氯己定醇皮肤消毒液在预防手术部位感染中的效果研究

目的探讨2%葡萄糖酸氯己定醇(2%CHG)皮肤消毒液对预防胃肠手术部位感染(SSI)的消毒效果,以降低手术部位感染率。方法对2014年1-12月在手术室行胃肠手术的患者进行前瞻性随机对照研究,将入选的90例行胃肠手术的患者进行随机分组,观察组45例患者使用2%CHG醇进行皮肤消毒,对照组45例患者使用5%聚维酮碘进行皮肤消毒,分别在两组患者进行皮肤消毒前及皮肤消毒后6、48h对手术部位的皮肤采样,进行细菌监测并比较两组间的差异。结果 2%CHG醇消毒液与聚维酮碘组相比,在皮肤消毒后及48h皮肤菌落数低,而且干燥时间短(P<0.05),观察组发生SSI1例,感染率2.2%;对照组SSI6例,感染率13.3%(P<0.05)。结论 2%CHG醇皮肤消毒液杀菌效果可靠,可降低SSI的发生率,并可减少皮肤表面的暂居菌,抑制其生长从而降低SSI风险。     

氯己定醇联合含碘手术薄膜对患儿行骨科手术切口感染的影响

目的探究氯己定醇联合含碘手术薄膜对儿童行骨科手术切口感染的影响。方法选取2015年4月-2016年5月于医院接受骨科手术的460例患儿为研究对象,按照随机数表法将所有患儿平均分为两组,每组230例,其中对照组患儿使用含碘消毒液联合含碘手术薄膜进行骨科手术,观察组患儿使用氯己定醇联合含碘手术薄膜进行骨科手术,比较两组患儿术后切口感染率、手术效果、揭开手术薄膜后细菌的阳性率;对发生感染的患儿进行病原菌培养与鉴定,分析病原菌的分布。结果观察组6例患儿发生切口感染,感染率为2.61%,观察组患儿感染人数以及感染率均低于对照组21例(9.13%),差异有统计学意义(χ~2=4.330,P<0.05);观察组患者手术切口薄膜起边率以及手术愈合时间均低于对照组患者,甲级愈合率高于对照组患者,观察组患者揭开手术薄膜后细菌的阳性率低于对照组患者,差异有统计学意义(χ~2=4.116,P<0.05);感染患儿临床送检标本共检测出病原菌67株,其中革兰阴性菌32株、革兰阳性菌27株、真菌6株、其他菌种2株。结论行骨科手术患儿切口感染的主要病原菌是革兰阴性菌,采用氯己定醇联合含碘手术薄膜能够有效降低手术患儿术后的感染率,提高术后恢复效果,对于提高患者的生活质量具有重要作用。     

2%葡萄糖氯己定皮肤消毒液在普外科手术患者的临床应用

目的探讨2%葡萄糖氯己定皮肤消毒液在普外科手术患者的临床应用,为有效预防与降低术后切口感染率提供依据。方法将2013年10月-2014年1月使用2%葡萄糖氯己定皮肤消毒液进行术前沐浴的89例患者为试验组,采用普通香皂进行术前沐浴的69例患者为对照组,比较两组患者手术部位切口感染率,数据采用SPSS 13.0软件进行统计分析。结果沐浴后试验组患者感染率为1.12%、对照组患者为10.14%;试验组89例中49例使用2%葡萄糖氯己定皮肤消毒液沐浴1次,1例发生感染,感染率为2.04%;40例患者沐浴两次,感染率为0。结论使用2%葡萄糖氯己定皮肤消毒液进行术前沐浴可以降低手术部位切口感染率,安全无刺激性,值得临床推广应用。     

