Swenson Brian R, Hedrick Traci L, Metzger Rosemarie, Bonatti Hugo, Pruett Timothy L, Sawyer Robert G
Departments of Surgery, University of Virginia Health System, Charlottesville, 22908-0300, USA.
Infect Control Hosp Epidemiol. 2009 Oct;30(10):964-71. doi: 10.1086/605926.
To compare the effects of different skin preparation solutions on surgical-site infection rates.
Three skin preparations were compared by means of a sequential implementation design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.
Single large academic medical center.
All adult general surgery patients.
The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001).
Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to chlorhexidine for this purpose in general surgery patients.
比较不同皮肤准备溶液对外科手术部位感染率的影响。
采用序贯实施设计比较三种皮肤准备方法。每种制剂在6个月期间被用作所有普通外科病例的首选方式。第1阶段使用聚维酮碘擦洗-涂抹组合（碘伏），在这些步骤之间使用异丙醇涂抹，第2阶段使用2%氯己定和70%异丙醇（氯己定预涂剂），第3阶段使用异丙醇中的碘聚维酮（速愈妥）。作为国家外科质量改进项目计划持续数据收集的一部分，对手术部位感染进行30天的跟踪。主要结局是以意向性治疗方式计算的6个月期间手术部位感染的总体发生率。
单一大型学术医疗中心。
所有成年普通外科患者。
该研究包括3209例手术。第3阶段感染率最低，异丙醇中的碘聚维酮作为首选准备方法（3.9%，第1阶段为6.4%，第2阶段为7.1%；P = 0.002）。在亚组分析中，聚维酮碘擦洗-涂抹准备的患者与异丙醇中的碘聚维酮准备的患者之间结局无差异，但与2%氯己定和70%异丙醇准备的患者相比，这两组患者的手术部位感染率均显著较低（4.8%对8.2%；P = 0.001）。
皮肤准备溶液是预防手术部位感染的重要因素。在普通外科患者中，基于碘伏的化合物在这方面可能优于氯己定。
