Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
J Hosp Infect. 2013 Jun;84(2):151-8. doi: 10.1016/j.jhin.2013.02.011. Epub 2013 Apr 25.
Sternal wound infection after cardiac surgery is a serious complication. Various perioperative strategies, including plastic adhesive drapes, are used to reduce bacterial contamination of surgical wounds.
To compare plastic adhesive drape to bare skin regarding bacterial growth in wound and time to recolonization of the adjacent skin intraoperatively, in cardiac surgery patients.
This single-blinded randomized controlled trial (May 2010 to May 2011) included 140 patients scheduled for cardiac surgery via median sternotomy. The patients were randomly allocated to the adhesive drape (chest covered with plastic adhesive drape) or bare skin group. Bacterial samples were taken preoperatively and intraoperatively every hour during surgery until skin closure.
Disinfection with 0.5% chlorhexidine solution in 70% alcohol decreased coagulase-negative staphylococci (CoNS), while the proportion colonized with Propionibacterium acnes was not significantly reduced and was still present in more than 50% of skin samples. P. acnes was significantly more common in men than in women. Progressive bacterial recolonization of the skin occurred within 2-3 h. At 120 min there were significantly more positive cultures in the adhesive drape group versus bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs 24%; P = 0.013). The only statistically significant difference in bacterial growth in the surgical wound was higher proportion of CoNS at the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).
Plastic adhesive drape does not reduce bacterial recolonization. P. acnes colonized men more frequently, and was not decreased by disinfection with chlorhexidine solution in alcohol.
心脏手术后胸骨伤口感染是一种严重的并发症。各种围手术期策略，包括使用塑料粘性手术巾，旨在减少手术伤口的细菌污染。
比较心脏手术患者中使用粘性手术巾与不使用粘性手术巾时，手术伤口的细菌生长和术中相邻皮肤再定植的时间。
这是一项单盲随机对照试验（2010 年 5 月至 2011 年 5 月），纳入了 140 名计划通过正中胸骨切开术进行心脏手术的患者。患者随机分配到粘性手术巾组（胸部覆盖塑料粘性手术巾）或不使用粘性手术巾组。术前和术中每小时采集细菌样本，直到皮肤缝合。
用 0.5%洗必泰溶液加 70%酒精消毒可减少凝固酶阴性葡萄球菌（CoNS），但痤疮丙酸杆菌的定植比例没有明显降低，仍有超过 50%的皮肤样本存在。男性中 P. acnes 比女性更常见。皮肤的细菌再定植在 2-3 小时内发生。在 120 分钟时，粘性手术巾组的 P. acnes 和 CoNS 阳性培养明显多于不使用粘性手术巾组（63%比 44%；P=0.034；45%比 24%；P=0.013）。手术伤口中细菌生长的唯一统计学差异是粘性手术巾组在手术结束时 CoNS 的比例更高（14.7%比 4.4%；P=0.044）。
塑料粘性手术巾并不能减少细菌再定植。P. acnes 在男性中更常见，用酒精中的洗必泰溶液消毒并不能减少其定植。
