Leclair J M, Winston K R, Sullivan B F, O'Connell J M, Harrington S M, Goldmann D A
Department of Nueorsurgery, Children's Hospital, Boston, Massachusetts.
Infect Control. 1988 Jan;9(1):8-12.
Wound contamination with endogenous bacterial scalp flora plays an important role in the pathogenesis of postoperative neurosurgical infections. To assess the effect of preoperative antiseptic shampoos on the emergence of resident scalp flora during surgery and subsequent wound contamination, we randomized 151 neurosurgical procedures into four study groups: group A--preoperative shampoos with chlorhexidine, surgical scalp preparation with chlorhexidine; group B--no shampoos, surgical preparation with chlorhexidine; group C--shampoos with iodophor, surgical preparation with iodophor; group D--no shampoos, surgical preparation with iodophor. Quantitative cultures of the scalp were obtained preoperatively and at the end of surgery, and qualitative wound cultures were taken prior to wound closure. Group A had the lowest concentration of bacteria on the scalp both preoperatively and postoperatively (median range = 30 [0-5.7 x 10(5)] and 0 [0-2.5 x 10(3)] respectively). Group A also had significantly fewer positive postoperative scalp cultures (29%) than groups B (51%), C (58%), and D (53%) (P less than 0.05), as well as fewer positive wound cultures (20% v 25%, 42%, and 30% respectively). A density of bacteria on the scalp of greater than 10(2)/4cm2 best predicted the presence of bacteria in the wound. Repeated preoperative shampoos with chlorhexidine reduce intraoperative emergence of resident skin flora and subsequent contamination of the wound.
内源性头皮细菌菌群导致的伤口污染在神经外科术后感染的发病机制中起重要作用。为评估术前抗菌洗发水对手术期间常驻头皮菌群出现及随后伤口污染的影响，我们将151例神经外科手术随机分为四个研究组：A组——术前用氯己定洗发水，手术时头皮用氯己定准备；B组——不用洗发水，手术时用氯己定准备；C组——用碘伏洗发水，手术时用碘伏准备；D组——不用洗发水，手术时用碘伏准备。术前及手术结束时获取头皮的定量培养物，伤口缝合前进行伤口定性培养。A组术前和术后头皮上的细菌浓度最低（中位数范围分别为30 [0 - 5.7×10(5)] 和0 [0 - 2.5×10(3)]）。A组术后头皮培养阳性率（29%）也显著低于B组（51%）、C组（58%）和D组（53%）（P < 0.05），伤口培养阳性率也更低（分别为20% 对25%、42%和30%）。头皮细菌密度大于10(2)/4cm2最能预测伤口中细菌的存在。术前反复使用氯己定洗发水可减少术中常驻皮肤菌群的出现及随后的伤口污染。
