Boekel Pamela, Blackshaw Rachel, Van Bavel Dirk, Riazi Arash, Hau Raphael
Austin Health, Heidelberg, Victoria, Australia.
ANZ J Surg. 2012 Nov;82(11):838-43. doi: 10.1111/j.1445-2197.2012.06208.x. Epub 2012 Sep 11.
The prevention of infection in joint replacement surgery is important. Preparing and draping the patient is fundamental to maintaining sterility of the operative field. One method of draping for total knee replacement (TKR) surgery involves cleaning the operative leg with antiseptic wash then covering the un-prepped foot with a sterile stockinette to sequester the foot from the sterile field. There are two main methods for applying this stockinette. This randomized, blinded control trial simulates stockinette application to assess if it prevents proximal microbial migration into the sterile field.
To simulate microbial presence, ultraviolet fluorescent powder Glitterbug Powder™ (Arrow Scientific Pty Ltd, Lane Cove, NSW, Australia) was applied to volunteers' feet to the level where antiseptic wash would routinely stop during preparation. The stockinette was applied. Two methods of application (above and below knee) and two surgeons were used. These were randomized for each application. The drapes were removed and a blinded assistant measured the distance of proximal spread of Glitterbug Powder™.
Both methods of application were associated with considerable proximal spread of Glitterbug Powder™. For the below knee method, mean proximal spread distance of 49.19%; for the above knee, mean of 71.8% proximal spread (P = 0.038). Multivariate linear regression analysis demonstrated that method and location of the contamination were predictive of the area of contamination and the percentage of the leg contaminated. No other factors (surgeon, gender, hirsute score) were predictive of either area or percentage contamination.
The surgical field for TKRs may be contaminated by significant proximal microbial spread from the unprepared foot with the use of a sterile stockinette drape.
关节置换手术中预防感染至关重要。患者的准备和铺巾对于维持手术区域的无菌状态至关重要。全膝关节置换术（TKR）手术的一种铺巾方法是先用抗菌洗液清洁手术肢体，然后用无菌弹力袜覆盖未准备的足部，以使足部与无菌区域隔离。应用这种弹力袜有两种主要方法。这项随机、双盲对照试验模拟弹力袜的应用，以评估其是否能防止近端微生物迁移到无菌区域。
为了模拟微生物的存在，将紫外线荧光粉Glitterbug Powder™（澳大利亚新南威尔士州莱恩科夫的Arrow Scientific Pty Ltd公司生产）涂在志愿者的足部，涂到准备过程中抗菌洗液通常停止的高度。然后应用弹力袜。使用了两种应用方法（膝盖以下和膝盖以上）以及两名外科医生。每次应用时这些都是随机的。移除铺巾后，由一名不知情的助手测量Glitterbug Powder™近端扩散的距离。
两种应用方法都伴随着Glitterbug Powder™相当程度的近端扩散。对于膝盖以下的方法，平均近端扩散距离为49.19%；对于膝盖以上的方法，平均近端扩散率为71.8%（P = 0.038）。多变量线性回归分析表明，污染的方法和位置可预测污染区域以及腿部受污染的百分比。没有其他因素（外科医生、性别、多毛评分）可预测污染区域或污染百分比。
在使用无菌弹力袜铺巾的情况下，TKR手术区域可能会因未准备的足部近端微生物的大量扩散而受到污染。