醋酸氯己定消毒膏杀菌效果的观察

目的了解醋酸氯己定消毒膏的杀菌效果。方法用载体定量杀菌试验对其杀菌效果进行观察。结果消毒膏22.4 mg/g醋酸氯己定作用1 m in,对大肠埃希菌和金黄色葡萄球菌、绿脓杆菌的杀灭对数值达到4.00以上;含22.4 mg/g醋酸氯己定作用2 m in,对白色念珠菌的杀灭对数值达4.00以上。该消毒膏放置54℃14 d,有效成分醋酸氯己定下降5.4%。结论消毒膏对细菌繁殖体和真菌杀灭效果好,性质稳定。     

葡萄糖酸盐氯己定应用于儿童静脉留置针皮肤消毒效果观察

目的 通过比较两种皮肤消毒剂使用的不同效果,探求幼儿留置针穿刺的最佳皮肤消毒剂.方法 选取2月龄～3岁患儿,按留置先后顺序随机抽取500例(静脉留置1次为1例),根据随机数字表将患儿分为观察组和对照组;两组患儿使用留置针、透明敷贴相同,分别为BD 24G安全型留置针、3M透明敷贴;观察组使用2％葡萄糖酸盐氯己定(CHG)进行皮肤消毒,对照组使用复合碘进行皮肤消毒.结果 观察组与对照组两组静脉留置患儿使用不同消毒剂消毒皮肤后相关数据比较,平均消毒待干时间观察组(14.64±1.31)s对照组(58.93±4.82)s(P＜0.01);一次穿刺成功率观察组为88.4％、对照组为81.6％,差异有统计学意义(P＜0.05);透明敷料松动率观察组为7.2％、对照组为25.6％,差异有统计学意义(P＜0.01);穿刺部位发红率观察组为1.6％、对照组为4.8％,差异有统计学意义(P＜0.05).结论 2％葡萄糖酸盐氯己定能有效用于儿童临床留置针穿刺皮肤消毒,它具有消毒待干时间短、一次穿刺成功率高、引起透明敷料松动及穿刺部位发红较少等优点,值得在儿童静脉留置消毒中推广.     

氯己定醇皮肤消毒液在预防导管相关血流感染中的效果研究

目的探讨2%葡萄糖酸氯己定(CHG)醇皮肤消毒液对预防经外周静脉导入中心静脉置管(PICC)导管相关血流感染(CRBSI)的消毒效果。方法对2013年1-12月行PICC置管的肿瘤患者进行前瞻性随机对照研究,将64例PICC置管的患者进行随机分组,观察组34例使用2%CHG醇进行皮肤消毒,对照组30例使用5%聚维酮碘进行皮肤消毒,分别于各组患者进行PICC置管前及置管后48h对置管周围部位的皮肤采样,进行细菌监测并比较两组间的差异。结果观察组在PICC置管前和置管后较对照组48h皮肤菌落数低、干燥时间短(P<0.05),观察组总置管日2 356d,无CRBSI发生;对照组总置管日1 970d,CRBSI 4例,2%CHG醇消毒液能降低CRBSI的发生率(P<0.05)。结论 2%CHG醇皮肤消毒液可降低PICC导管相关血流感染的发生率,并可减少皮肤表面的暂居菌,抑制其生长从而降低CRBSI风险。     

2％葡萄糖氯己定在骨科术前皮肤清洁消毒中的应用研究

目的 探讨2％葡萄糖氯己定(2％CHG)皮肤消毒液沐浴在骨科无菌手术前运用的可行性,有效预防与降低术后切口感染率.方法 以160例骨科择期手术患者按术前两晚+术日晨、术前一晚+术日晨、术日晨2％CHG沐浴和改良骨科备皮法随机均分为试验组A、试验组B、试验组C和对照组,分别于各组患者首次备皮前、手术消毒前及术后24 h对手术野皮肤采样,进行细菌检测并比较各组间差异.结果 手术消毒前细菌培养与基线(首次备皮前)比较,试验组A、试验组B与对照组的细菌清除率分别为99.0％、98.9％ 97.9％,差异无统计学意义,试验组C细菌的清除率为95.8％,低于对照组,差异有统计学意义(P＜0.05);术后24 h手术野皮肤细菌培养,细菌菌落数试验组A为(3.90±1.80) CFU/cm2,对照组为(6.57±1.04) CFU/cm2,两组差异有统计学意义(P＜0.05),其余各组与对照组相比菌落数均值差异无统计学意义,各组患者术后均无切口感染发生.结论 术前两晚+术日晨2％CHG消毒液沐浴法在提高患者满意度、降低耗材和术后24 h手术野菌落数培养等均优于改良骨科备皮法;术前备皮效果同于改良骨科备皮法,具有较大的临床价值.     

