胸腹部手术患者不同皮肤消毒方法效果比较

为研究不同手术野皮肤消毒方法的消毒效果,采用现场消毒试验方法进行了观察。结果,所有消毒前采样,经培养全部有菌生长;经鉴定主要有金黄色葡萄球菌、枯草芽孢杆菌、微球菌、大肠杆菌。消毒后采样检测结果显示,A、B、C等3组消毒后全部无菌生长;D组有1例培养阳性,检测出枯草杆菌;E、G、H等3组消毒后各有2例培养阳性,检测出微球菌和金黄色葡萄球菌;F组消毒后有5例培养阳性,检测出枯草杆菌和微球菌。结论,手术野皮肤消毒以碘酊与乙醇双消毒和含有效碘10 g/L的碘伏消毒效果较为可靠。     

手术前葡萄糖酸氯己定局部擦浴对降低手术部位感染的效果观察北大核心

目的探讨葡萄糖酸氯己定手术前擦浴手术部位皮肤效果,以预防和减少手术部位感染。方法将60岁以上腰椎间盘突出或椎管狭窄行内固定手术病人随机分为试验组和对照组,每组100例,试验组除在手术前晚沐浴外,在手术前1 d和手术前2 h对手术部位皮肤用20 g/L葡萄糖酸氯己定擦浴;对照组仅在手术前用含碘消毒液消毒皮肤,比较两组病人的手术部位感染情况。结果试验组术后30 d内有1例患者发生手术部位切口感染,对照组术后30 d内有5例发生了切口感染。结论葡萄糖酸氯己定可清洁消毒手术部位皮肤,减少手术部位切口感染率。     

两种皮肤消毒方法在新生儿手术伤口管理中的应用效果观察

目的 对2种术前皮肤清洁和术后消毒方法在新生儿手术伤口管理中的应用效果进行观察比较.方法 选择2018年1月—2019年6月某医院新生儿外科行手术治疗的108例患儿为研究对象,按收住院及手术时间顺序随机分为观察组(56例)与对照组(52例),观察组采用0.02％洗必泰皮肤沐浴和术后2％葡萄糖酸氯己定皮肤消毒液进行消毒,...     

葡萄糖氯己定术前洗浴在阑尾切除术切口感染控制中的应用

[目的]探讨葡萄糖氯己定术前洗浴在阑尾切除术切口感染控制中的应用。[方法]将160例行阑尾切除手术病人根据随机数字表法分为观察组及对照组各80例,对照组病人术前做常规处理,观察组于术前及术后采用氯己定洗浴预防感染。比较两组病人术后切口感染情况、愈合情况及住院时间。[结果]观察组病人感染率、感染程度低于对照组,切口甲级愈合率高于对照组,术后发热持续时间、切口愈合时间、伤口拆线时间及住院时间短于对照组(P0.05)。[结论]对阑尾切除术病人于术前应用氯己定洗浴可有效预防术后切口感染,降低切口感染严重程度,促进切口甲级愈合,缩短切口愈合时间,从而改善病人预后。     

葡萄糖酸氯己定术前沐浴预防骨科切口感染的效果分析北大核心

目的了解葡萄糖酸氯己定术前沐浴降低手术切口感染的效果。方法对骨科部分手术开展目标性监测,将使用葡萄糖酸氯己定术前沐浴组与未使用组进行对比。结果未使用葡萄糖酸氯己定术前沐浴组监测例数220例,发生5例表浅切口感染,感染发生率为2.27%;使用葡萄糖酸氯己定术前沐浴组监测例数248例,未发生切口感染。结论使用葡萄糖酸氯己定术前沐浴,可有效降低手术切口感染的发生率。     

简化药浴在干细胞移植患者体表消毒中的应用

目的:比较碘伏药浴与葡萄糖酸氯己定简化药浴在造血干细胞移植患者体表消毒中的应用效果。方法:选择2011年6月~2012年6月收治的52例造血干细胞移植患者为对照组进行磺伏药浴,选择2012年7月~2013年6月收治的63例造血干细胞移植患者为试验组进行葡萄糖酸氯己定消毒液药浴。比较两组患者在消毒效果、药浴舒适度、水温耐受度及护士平均工作时间方面的差异。结果:两种消毒液在消毒效果方面无明显差异,但在药浴舒适度、水温耐受度方面试验组优于对照组,且护士平均工作时间短于对照组。结论:葡萄糖酸氯己定简化药浴能够提高患者舒适度,减轻护士工作量,值得临床推广应用。     

