Clinic of Orthopaedic Surgery, Kanagawa Rehabilitation Hospital, Kanagawa, Japan;Department of Orthopaedic Surgery, The Jikei University, School of Medicine, Tokyo, Japan.
Clinic of Orthopaedic Surgery, Kanagawa Rehabilitation Hospital, Kanagawa, Japan.
Acta Orthop Traumatol Turc. 2020 Nov;54(6):587-590. doi: 10.5152/j.aott.2020.19084.
The aim of this study was to analyze the contamination rates of the skin under the iodophor-impregnated plastic adhesive drape (IOD) at the time of incision closure in total hip arthroplasty (THA).
A total of 225 patients undergoing primary THA (28 men, 197 women; mean age=65 years; age range=30-85) were included in this study. After asepsis using a solution of 1% chlorhexidine with 83% alcohol by volume, the surgical site was painted with a 10% povidone-iodine solution, and IOD was attached tautly at the start of surgery. Swabs of the surgical site were collected as follows: swab A from the skin before IOD application, swab B from the surface of the IOD at the time of incision closure, and swab C from the skin after peeling back the IOD. The obtained samples were promptly sent for microbiological analysis. The contamination rate was determined for swabs A, B, and C, and the contamination rate of swab C was compared with that of swabs A and B, and the bacterial species were identified.
Positive cultures were seen in 8 cases (3.6%) for swab A, 10 cases (4.4%) for swab B, and 22 cases (9.8%) for swab C. The contamination rate of swab C was significantly higher than that of swabs A (p=0.008) and B (p=0.028). Coagulase-negative Staphylococcus (n=10) and Cutibacterium acnes (n=7) were the most frequently cultured microorganisms from swab C.
In THA, the contamination rate of the skin after peeling off the IOD before incision closure was higher than that of the skin immediately after sterilization with povidone-iodine and higher than that on the IOD at the time of incision closure. The detected bacterial species were considered clinically significant pathogens. Preventive measures against infection, such as minimizing stripping of the IOD or re-sterilizing bare skin after IOD stripping, should be instituted in consideration of these findings when performing THA using IOD.
本研究旨在分析髋关节置换术（THA）切皮时聚维酮碘浸渍塑料胶膜（IOD）下皮肤的污染率。
本研究纳入 225 例行初次 THA 的患者（28 名男性，197 名女性；平均年龄=65 岁；年龄范围 30-85 岁）。采用体积分数为 1%洗必泰与 83%乙醇的溶液进行消毒后，用 10%聚维酮碘溶液对手术部位进行涂擦，手术开始时将 IOD 紧绷地贴附。在以下位置采集手术部位的拭子：IOD 应用前的皮肤拭子 A、切口关闭时 IOD 表面的拭子 B 和 IOD 剥离后皮肤的拭子 C。立即将获得的样本送去进行微生物分析。确定拭子 A、B 和 C 的污染率，并比较拭子 C 与拭子 A 和 B 的污染率，同时鉴定细菌种类。
拭子 A 阳性培养 8 例（3.6%），拭子 B 阳性培养 10 例（4.4%），拭子 C 阳性培养 22 例（9.8%）。拭子 C 的污染率明显高于拭子 A（p=0.008）和 B（p=0.028）。从拭子 C 中最常培养到的微生物是凝固酶阴性葡萄球菌（n=10）和痤疮丙酸杆菌（n=7）。
在 THA 中，切皮前剥离 IOD 时皮肤的污染率高于聚维酮碘消毒后的皮肤，也高于切口关闭时 IOD 上的皮肤。所检测到的细菌种类被认为是临床上有意义的病原体。考虑到这些发现，在使用 IOD 进行 THA 时，应采取预防感染的措施，如尽量减少 IOD 的剥离或在剥离 IOD 后对裸露皮肤进行重新消毒。
