Salvi M, Chelo C, Caputo F, Conte M, Fontana C, Peddis G, Velluti C
Orthopaedic Department, University of Cagliari, Casa di Cura Polispecialistica Sant' Elena, Viale Marconi 160, 09045, Quartu SE, Cagliari, Italy.
Knee Surg Sports Traumatol Arthrosc. 2006 Jan;14(1):27-31. doi: 10.1007/s00167-005-0632-y. Epub 2005 Jul 30.
This study attempts to establish the actual effectiveness of pre-surgical disinfection of the patient and surgeon's hands. We evaluated bacterial density and composition on the skin of 15 patients undergoing knee arthroscopy and the left hand of two surgeons after standard disinfection with povidone-iodine. Three samples were taken after the first 6-min scrub in the first surgical operation from the periungual space of the 1 degrees finger, from the interdigital space between the 2 degrees and 3 degrees fingers and from the transverse palmar crest of the left hand of two surgeons for seven consecutive surgical sessions, for a total of 42 samples, and two samples from the pre-patellar skin and from the popliteal skin of 15 patients undergoing knee arthroscopy, for a total of 30 samples. Pre-surgical handwashing and disinfection procedures were identical in each case. Pre-surgical disinfection of the patient's skin with povidone-iodine was shown to be completely effective, with 100% of samples negative. Samples taken from the interdigital space and the palmar crest (100% of samples negative) demonstrated the efficacy of disinfection of the surgeon's hands with povidone-iodine, while the periungual space was contaminated in 50% of the samples. The bacterial strains isolated belong to the staphylococcus genus in 100% of the cases, with pathogenic strains in 29.6% of the cases. Standard pre-surgical disinfection of skin in areas easily accessible to the disinfectant is sufficient in itself to guarantee thorough sanitization. Standard scrubbing of the surgeon's hands is insufficient in eliminating bacterial contamination, including pathogenic germs, in the periungual space, where it is probably difficult for the disinfectant to come into contact with the skin.
本研究旨在确定患者及外科医生术前手部消毒的实际效果。我们评估了15例行膝关节镜检查患者的皮肤以及两名外科医生左手在使用聚维酮碘进行标准消毒后的细菌密度和组成。在首次手术中，在前6分钟刷洗后，从两名外科医生左手的食指甲沟、中指与无名指指间以及掌横纹处采集三个样本，连续七个手术时段，共42个样本；从15例行膝关节镜检查患者的髌前皮肤和腘窝皮肤采集两个样本，共30个样本。每种情况下术前洗手和消毒程序均相同。结果显示，用聚维酮碘对患者皮肤进行术前消毒完全有效，100%的样本呈阴性。从指间和掌横纹处采集的样本（100%呈阴性）表明用聚维酮碘对外科医生手部消毒有效，而甲沟处50%的样本受到污染。分离出的细菌菌株100%属于葡萄球菌属，其中29.6%为致病菌株。消毒剂易于触及部位的标准术前皮肤消毒本身足以保证彻底清洁。外科医生手部的标准刷洗不足以消除甲沟处的细菌污染，包括致病微生物，因为消毒剂可能难以接触到该部位的皮肤。
