Preoperative shower revisited: Can high topical antiseptic levels be achieved on the skin surface before surgical admission?
Preoperative shower revisited: Can high topical antiseptic levels be achieved on the skin surface before surgical admission?
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DOI：
10.1016/j.jamcollsurg.2007.12.054
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发表时间：
2008-08-01
影响因子：
5.2
通讯作者：
Towne, Jonathan B.
中科院分区：
文献类型：
--
作者：
Edmiston, Charles E., Jr.;Krepel, Candace J.;Towne, Jonathan B.
背景：皮肤无菌是降低手术部位感染风险的前哨策略。在这项研究中，术前使用4% CHG肥皂或2% CHG浸渍聚酯布淋浴/皮肤清洁后，测定葡萄糖酸氯己定（CHG）的皮肤浓度。研究设计：受试者被随机分为三个淋浴（4%肥皂）/皮肤清洁（2%布）组（每组n = 20）：（1组A/B）晚上，（2组A/B）早上，或（3组A/B）晚上和早上。在淋浴或皮肤清洁后，志愿者回到研究者的实验室，在五个不同的皮肤部位测定CHG皮肤表面浓度。将CHG浓度与CHG最低抑制浓度（MIC90）进行比较，CHG最低抑制浓度抑制90%的葡萄球菌皮肤分离物。结果：61株皮肤分离物的CHG MIC90浓度为4.8 ppm。在1A组中，4% CHG皮肤浓度范围为17.2至31.6 ppm，而在ib组（2%）中，CHG浓度范围为361.5至589.5 ppin （p < 0.0001）。在2A组（4%），CHG水平分别为51.6 - 119.6 ppm和848.1 - 1049.6 ppm (2%) （p < 0.0001）。4% CHG组（3A组）的CHG水平为101.4至149.4 ppm，而2% CHG布（313组）的CHG水平为1484.6至2031.3 ppm （p < 0.0001）。在4% CHG组中，1A组7名（35%）受试者、2A组3名（15%）受试者和3A组5名（25%）受试者的选定部位未检测到有效CHG水平。结论：使用4% CHG后，大多数皮肤部位均达到有效的CHG水平；即使在重复应用后，在选择性地点也注意到防腐剂覆盖的空白。使用2% CHG涤纶布导致相当高的皮肤浓度，没有防腐覆盖的间隙。入院前有效的皮肤去殖对降低手术部位感染的风险起着重要的作用。
BACKGROUND: Skin asepsis is a sentinel strategy for reducing risk of surgical site infections. In this study, chlorhexidine gluconate (CHG) skin concentrations were determined after preoperative showering/skin cleansing using 4% CHG soap or 2% CHG-impregnated polyester cloth.STUDY DESIGN: Subjects were randomized to one of three shower (4% soap)/skin cleansing (2% cloth) groups (n = 20 per group): (group 1 A/B) evening, (group 2 A/B) morning, or (group 3 A/B) evening and morning. After showering or skin cleansing, Volunteers returned to the investigator Is laboratory where CHG skin surface concentrations were determined at five separate skin sites. CHG concentrations were compared with CHG minimal inhibitory concentration that inhibits 90% (MIC90) of staphylococcal skin isolates.RESULTS: CHG MIC90 for 61 skin isolates was 4.8 parts per million (ppm). In group 1A, 4% CHG skin concentrations ranged from 17.2 to 31.6 ppm, and CHG concentrations were 361.5 to 589.5 ppin (p < 0.0001) in group I B (2%). In group 2A (4%), CHG levels ranged from 51.6 to 119.6 ppm and 848.1 to 1,049.6 ppm in group 2B (2%), respectively (p < 0.0001). CHG levels ranged from 101.4 to 149.4 ppm in the 4% CHG group (group 3A) compared with 1,484.6 to 2,031.3 ppm in 2% CHG cloth (group 313) group (p < 0.0001). Effective CHG levels were not detected in the 4% CHG group in selected sites in seven (35%) subjects in group 1A, three (15%) in group 2A, and five (25%) in group 3A.CONCLUSIONS: Effective CHG levels were achieved on most skin sites after using 4% CHG; gaps in antiseptic coverage were noted at selective sites even after repeated application. Use of the 2% CHG polyester cloth resulted in considerably higher skin concentrations with no gaps in antiseptic coverage. Effective decolonization of the skin before hospital admission call play an important role in reducing risk of surgical site infections.