物的存在，预防SSI仍存在一定困难。来自Pennsylvania, Philadelphia的Tiffany N. Morrison等认为SSI是由手术铺单造成的，在贴切口保护膜之前再次消毒术区皮肤可能减少SSI的发生。

方法：该研究采用随机、双盲、前瞻的方法，2010年3月至2011年11月共600名全关节置换的患者参与。对照组采用标准的术区皮肤准备方法，即术前洗必泰清洗，术中酒精、碘伏消毒后再铺单，待术区皮肤干燥后再贴切口保护膜。试验组皮肤消毒处理基本相同，但在贴切口保护膜之前再用安尔碘消毒一次。组间其他的混杂因素无差异。

结果：最终有581名患者纳入研究。切口贴膜之前再次消毒可明显减少全关节置换患者SSI的发生率。实验组未发生SSI(0/284)，而对照组SSI的发生率为2.06%（6/297）(p<0.0307)。试验组术后6周内出现皮肤刺激现象（skin blistering）的比例为3.52% (10/284)，亦低于对照组6.23% (18/289)，但组间比较无差异 (p=0.1745)。

讨论和结论：铺单后手术贴膜前再次消毒确实可以明显降低SSI的发生率。作者认为再次消毒可以杀灭铺单过程中可能带来的污染病原体。再次消毒对于改进术区准备是非常有意义的。

Prospective, Randomized, Blinded Study to Evaluate Two Surgical Skin Preparations in Reducing SSI after TJA

INTRODUCTION: Surgical site infection (SSI) following total joint arthroplasty (TJA) is a devastating complication on patients and healthcare. Due to the presence of foreign material, prevention of SSI in this patient population is challenging. We hypothesized that a majority of contaminants of the surgical site are introduced during surgical draping and that repeat skin antisepsis prior to application of the incise drape is likely to reduce the incidence of SSI.
METHODS: This randomized, single-blind, prospective study recruited 600 patients undergoing TJA between March 2010 and Nov 2011 at a single center. In the control group standard skin preparation with chlorhexidine (pre-op shower), alcohol and betadine (intra-op skin preparation) was performed, followed by surgical draping. The incise drape was applied once the skin was dry. In the experimental group identical prep of the skin was performed, but prior to application of the incise drape, additional skin preparation with iodine povacrylex (iodophor)/alcohol combination was applied. There were no differences shown in any confounding variables.
RESULTS: A total of 581 patients were eligible for randomization. The repeat antisepsis prior to incise draping significantly reduced the incidence of SSI in patients undergoing TJA; there were no patients diagnosed with SSI in the experimental group (0/284) compared to a 2.06% incidence of SSI in the control group (6/297) (p<0.0307). Skin blistering within six weeks after surgery was also lower in the experimental group at 3.52% (10/284) versus 6.23% (18/289) in the control group (p=0.1745).
DISCUSSION AND CONCLUSION: Repeat skin antisepsis after surgical draping and prior to incise draping does lead to a significant reduction in SSI; we believe this benefit is a result of removing contaminating organisms that gain access to the surgical site during surgical draping. Reduction in skin blistering may also be attributed to this effect. While the use of any skin prep which contains alcohol requires caution due to its flammable nature, we believe that with proper precautions; repeat skin antisepsis is a valuable addition to surgical preparation.