皮肤抗菌的最佳产品。

Best products for skin antisepsis.

机构信息

J.M. Boyce Consulting, LLC, Middletown, CT.

出版信息

Am J Infect Control. 2023 Nov;51(11S):A58-A63. doi: 10.1016/j.ajic.2023.02.002.

DOI:10.1016/j.ajic.2023.02.002

PMID:37890954

Abstract

BACKGROUND

Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and other health care associated infections.

METHODS

A PubMed search was performed to update the evidence on skin antiseptic products and practices.

RESULTS

Current guidelines for prevention of surgical site infections (SSIs) recommend preoperative baths or showers with a plain or antimicrobial soap prior to surgery, but do not make recommendations on the timing of baths, the total number of baths needed, or about the use of chlorhexidine gluconate (CGH)-impregnated cloths. Randomized controlled trials have demonstrated that pre-operative surgical hand antisepsis using an antimicrobial soap or alcohol-based hand rub yields similar SSI rates. Other studies have reported that using an alcohol-based hand rub caused less skin irritation, was easier to use, and required shorter scrub times than using antimicrobial soap. Current SSI prevention guidelines recommend using an alcohol-containing antiseptic for surgical site infection. Commonly used products contain isopropanol combined with either CHG or with povidone-iodine. Surgical site preparation protocols for shoulder surgery in men may need to include coverage for anaerobes. Several studies suggest the need to monitor and improve surgical site preparation techniques. Daily bathing of intensive care unit (ICU) patients with a CHG-containing soap reduces the incidence of central line-associated bloodstream infections (CLABSIs). Evidence for a similar effect in non-ICU patients is mixed. Despite widespread CHG bathing of ICU patients, numerous barriers to its effective implementation exist. Measuring CHG levels on the skin is useful for identifying gaps in coverage and suboptimal skin concentrations. Using alcohol-based products with at least 2% CHG for skin preparation prior to central line insertion reduces CLABSIs.

CONCLUSIONS

Progress has been made on skin antisepsis products and protocols, but improvements in technique are still needed.

摘要

背景

在手术前，皮肤消毒剂用于多种目的，用于给高危患者沐浴，以减少中心静脉相关感染和其他医疗相关感染。

方法

对 PubMed 进行了搜索，以更新皮肤消毒剂产品和实践的证据。

结果

目前预防手术部位感染（SSI）的指南建议术前用普通或抗菌肥皂洗澡或淋浴，但不建议洗澡的时间、所需的总洗澡次数，或关于氯己定葡萄糖酸盐（CGH）浸渍布的使用。随机对照试验表明，术前使用抗菌肥皂或酒精基洗手液进行手部消毒可产生相似的 SSI 率。其他研究报告称，使用酒精基洗手液引起的皮肤刺激较小，使用更方便，且刷洗时间短于使用抗菌肥皂。目前的 SSI 预防指南建议使用含酒精的消毒剂预防手术部位感染。常用的产品含有异丙醇，与 CHG 或聚维酮碘合用。男性肩部手术的手术部位准备方案可能需要包括厌氧菌覆盖。几项研究表明，需要监测和改进手术部位准备技术。每天用含 CHG 的肥皂给重症监护病房（ICU）患者洗澡可降低中心静脉相关血流感染（CLABSI）的发生率。在非 ICU 患者中类似效果的证据不一。尽管 ICU 患者广泛使用 CHG 洗澡，但在有效实施方面仍存在许多障碍。测量皮肤中的 CHG 水平有助于确定覆盖范围的差距和皮肤浓度不理想。在中心静脉导管插入前使用至少含有 2%CHG 的酒精基产品进行皮肤准备可降低 CLABSI 的发生率。