Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Antimicrob Resist Infect Control. 2020 Jul 31;9(1):120. doi: 10.1186/s13756-020-00780-z.
Preoperative skin antisepsis is an essential component of safe surgery. However, it is unclear how many antiseptic paints are needed to eliminate bacteria prior to incision. This study compared microbial skin counts after two and three antiseptic paints.
We conducted a prospective cohort study in non-emergency patients receiving a cardiac/abdominal surgery with standardized, preoperative skin antisepsis consisting of an alcoholic compound and either povidone iodine (PI) or chlorhexidine (CHX). We obtained three skin swabs from the participant's thorax/abdomen using a sterile template with a 25 cm window: After collection of the first swab prior to skin antisepsis, and once the second and third application of PI/CHX had dried out, we obtained a second and third swab, respectively. Our primary outcome was the reduction in microbial skin counts after two and three paints of PI/CHX.
Among the 239 enrolled patients, there was no significant difference in the reduction of mean square root-transformed microbial skin counts with three versus two paints (P = 0.2). But distributions of colony forming units (CFUs) decreased from paint 2 to 3 in a predefined analysis (P = 0.002). There was strong evidence of an increased proportion of patients with zero CFU after paint 3 versus paint 2 (P = 0.003). We did not identify risk factors for insufficient reduction of microbial skin counts after two paints, defined as the detection of > 5 CFUs and/or ≥ 1 pathogens.
In non-emergency surgical patients, three antiseptic paints may be superior to two paints in reducing microbial skin colonization prior to surgery.
术前皮肤消毒是安全手术的重要组成部分。然而，目前尚不清楚在切口前需要使用多少种抗菌涂料来消除细菌。本研究比较了使用两种和三种抗菌涂料后微生物皮肤计数的情况。
我们进行了一项前瞻性队列研究，纳入了接受心脏/腹部手术的非紧急患者，术前皮肤消毒采用标准化的酒精制剂和聚维酮碘（PI）或洗必泰（CHX）。我们使用带有 25cm 窗口的无菌模板从患者的胸部/腹部获得三个皮肤拭子：在进行 PI/CHX 的第一次皮肤消毒前收集第一个拭子后，以及在 PI/CHX 的第二次和第三次应用干燥后，分别获得第二个和第三个拭子。我们的主要结局是使用 PI/CHX 进行两次和三次涂药后微生物皮肤计数的减少。
在 239 名入组患者中，使用三种涂料与两种涂料相比，平均平方根转化后的微生物皮肤计数减少没有显著差异（P=0.2）。但是，在预先定义的分析中，菌落形成单位（CFU）的分布从第二次涂药到第三次涂药减少（P=0.002）。有强有力的证据表明，与第二次涂药相比，第三次涂药后 CFU 为零的患者比例增加（P=0.003）。我们没有发现导致两次涂药后微生物皮肤计数减少不足（定义为检测到>5CFU 和/或≥1种病原体）的危险因素。
在非紧急手术患者中，与使用两种抗菌涂料相比，使用三种抗菌涂料可能在手术前更能减少皮肤微生物定植。