一次性医用消毒湿巾的皮肤消毒效果评价

摘要 目的 观察一次性医用消毒湿巾的消毒效果,为临床使用提供参考依据。方法 通过悬液定量杀菌试验和现场消毒试验方法,对消毒湿巾杀菌效果进行观察。结果 该消毒湿巾为医用无纺布喷淋2% 葡萄糖酸氯己定水溶液制备而成。将消毒湿巾挤出液做悬液定量杀菌试验,作用 0.5 min,对金黄色葡萄球菌、大肠杆菌和铜绿假单胞菌平均杀灭对数值＞5.00,对白色念珠菌平均杀灭对数值＞4.00。用该消毒湿巾对皮肤擦拭消毒作用3 min,可使皮肤自然菌对数值降低＞ 1.0。结论 该消毒湿巾对试验指标菌和皮肤自然菌均有较好的杀灭效果。     

2％葡萄糖氯己定联合早期肛门封闭在Miles手术会阴部切口感染中的预防效果

目的探讨2%葡萄糖氯己定消毒液联合早期肛门封闭在Miles手术患者会阴部切口感染预防中的应用。方法选取行Miles手术患者62例,随机分为观察组32例和对照组30例。对照组进行常规术前准备和术中常规手术;观察组在常规术前准备的基础上,于术前3 d开始予2%葡萄糖氯己定皮肤消毒液擦洗会阴部,术中在麻醉消毒后立即封闭肛门,比较2组患者术后会阴部切口感染的发生率。结果观察组术后会阴部切口感染率为6. 3%(2/32),显著低于对照组的术后切口感染率30. 0%(9/30)(P 0. 05);观察组术后抗生素使用时间和住院时间显著短于对照组,住院费用显著低于对照组,护理满意度显著高于对照组(P 0. 05)。结论在术前3 d常规准备的同时给予2%葡萄糖氯己定皮肤消毒液擦洗会阴部,术中在麻醉消毒后立即封闭肛门,能有效降低术后会阴部切口感染的发生率,是预防Miles术后会阴部切口感染的有效预防措施,且还能缩短患者术后抗生素使用时间和住院时间,降低住院总费用,提高患者满意度。     

葡萄糖酸氯己定与聚维酮碘用于术前皮肤准备的效果比较

摘要 目的 研究对比2%葡萄糖酸氯己定消毒液与聚维酮碘消毒液在骨科术前皮肤准备中的消毒效果。方法 选取2014年3月-2016年1月接受手术的骨科患者142例。根据皮肤消毒方法分为观察组与对照组,每组71例,观察组采用2%葡萄糖酸氯己定消毒液联合手术薄膜、对照组采用聚维酮碘消毒液联合手术薄膜,对比2组的消毒效果。结果 观察组术后切口部位细菌培养的阳性率为1.41%,显著低于对照组的9.86%;术后观察组皮肤菌落数显著低于对照组;观察组抑菌效果持续时间显著高于对照组,而术后感染发生率明显低于对照组。结论 2%葡萄糖酸氯己定消毒液在骨科术前皮肤准备中的消毒效果显著且持续时间较长,可有效降低手术切口感染率。     

The effect of nurse‐performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery

Aim. To determine the effect of preoperative skin preparation procedures performed by nurses on postoperative surgical site infection in abdominal surgery. Background. Despite all interventions, postoperative SSIs still greatly affect mortality and morbidity. Design. This is an experimental study. Methods. Procedures developed for nurse application of preoperative skin preparations were tested on a control group (n = 39) and study group (n = 43). Results. Only clinical routines for preoperative skin preparation were performed on the control group patients. Control group members’ skins were mostly prepared by shaving with a razor blade (41%). For the study group members, the researchers used the preoperative skin preparation procedure. Clippers were used to prepare 55·8% of study group members while 44·2% of them were not treated with the clipper because their wounds were clean. As a requirement of the procedure, all members of the study group had a chlorhexidine bath at least twice after being hospitalised and at least once a night before the operation under controlled conditions. In the group where chlorhexidine bath was not applied, the infection risk was found to be 4·76 times (95%CI = 1·20–18·83) greater even after corrections for age and gender had been made. The difference between control group and study group with respect to surgical site infections was also statistically significant (p < 0·05). Conclusion. Preoperative skin preparation using clipper on the nights before an operation and a 50 ml chlorhexidine bath excluding head area taken twice in the pre‐operative period are useful to reduce SSI during postoperative period. Relevance to clinical practice. We find that preoperative skin preparation using the procedures developed as a result of findings of this study is useful in reducing surgical site infection during the postoperative period.     