高效液相色谱法测定纳米消毒凝胶中醋酸氯己定的含量

目的：建立高效液相色谱法测定纳米复方消毒凝胶中醋酸氯己定的含量。方法：样品用乙醇溶解稀释提取，采用乙腈-磷酸二氢钾（50＋50）流动相体系，pH2．5，SEPELCO BDS C18柱，流速1ml／min，检测波长254nm。结果：醋酸氯己定在0．00318％-0．0318％范围内线性关系良好，r=0．9999，回收率94．3％-99．3％，RSD 1．5％。结论：方法操作简便、重现性好、结果准确，适用于醋酸氯己定的质量控制。     

高效液相色谱法测定消毒卫生产品中的醋酸氯己定

[目的]建立含醋酸氯己定消毒产品的高效液相色谱测定方法。[方法]液相色谱法测定采用Symmetry—Shield”RP18柱，乙腈＋0．02mol／L磷酸二氢钾（30＋70）流动相体系，在pH为2．60，流速0．8ml／min，检测波长259tinl的条件下，测定经乙醇提取稀释的样品。[结果]醋酸氯己定在0．02～0．50g／L范围内线性关系良好，r=0．9999，加标回收率为99．58％～101．37％，相对标准偏差（RSD）为1．92％。[结论]该方法测定消毒产品中醋酸氯己定，样品处理简便、方法精密度好、准确可靠、适用性强，可以满足日常检测和质量控制工作需要。     

葡萄糖酸氯己定醇皮肤消毒液对多药耐药菌的杀菌效果评价

目的 评价葡萄糖酸氯己定醇皮肤消毒液对多药耐药菌的杀灭作用,为临床合理选用消毒剂提供依据.方法 采用悬液定量杀菌方法,设试验组:耐甲氧西林金黄色葡萄球菌、产ESBLs大肠埃希菌和泛耐药铜绿假单胞菌3种多药耐药菌;对照组:与试验组相对应的金黄色葡萄球菌、大肠埃希菌和铜绿假单胞菌3种非耐药菌;比较葡萄糖酸氯己定醇皮肤消毒液对耐药菌和非耐药菌的杀灭作用.结果 2％葡萄糖酸氯己定醇皮肤消毒液原液作用30 s、1、3 min对试验组和对照组的杀灭对数值均＞5.0.结论 2％葡萄糖酸氯己定醇皮肤消毒液对多药耐药菌的杀灭作用与非耐药菌同样快速和有效.     

Delayed antimicrobial effects of skin disinfection by alcohol.

Aqueous suspensions of Staphylococcus aureus were deposited on a Millipore filter and then exposed for a few seconds to 70% ethyl alcohol. Viable counts of bacteria extracted from the filter immediately after exposure to alcohol, and, in replicate experiments, after a further period of 3 h, showed that the mean immediate reduction of 97.6% in viable counts after treatment with alcohol was followed by a further mean reduction of 67.1% in the further 3 h holding time; the same bacterial suspensions allowed to dry on Millipore filters without exposure to alcohol showed a significantly smaller mean reduction in viable counts (34.3%) during a further 3 h holding time. These findings support the view that the reported further fall in numbers of bacteria on hands while wearing gloves for 3 h after alcohol disinfection can be explained by sublethal damage to some of the bacteria, from which they can recover only if promptly inoculated on culture medium.     

