Investigation Performed at the University of Washington, Department of Orthopedics and Sports Medicine, Seattle, WA, USA.
Harborview Medical Center Department of Anesthesiology and Pain Medicine Division of Critical Care Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA.
Int Orthop. 2023 Jun;47(6):1511-1515. doi: 10.1007/s00264-023-05786-x. Epub 2023 Mar 29.
The objective of this study was to characterize the temporal dynamics of Cutibacterium repopulation of the skin surface after application of chlorhexidine to the shoulder.
Ten shoulders in five male subjects were used. A skin swab was taken prior to (0 minutes) and then at three, 30, 60, 120, and 240 minutes after skin preparation with 2% chlorhexidine gluconate and 70% isopropyl alcohol. Semi-quantitative bacterial load was measured for each timepoint.
From zero minutes (pre-treatment) to three minutes, chlorhexidine-isopropyl alcohol reduced the skin bacterial load in eight out of ten shoulders. Of these eight shoulders, four (50%) had growth by 30 minutes, seven (88%) had growth by 60 minutes, and all eight (100%) had growth by 240 minutes. Compared to the three minutes after chlorhexidine application, bacterial load had significantly increased by 60 minutes but were still significantly lower than the pre-prep bacterial load (0 minutes).
Following standard surgical skin preparation with chlorhexidine-isopropyl alcohol, the surface of the shoulder is repopulated with Cutibacterium within one hour, presumably from reservoirs in sebaceous glands not penetrated by topical antiseptic agents. Since these dermal glands are transected by skin incision for shoulder arthroplasty, this study suggests that they may be sources of wound contamination during surgery in spite of skin preparation with chlorhexidine.
本研究旨在描述在肩部使用洗必泰进行皮肤准备后，皮肤表面的葡萄球菌属重新定植的时间动态变化。
本研究使用了 5 名男性受试者的 10 个肩部。在使用 2%葡萄糖酸氯己定和 70%异丙醇进行皮肤准备之前（0 分钟），然后在 3、30、60、120 和 240 分钟时，从每个时间点采集皮肤拭子。测量每个时间点的半定量细菌负荷。
从 0 分钟（预处理）到 3 分钟，氯己定-异丙醇降低了 10 个肩部中的 8 个肩部的皮肤细菌负荷。在这 8 个肩部中，有 4 个（50%）在 30 分钟时出现生长，7 个（88%）在 60 分钟时出现生长，所有 8 个（100%）在 240 分钟时出现生长。与氯己定应用后 3 分钟相比，60 分钟时的细菌负荷显著增加，但仍明显低于预处理细菌负荷（0 分钟）。
在使用氯己定-异丙醇进行标准手术皮肤准备后，在 1 小时内，肩部表面会被葡萄球菌属重新定植，这可能是由于表皮腺未能被局部抗菌剂渗透而从皮脂腺中的储备中定植。由于这些真皮腺在进行肩部关节置换术时被皮肤切口切断，因此尽管使用了氯己定进行皮肤准备，本研究表明它们可能是手术过程中伤口污染的来源。
