Department of Regenerative Medicine, United Stated Army Institute of Surgical Research, San Antonio, Texas 78234, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):760-4. doi: 10.1097/TA.0b013e31823c97f5.
There are no established guidelines for the surgical prep of an external fixator in the operative field. This study investigates the effectiveness of different prep solutions and methods of application.
Forty external fixator constructs, consisting of a rod, pin, and pin to rod coupling device, were immersed in a broth of Staphylococcus aureus (lux) for 12 hours. Constructs were then randomized into four treatment groups: chlorhexidine-gluconate (CHG) (4%) scrub, CHG (4%) spray, povidone-iodine (PI) (10%) scrub, and PI (10%) spray. Each construct was imaged with a specialized photon capturing camera system yielding the quantitative and spatial distribution of bacteria both before and after the prep. Each pin to bar clamp was loosened and moved 2 cm down the construct, simulating an external fixator adjustment, and reimaged. Spatial distribution of bacteria and total bacteria counts were compared.
There was a similar reduction in bacteria after surgical prep when comparing all four groups independently (p = 0.19), method of application (spray vs. scrub, p = 0.27), and different solutions (CHG vs. PI, p = 0.41). Although bacteria were evident in newly exposed areas after external fixator adjustment, most notably within the loosened pin to bar clamp, it did not result in an increase in bacteria counts (all four groups, p = 0.11; spray vs. scrub, p = 0.18; CHG vs. PI, p = 0.99).
Although there was no increase in bacteria counts after the simulated external fixator adjustment, it did expose additional bacteria previously unseen. Although there was no difference in surgical prep solution or method of application, consideration must be given to performing an additional surgical prep of the newly exposed surface after loosening of each individual external fixator component as this may further minimize potential bacteria exposure.
目前对于手术野中外固定器的外科准备还没有既定的准则。本研究旨在调查不同准备溶液和应用方法的有效性。
将 40 个由杆、钉和钉棒连接装置组成的外固定器结构浸泡在金黄色葡萄球菌（lux）肉汤中 12 小时。然后将结构随机分为四组治疗：氯己定葡萄糖酸盐（CHG）（4%）擦洗、CHG（4%）喷雾、聚维酮碘（PI）（10%）擦洗和 PI（10%）喷雾。使用专门的光子捕获相机系统对每个结构进行成像，以获得细菌的定量和空间分布，包括准备前后。每个钉棒夹具都松开并向下移动 2 厘米，模拟外固定器调整，然后重新成像。比较了细菌的空间分布和总细菌计数。
当独立比较所有四组（p = 0.19）、应用方法（喷雾与擦洗，p = 0.27）和不同溶液（CHG 与 PI，p = 0.41）时，外科准备后细菌的减少情况相似。尽管在外部固定器调整后新暴露的区域中仍可见细菌，尤其是在松动的钉棒夹具中，但这并未导致细菌计数增加（所有四组，p = 0.11；喷雾与擦洗，p = 0.18；CHG 与 PI，p = 0.99）。
尽管在模拟外固定器调整后细菌计数没有增加，但确实暴露了以前看不见的额外细菌。虽然外科准备溶液或应用方法没有差异，但必须考虑在每个外固定器组件松动后对新暴露的表面进行额外的外科准备，因为这可能进一步最大限度地减少潜在的细菌暴露。
