Kozon Isabella, Riahi Sam, Lundbye-Christensen Søren, Thøgersen Anna Margrethe, Ejlertsen Tove, Aaen Dorthe, Paulsen Kirsten I, Hjortshøj Søren
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark.
Am J Infect Control. 2017 Aug 1;45(8):866-871. doi: 10.1016/j.ajic.2017.03.019. Epub 2017 May 16.
Infections in cardiac implantable electronic devices (CIEDs) constitute a serious complication. We sought to identify contamination of gloves before handling the device in primary and replacement CIED procedures.
Two groups of 30 patients underwent primary CIED implantation or replacement. Before the device entered the surgical field, surgeon and assistant imprinted their outer gloves on aerobe and anaerobe agar plates, and a wound swab was performed. Samples were cultured, and the presence of bacteria was identified, counted as the number of colony forming units, and characterized to the level of genus and species.
Samples from 40 (67%) procedures revealed bacteria on surgeons' or assistants' gloves. Contamination occurred in 80% of replacements and 67% of primary implantations (risk difference, 13%; 95% confidence interval [CI], -8.8 to 35.5). Contamination of surgeons' and assistants' gloves occurred in 55% and 44% of procedures, respectively. Coagulase-negative Staphylococcus (CNS) occurred in 52%, and Propionibacterium spp (PS) occurred in 84% of positive cases. For every 15 minutes of procedure time, colony levels increased by 7.4% (95% CI, 1.4%-13.4%).
Contamination of gloves is common during CIED procedures before handling the device. Therefore, devices are often handled with contaminated gloves. The most prevalent bacteria were PS and CNS, which are associated with clinical CIED infections. Changing outer gloves before handling the device might improve sterile state and lower infection risk.
心脏植入式电子设备（CIED）感染是一种严重的并发症。我们试图确定在初次和更换CIED手术中处理设备前手套的污染情况。
两组各30例患者分别接受初次CIED植入或更换手术。在设备进入手术区域前，外科医生和助手将其外层手套印在需氧和厌氧琼脂平板上，并进行伤口拭子采样。对样本进行培养，鉴定细菌的存在，以菌落形成单位数量计数，并鉴定到属和种水平。
40例（67%）手术的样本显示外科医生或助手的手套上有细菌。80%的更换手术和67%的初次植入手术出现污染（风险差异为13%；95%置信区间[CI]，-8.8至35.5）。外科医生和助手手套的污染分别发生在55%和44%的手术中。凝固酶阴性葡萄球菌（CNS）在52%的阳性病例中出现，丙酸杆菌属（PS）在84%的阳性病例中出现。每进行15分钟的手术时间，菌落水平增加7.4%（95%CI，1.4%-13.4%）。
在CIED手术中处理设备前，手套污染很常见。因此，设备常被戴着污染的手套进行操作。最常见的细菌是PS和CNS，它们与临床CIED感染有关。在处理设备前更换外层手套可能会改善无菌状态并降低感染风险。