不同备皮方法对普外科手术术野皮肤状况的影响

目的探讨不同备皮方法对普外科手术术野皮肤状况及对术后感染率的影响。方法选择2011年1—12月在上海交通大学医学院附属新华医院崇明分院普外科择期手术患者120例,随机分为实验组和对照组各60例,分别予以不剃毛备皮法和剃毛备皮法。观察两组患者术前皮肤损伤情况和术后切口感染发生率。结果对照组在放大镜下可见皮损23例,占38.3%;肉眼可见皮损3例,占5.0%;实验组无皮损;两组比较差异有统计学意义(P<0.05)。实验组术后发生切口感染2例,占3.4%;对照组术后发生切口感染3例,占5.0%,两组比较差异无统计学意义(P>0.05)。结论在部分普外科手术前的皮肤准备中,可以采用不剃毛备皮法能减少对皮肤的损伤,降低切口发生感染的风险。     

皮肤外科门诊手术切口感染相关因素分析

【】目的 了解皮肤外科门诊手术切口感染发生情况,并分析其危险因素。方法 选择皮肤外科门诊手术患者930例,共1101个手术伤口,记录患者手术切口感染发生情况,采用自设的门诊手术切口感染危险因素调查表收集资料。结果 皮肤外科门诊手术患者切口感染发生率6.1%。Logistic回归分析显示,手术部位、糖尿病史、吸烟史、切口长度、拆线时间、术后疼痛、外用抗生素软膏、手术季节是皮肤外科门诊手术切口感染发生的危险因素。结论 皮肤外科门诊手术患者切口感染发生与自身、疾病手术、术后护理多种危险因素相关,应通过全面的危险因素评估,采取有效的预防措施,加强护理宣教,降低切口感染的发生。     

Examination of the efficacy of olanexidine gluconate for surgical site infections in colorectal cancer elective surgery

IntroductionThe preoperative skin antiseptic, olanexidine gluconate (OLG), which has been available in Japan since 2015, is also known to be effective against methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Pseudomonas aeruginosa. This study attempted to clarify OLG efficacy against surgical site infections and antiseptic-related adverse events as compared to conventionally used povidone iodine (PVP–I).MethodsPropensity score matching was performed on 307 patients who underwent surgery for colorectal tumors at our hospital. All 116 cases (58 PVP-I cases, 58 OLG cases) who were diagnosed with colorectal cancer were included. We examined surgical site infection rate after disinfection using PVP-I and OLG, length of hospitalization stay (days) after surgery, adverse events associated with antiseptics, and additional medical costs associated with adverse events caused by antiseptics.ResultsThe surgical site infection rate was 8.6% in both the PVP-I and OLG groups, with no significant difference observed. The number of postoperative hospitalization days in the PVP-I group was 12.9 (±6.9) days and 16.4 (±14.6) days in the OLG group, which exhibited no significant difference (p = 0.10). Although no complications due to antiseptics were observed in the PVP-I group, skin-related side effects were observed in 8 patients (13.8%) in the OLG group. The median additional medical cost was 730 [120–1823] yen.ConclusionsOLG was as effective as the conventional PVP-I for surgical site infections during colorectal cancer elective surgery. However, significantly higher skin disorders occurred in OLG, thereby making it necessary to evaluate antiseptic use in conjunction with patient burden.     

