Kaiser A B, Kernodle D S, Barg N L, Petracek M R
Department of Medicine, Saint Thomas Hospital, Nashville, TN 37202.
Ann Thorac Surg. 1988 Jan;45(1):35-8. doi: 10.1016/s0003-4975(10)62391-0.
We undertook a prospective randomized observer-blinded study comparing the ability of preoperative showers with chlorhexidine gluconate (Hibiclens), povidone-iodine (Betadine), and a lotion soap (Safe 'N Sure) to diminish the staphylococcal skin flora of patients. By block randomization, patients scheduled for an elective cardiac operation or coronary artery angioplasty were assigned to shower with one of the study skin cleansers either once (evening only) or twice (both evening and morning) before the procedure. Semiquantitative samples for culture were obtained from the subclavian and inguinal sites on the evening before the procedure (baseline culture) and again the next morning before the operation. The chlorhexidine skin cleanser consistently reduced staphylococcal colony counts at both the subclavian and inguinal sites before the procedure. This reduction was significant for patients showering both evening and morning (p less than 0.05). The use of the povidone-iodine skin cleanser inconsistently affected skin flora. Patients using lotion soap either experienced no change or had an increase in colony counts. Chlorhexidine is more effective than povidone-iodine in diminishing skin colonization with staphylococci in patients before operation. Repeated applications of chlorhexidine are superior to a single shower with this agent.
我们进行了一项前瞻性随机观察者盲法研究，比较术前使用葡萄糖酸氯己定（洗必泰）、聚维酮碘（碘伏）和一种沐浴露肥皂（Safe 'N Sure）沐浴减少患者皮肤葡萄球菌菌群的能力。通过区组随机化，将计划进行择期心脏手术或冠状动脉血管成形术的患者分配为在手术前用其中一种研究用皮肤清洁剂沐浴一次（仅在晚上）或两次（晚上和早上）。在手术前一晚（基线培养）以及手术次日早晨再次从锁骨下和腹股沟部位获取用于培养的半定量样本。在手术前，氯己定皮肤清洁剂持续降低了锁骨下和腹股沟部位的葡萄球菌菌落计数。对于早晚都沐浴的患者，这种降低具有显著意义（p小于0.05）。聚维酮碘皮肤清洁剂对皮肤菌群的影响不一致。使用沐浴露肥皂的患者要么菌落计数没有变化，要么有所增加。在减少术前患者皮肤葡萄球菌定植方面，氯己定比聚维酮碘更有效。氯己定重复使用优于单次使用该制剂。
