Wing, Operational Medicine Division, 59th Medical Wing Center for Advanced Molecular Detection, San Antonio-Lackland, TX 78236.
Wing, Operational Medicine Division, 59th Medical Wing Science and Technology, San Antonio-Lackland, TX 78236.
Mil Med. 2021 Jan 25;186(Suppl 1):122-128. doi: 10.1093/milmed/usaa440.
The purpose of this investigation was to evaluate the efficacy of currently employed commercial disinfectants in a simulated austere surgical environment similarly faced by ground surgical teams in forward deployed positions. Severe contamination of traumatic combat wounds along with limitations of operations in austere environments may result in available disinfectants providing inadequate surgical instrument decontamination.
The study consisted of nine experimental groups and two control groups evaluating hemostatic forceps found in kits of ground surgical teams. Hemostats were contaminated in a manner replicating the use in austere wartime surgery, cleaned by manual debridement and soaked in a disinfectant. Initially, instruments were debrided in one of three initial liquids (potable water, sterile water, or potable water with Envirocleanse A) and subsequently treated with one of three terminal disinfectants (Cidex OPA, CaviCide, or Neutral Disinfectant Cleaner). Treated hemostats were placed in sterile wire-closure bags for various storage times and tested for viable bacteria measured by colony-forming units.
Our findings indicated that mechanical debridement in water, independent of Envirocleanse A, followed by soaking in any of the three terminal disinfectants achieved a marked reduction in recovered bacteria from hemostats regardless of storage length. Of the three disinfectants tested, Cidex OPA appeared to be the most robust in terms of decontamination, followed by CaviCide and Neutral Disinfectant Cleaner.
This study supports the conclusion that all evaluated disinfectants are capable of rapidly producing instruments with minimal bacterial contaminants when standard sterilization is unavailable. Therefore, when lifesaving surgical intervention must be performed in a deployed environment, austere surgical teams can confidently utilize either product with minimal risk of infection. However, of the disinfectants, Cidex OPA appears to be most effective in reducing bacterial contamination for both rapid and slow turnover of instrument usage, and thus, the disinfectants are recommended for application when sterilization is not available.
本研究的目的是评估在类似战地外科团队在前沿部署位置所面临的严峻环境下，目前使用的商业消毒剂的功效。严重污染的创伤性战伤以及在严峻环境下操作的限制可能导致现有的消毒剂无法充分消毒手术器械。
该研究包括九个实验组和两个对照组，评估了野战外科团队套件中的止血夹。通过模拟在严峻战时手术中的使用方式对止血夹进行污染，通过手动清创和浸泡在消毒剂中进行清洁。最初，器械在三种初始液体（饮用水、无菌水或含 Envirocleanse A 的饮用水）中的一种中进行清创，然后用三种终末消毒剂（Cidex OPA、CaviCide 或中性消毒剂清洁剂）之一进行处理。处理后的止血夹被放置在无菌的金属丝封口袋中进行各种储存时间，并通过菌落形成单位测试来测量活菌。
我们的研究结果表明，无论储存时间长短，机械清创在水中，无论是否使用 Envirocleanse A，然后浸泡在三种终末消毒剂中的任何一种中，均可显著减少从止血夹中回收的细菌。在所测试的三种消毒剂中，Cidex OPA 在去污方面似乎最有效，其次是 CaviCide 和中性消毒剂清洁剂。
本研究支持以下结论，即在无法进行标准消毒时，所有评估的消毒剂都能够快速生产出细菌污染最少的器械。因此，当在部署环境中必须进行救生手术干预时，严峻手术团队可以自信地使用任何一种产品，而感染风险最小。然而，在所测试的消毒剂中，Cidex OPA 似乎在快速和慢速器械使用周转率下都能更有效地减少细菌污染，因此，在无法进行消毒时推荐使用这些消毒剂。