预防性应用抗生素预防乳腺癌手术后手术部位感染的Meta分析

目的系统评价预防性应用抗生素预防乳腺癌手术后手术部位感染的疗效。方法检索1975年至2013年3月公开发表的所有预防性使用抗菌药物对乳腺癌手术后手术部位感染影响的随机对照试验,进行荟萃分析及系统评价。结果筛选符合纳入标准的随机对照试验7项,共2220例患者;共有150例发生感染,感染率为6．76％。其中预防性应用抗生素组1115例,有53例发生感染,感染率为4．75％;对照组1105例,有97例发生感染,感染率为8．75％。分析发现,与对照组相比,预防性使用抗菌药物组可以减少手术部位感染48％（OR0．52,95％C10．37—0．73,P=0．0002）。结论预防性应用抗生素能有效降低乳腺癌手术后手术部位感染率。     

Evaluation of donor skin disinfection methods

BACKGROUND : Because most bacteria isolated from contaminated platelet concentrates are thought to originate from the donor's skin, the efficacy of four methods of skin disinfection was compared. STUDY DESIGN AND METHODS : Contact plates were used for antecubital skin cultures after they were demonstrated to be easier to use and at least as sensitive as a swab system. One antecubital fossa of each subject was disinfected by a standard method, the use of a povidone-iodine swabstick containing 0.75-percent available iodine followed by the use of a povidone-iodine swabstick containing 1-percent available iodine. The other arm was disinfected with either a 70-percent isopropyl alcohol scrub followed by an ampoule of 2-percent iodine tincture (Group 1; n = 126); a green-soap sponge followed by a 70-percent isopropyl alcohol swab, used for donors who are allergic to iodine (Group 2; n = 30); or a 0.5-percent chlorhexidine gluconate and 70-percent isopropyl alcohol sponge followed by an ampoule of 0.5-percent chlorhexidine gluconate and 70-percent isopropyl alcohol (Group 3; n = 40). Contact plate cultures were done before and after disinfection, and colonies counted after a 48-hour 37°C incubation period. RESULTS : Similar numbers of bacteria grew from both antecubital fossae of the same subject before disinfection (p = 0.71). Compared to the standard povidoneiodine method, isopropyl alcohol and tincture of iodine resulted in significantly less bacterial growth (p<0.001), the green soap and isopropyl alcohol method resulted in significantly more bacterial growth (p<0.001), and the chlorhexidine gluconate and isopropyl alcohol method resulted in similar amounts of bacterial growth (p>0.3). CONCLUSION : Isopropyl alcohol scrub followed by iodine tincture is more efficacious than povidone-iodine as measured by contact plate cultures. For donors who are allergic to iodine, chlorhexidine gluconate and isopropyl alcohol is more efficacious than green soap and isopropyl alcohol.     

Prevention of surgical site infections

In the current era of pay-for-performance standards, the incidence of surgical site infections is increasingly becoming an institutional marker of quality assurance. Surgical site infections lead to increased morbidity and mortality in the surgical population and contribute to an already rising healthcare cost. As a result, the surgical community goes to great lengths to prevent this costly and occasionally lethal complication. Many practices are evidence based, however, many are not. In this article, the most commonly used preventive strategies in practice today and the evidence behind each are reviewed. In addition, an overview of the epidemiology, pathophysiology and microbiology of surgical site infections will be provided.     

不同消毒方法对呼吸机管道消毒效果的比较

[目的]研究不同消毒方法对呼吸机管道的消毒效果,选择最佳消毒方法。[方法]采用棉拭子涂抹采样和细菌检测方法,对全自动清洗消毒机（观察组）和消毒液浸泡法（对照组）消毒呼吸机管道的效果进行比较观察。[结果]观察组检测500件,消毒效果合格率为100％,对照组检测500件,消毒效果合格率为80％,差异有统计学意义（P〈0．05）。污染呼吸机管道检出的细菌均为条件致病菌,以革兰阴性杆菌为主,其中不动杆菌和铜绿假单胞菌检出率最高。[结论]全自动清洗消毒机消毒效果明显优于消毒液浸泡法。     

Simple methodology for detecting time shifts in surgical site infections: a study in digestive,breast, and thoracic surgery

To simplify the data mining surveillance system for the monitoring of surgical site infections (SSIs), electronic analysis of a total of 3100 patients was done. Using Layered Analyses, the Cross-Table option of a globally available software detected emerging or disappearing SSIs according to specific parameters. This methodology may facilitate the detection of SSI shifts.