Lin Yu-shuang, Chen Jiong, Li Qiang, Pan Ke-ping
Department of Burns, Third Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325200, China.
Chin Med J (Engl). 2009 Apr 20;122(8):927-30.
Transparent dressings are commonly used to cover central venous catheter sites. However, it has been suggested that they might not allow adequate moisture vapor transmission, resulting in local moistness that promotes bacterial growth. We compared the moisture vapor transmission rates (MVTRs) of different, currently used transparent and traditional gauze dressings. We aimed to determine the MVTRs at different temperatures and humidities.
The dressings were used to seal 50-ml plastic centrifuge tubes containing 20 ml deionized water: Tubes in group 1 were covered with 12 layers of ordinary gauze, group 2 with IV3000, group 3 with OPSITE FLEXIGRID, group 4 with 3M HP Tegaderm, and group 5 with 3M Tegaderm. The tubes were placed upright in an artificial climate cabinet, so that the dressings were not touching the water, in order to simulate the conditions of medical dressings in contact with the skin. The average MVTRs were determined under different conditions. MVTRs were also determined with tubes from groups 2 - 5 laid on their sides, allowing the dressings to touch the water, so simulating contact of the dressings with sweating skin, or wounded skin with exudates. We also calculated the dressings' self-reactive abilities by comparing their MVTRs in contact with the water surface with those when not in contact with the water surface.
Group 1 demonstrated the highest MVTR, followed by groups 2, 4, 3 and 5 under conditions simulating contact of the dressings with normal skin at the following temperatures and humidities: 20 degrees C/30%, 20 degrees C/60%, 20 degrees C/90%, 37 degrees C/30%, 37 degrees C/60% and 37 degrees C/90%. When the relative humidity (RH) increased, the MVTRs decreased. The MVTRs differed significantly among different dressings and RHs: At high temperature (37 degrees C) and high humidity (90%), the MVTR of the transparent dressings in group 2 was higher than that of group 1 (P < 0.01). The reactive MVTR was highest in group 2 (10.2 - 16.3 times > MVTR) while that of group 4 was second highest (2.6 - 9.6 times > MVTR).
RH and temperature had significant effects on the MVTRs of different dressings. The IV3000 transparent dressing used in group 2 was as effective as ordinary gauze. These results suggest that increased infection rates due to low MVTRs might not be a problem. The clinical implications of these observations for catheter-related infections need to be further investigated in multicenter studies.
透明敷料常用于覆盖中心静脉导管部位。然而,有人认为它们可能无法实现足够的水汽透过率,导致局部潮湿,从而促进细菌生长。我们比较了目前使用的不同透明敷料和传统纱布敷料的水汽透过率(MVTR)。我们旨在确定不同温度和湿度下的MVTR。
用敷料密封装有20 ml去离子水的50 ml塑料离心管:第1组的试管覆盖12层普通纱布,第2组覆盖IV3000,第3组覆盖OPSITE FLEXIGRID,第4组覆盖3M HP Tegaderm,第5组覆盖3M Tegaderm。将试管直立放置在人工气候箱中,使敷料不接触水,以模拟医用敷料与皮肤接触的情况。在不同条件下测定平均MVTR。对于第2 - 5组的试管,也将其侧放,使敷料接触水,从而模拟敷料与出汗皮肤或有渗出液的伤口皮肤接触的情况,测定MVTR。我们还通过比较敷料与水面接触时和不与水面接触时的MVTR来计算敷料的自反应能力。
在模拟敷料与正常皮肤在以下温度和湿度条件下接触时,第1组的MVTR最高,其次是第2组、第4组、第3组和第5组:20℃/30%、20℃/60%、20℃/90%、37℃/30%、37℃/60%和37℃/90%。当相对湿度(RH)增加时,MVTR降低。不同敷料和RH之间的MVTR差异显著:在高温(37℃)和高湿度(90%)下,第2组透明敷料的MVTR高于第1组(P < 0.01)。第2组的反应性MVTR最高(比MVTR高10.2 - 16.3倍),而第4组的反应性MVTR次之(比MVTR高2.6 - 9.6倍)。
RH和温度对不同敷料的MVTR有显著影响。第2组使用的IV3000透明敷料与普通纱布效果相当。这些结果表明,由于MVTR低导致感染率增加可能不是问题。这些观察结果对导管相关感染的临床意义需要在多中心研究中进一步调查。