Department of Orthopaedic Surgery, Kanagawa Rehabilitation Hospital, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Japan.
Department of Orthopaedic Surgery, Kanagawa Rehabilitation Hospital, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Japan.
J Orthop Sci. 2024 Sep;29(5):1220-1225. doi: 10.1016/j.jos.2023.09.008. Epub 2023 Oct 13.
In shoulder surgery, low-virulence bacteria such as Cutibacterium acnes and coagulase-negative staphylococci can cause postoperative infection. However, the degree of sterility during surgery after disinfection is not known, and the efficacy of double skin preparation for such bacteria is unclear. This study aimed to evaluate chronological changes in the surgical field contamination rate in the shoulder joint and to compare single and double skin preparation.
In total, 126 shoulders in 121 patients undergoing shoulder surgery (64 men, 62 women; mean age 64 years) were enrolled. Patients were divided into two groups: single skin preparation, where the site was painted with 10% povidone iodine, and double skin preparation, where the site was treated with 1% chlorhexidine gluconate/83% isopropyl alcohol and painted 10% povidone iodine. Swab samples from the axillary and proximal areas in the surgical field were collected chronologically before starting surgery and at 30, 60, and 120 min after starting surgery (MAS). The contamination rate of each sample was compared and detected species were evaluated.
The contamination rate for the axillary area was 48.4%, 85.9%, 95.3%, and 97.1% in the single-preparation group and 32.3%, 72.6%, 87.1%, and 91.2% in the double-preparation group before starting surgery and 30, 60, and 120 MAS, respectively, and that the proximal area was 12.5%, 26.6%, 29.7%, and 35.3% in the single-preparation group and 16.1%, 19.4%, 27.4%, and 38.2% in the double-preparation group, respectively. Significant differences were not seen between the groups by area or time point. Most detected species were Cutibacterium acnes and coagulase-negative staphylococci.
The incidence of surgical field contamination in shoulder joint was high from immediately after starting surgery. In the axillary area, the contamination rates exceeded 70% from 30 MAS in both groups. Measures against infection should be instituted considering these findings when performing shoulder surgery.
在肩关节手术中，低毒细菌（如痤疮丙酸杆菌和凝固酶阴性葡萄球菌）可引起术后感染。然而，消毒后手术过程中的无菌程度尚不清楚，并且双皮肤准备对这些细菌的效果也不清楚。本研究旨在评估肩关节手术中手术野污染率的时间变化，并比较单次和双次皮肤准备。
共纳入 121 例（64 名男性，62 名女性；平均年龄 64 岁）接受肩关节手术的 126 例（肩）患者。患者分为两组：单皮肤准备组，局部涂 10%聚维酮碘；双皮肤准备组，局部用 1%葡萄糖酸氯己定/83%异丙醇处理，然后涂 10%聚维酮碘。手术开始前、手术开始后 30、60 和 120 分钟（MAS）时，从手术野的腋窝和近端区域采集拭子样本。比较每个样本的污染率，并评估检测到的物种。
在单准备组中，腋窝区域的污染率分别为术前 48.4%、85.9%、95.3%和 97.1%，手术开始后 30、60 和 120 MAS 时分别为 32.3%、72.6%、87.1%和 91.2%；在双准备组中，腋窝区域的污染率分别为 12.5%、26.6%、29.7%和 35.3%，手术开始后 30、60 和 120 MAS 时分别为 16.1%、19.4%、27.4%和 38.2%。区域或时间点之间未观察到两组之间的显著差异。大多数检测到的物种为痤疮丙酸杆菌和凝固酶阴性葡萄球菌。
肩关节手术中手术野污染的发生率很高，从手术开始后立即开始。在腋窝区域，两组在 30 MAS 时的污染率均超过 70%。在进行肩关节手术时，应考虑这些发现采取感染预防措施。
