Georgetown University School of Medicine, Washington, District of Columbia, USA.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Int Wound J. 2021 Oct;18(5):664-669. doi: 10.1111/iwj.13568. Epub 2021 May 6.
Many surgeons use a single table of instruments for both excisional debridement and coverage/closure of infected wounds. This study investigates the effectiveness of a two-table set-up of sterile instruments, in addition to glove exchange, to reduce instrument cross-contamination during these procedures. This is a prospective, single-site, institutional review board-approved observational study of surgical debridements of infected wounds over a 17-month period. Two separate sterile surgical tables were used for each case: Table A for initial wound debridement (debridement set-up) and Table B for wound coverage/closure (clean set-up). Swabs of each table and its respective instruments were taken after debridement but prior to coverage/closure. The primary outcome of interest was bacterial growth at 48 hours. There were 72 surgical cases included in this study. Culture results of Table A demonstrated bacterial growth in 23 of 72 (32%) cases at 48 hours compared with 5of 72 (7%) from Table B (P = .001). These data suggest that there is significant bacterial contamination of surgical instruments used for debridement of infected wounds. Use of a two-table set-up reduced instrument cross-contamination by 78%, suggesting avoidable re-contamination of the wound.
许多外科医生在进行清创术和感染伤口覆盖/闭合时使用单一的器械表。本研究调查了在这些手术过程中，除了更换手套外，使用无菌器械的两表设置以减少器械交叉污染的效果。这是一项为期 17 个月的前瞻性、单站点、机构审查委员会批准的感染性伤口清创术的观察性研究。每个病例都使用了两张单独的无菌手术台：A 台用于初次清创（清创设置），B 台用于伤口覆盖/闭合（清洁设置）。在清创后但在覆盖/闭合之前，对每张桌子及其各自的器械进行了拭子取样。主要观察结果是 48 小时时的细菌生长情况。本研究共纳入 72 例手术病例。结果显示，48 小时时 A 表的 23 例（32%）与 B 表的 72 例（7%）相比，有细菌生长（P=0.001）。这些数据表明，用于清创术的外科器械存在显著的细菌污染。两表设置可将器械交叉污染减少 78%，提示伤口存在可避免的再污染。