Surgical hand disinfection: effect of sequential use of two chlorhexidine preparations

The antimicrobial efficacy of three 'two-phase' surgical hand disinfection procedures was compared, in a volunteer study, to 60% n-propanol, applied for 5 min, which is the reference hand-disinfection procedure used in Austria and West Germany (FRG). The procedures involved sequential use of unmedicated soap or a disinfectant-detergent containing 4% chlorhexidine gluconate (CHX; 'Hibiscrub') followed by a handrub preparation containing 70% w/w isopropanol plus 0.5% CHX ('Hibisol'). The immediate and sustained effects (3 h) of washing with unmedicated soap (3 min) followed by rubbing on 'Hibisol' (4 min) were significantly smaller (log10 reductions of 1.72 and 1.12) than with each of the other procedures. Use of 'Hibiscrub' (3 min) and 'Hibisol' (4 min) produced log10 reductions of 2.50 and 1.71, equalling those of the reference procedure with n-propanol (2.49 and 1.78). When 'Hibisol' was used for 5 min rather than 4 min, a considerable, though not significant, increase in effect was achieved (log10 reductions of 2.90 and 2.07). Replacement of unmedicated soap by 'Hibiscrub' could significantly improve the effectiveness of the hand disinfection procedure commonly used by surgeons in German-speaking countries; namely to wash hands first with soap and then disinfect them with an alcoholic preparation. It may also be of additional advantage as this adds another 'layer' of CHX when 'Hibisol' rather than alcohol alone is used.     

A comparison of triclosan and chlorhexidine preparations with 60 per cent isopropyl alcohol for hygienic hand disinfection

Four detergent preparations containing triclosan; two alcoholic products, containing triclosan and chlorhexidine respectively, and a detergent preparation containing chlorhexidine were compared with 60 per cent isopropyl alcohol following a single hand wash using Escherichia coli as the test organism. In vitro tests indicated that all had a high activity against hospital pathogens. The triclosan-containing preparations exhibited a significant pathogens. The triclosan-containing preparations exhibited a significant residual activity. Experiments in volunteers showed that 0.5 per cent alcoholic triclosan was significantly more effective than all other preparations tested. All the detergent preparations had an effect similar to that of 60 per cent isopropyl alcohol. None of the seven products evaluated was significantly less bactericidal than 60 per cent isopropyl alcohol.     

Povidone-iodine and chlorhexidine gluconate-containing detergents for disinfection of hands

The efficacy of a povidone-iodine and a chlorhexidine gluconate detergent was evaluated for ‘hygienic’ and ‘surgical’ hand disinfection. Rubbing 60 per cent iso-propanol on to the hands for 1 min was used as a standard for ‘hygienic’ disinfection, with Escherichia coli as the test organism. The mean log reduction obtained was 3.16 with povidone-iodine and 2.92 with chlorhexidine. These were considerably less than obtained with iso-propanol which produced a reduction of 4.23 and 4.30 orders of magnitude. In the ‘surgical’ hand disinfection tests, a 5 min wash with povidone-iodine and a 3 min wash with chlorhexidine detergent were compared with rubbing 60 per cent n-propanol or iso-propanol on to the hands for 5 min; n-propanol was taken as the standard preparation. Immediately after disinfection the log reduction in the resident flora was 0.92 with povidone-iodine and 0.78 with chlorhexidine, whereas n-propanol gave a log reduction of 3.43. After wearing a surgical glove for 3 h a log reduction of 0.24 was obtained with povidoneiodine, 0.75 with chlorhexidine and 2.94 with n-propanol. Treatment with iso-propanol gave a log reduction of 1.04. Thus, alcohols are shown by these tests to be far more effective than povidone-iodine or chlorhexidine detergent preparations in ‘hygienic’ as well as ‘surgical’ hand disinfection.