Bak John, Le Jason, Takayama Toshio, Gibson Angela, Zerbel Sara, Safdar Nasia, Matsumura Jon S
University of Wisconsin School of Medicine and Public Health, Madison, WI.
Division of Vascular Surgery, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI.
Ann Vasc Surg. 2017 Aug;43:197-202. doi: 10.1016/j.avsg.2016.11.011. Epub 2017 Mar 22.
Surgical site infections (SSIs) are a significant burden to patients and health care systems. This retrospective study evaluates the observed rates of SSI after our institution implemented chlorhexidine gluconate-impregnated (CHG) cloth as a preoperative antiseptic preparation in elective vascular surgery.
Between March 2011 and January 2012, we reviewed 250 patients who underwent elective vascular surgery who used the CHG cloth preoperatively. Their rate of SSIs was compared with 252 control patients who received the CHG shower preoperatively during the preintervention period. Urgent and emergent cases were excluded. The primary outcome measured was SSI within 30 days of index operation.
There was no baseline difference in mean age, gender distribution, smoking status, diabetes, chronic obstructive pulmonary disease, and the number of patients with body mass index >40 between the cohorts. There was no difference in the overall rate (5.6% vs. 5.6%, P = 1.00) and type of SSIs between the 2 groups, but the control group trended toward deeper infections (4 deep incisional and 2 organ space vs. none and 1, respectively). The control group also had more dirty or infected wound categories (10 vs. 21.4%, P < 0.01) and more perioperative antibiotic errors and hypothermia (P < 0.02).
There was no observed difference in SSI rates before and after implementation of the CHG as the preoperative method of skin decontamination in our retrospective case-control cohorts.
手术部位感染(SSIs)对患者和医疗保健系统而言是一项重大负担。本回顾性研究评估了在我们机构将葡萄糖酸氯己定浸渍布(CHG)用作择期血管手术术前抗菌准备后观察到的手术部位感染发生率。
在2011年3月至2012年1月期间,我们回顾了250例行择期血管手术且术前使用CHG布的患者。将他们的手术部位感染发生率与252例在干预前期接受术前CHG淋浴的对照患者进行比较。排除急诊和紧急情况病例。测量的主要结局指标是初次手术后30天内的手术部位感染。
两组患者在平均年龄、性别分布、吸烟状况、糖尿病、慢性阻塞性肺疾病以及体重指数>40的患者数量方面无基线差异。两组之间手术部位感染的总体发生率(5.6%对5.6%,P = 1.00)和类型无差异,但对照组有深部感染的趋势(分别为4例深部切口感染和2例器官间隙感染,而CHG布组无深部切口感染且器官间隙感染为1例)。对照组的脏污或感染伤口类别也更多(10%对21.4%,P < 0.01),围手术期抗生素使用错误和体温过低的情况也更多(P < 0.02)。
在我们的回顾性病例对照队列中,将CHG用作术前皮肤去污方法前后,未观察到手术部位感染发生率有差异。