神经外科使用405纳米蓝光系统作为降低环境污染和围手术期感染的辅助手段：一项前瞻性观察队列研究的结果
The Use of a 405-nm Blue Light System in a Neurosurgical Department as an Adjunct for Lowering Environmental Contamination and Perioperative Infections: Results from a Prospective Observational Cohort Study.
作者信息
Restelli Francesco, Broggi Morgan, Mazzapicchi Elio, Bricchi Monica, Iuele Luigi, Gemma Marco, Tramacere Irene, Del Bene Massimiliano, Rubiu Emanuele, Schiariti Marco, Ferroli Paolo, Acerbi Francesco, Piccardi Annica, DiMeco Francesco, Broggi Giovanni
机构信息
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan , Italy.
Microsurgical Experimental Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan , Italy.
出版信息
Neurosurgery. 2025 Apr 14;97(3):727-735. doi: 10.1227/neu.0000000000003441.
BACKGROUND AND OBJECTIVES
No data exist regarding the potential impact of a blue light system on environmental colonization and perioperative infections in neurosurgery. Main objective of this work was to analyze the clinical efficacy of a novel blue light system on the rate of environmental colonization and perioperative infections in a neurosurgical department.
METHODS
In this observational prospective cohort study, we prospectively enrolled all head/spine neurosurgical patients (January-December 2023) at a third-level referral center in Italy. Patients were followed after surgery in two separate neurosurgical wards, following normal institutional protocol. One ward was previously equipped with the INTEGRALIS® (Artemide®) blue light (405 nm) as the primary light source and the other with common neon lights. We longitudinally assessed both wards for environmental colonization (contact plates, contact swabs, and air samplings) and for the rate of clinically manifest perioperative infections (primary end points). A dedicated questionnaire evaluated patient and health professional satisfaction with the new luminous system (secondary end point).
RESULTS
Nine hundred seventy-seven patients (5765 days of hospitalization, DoH) and 1252 patients (6332 DoH) were followed, respectively, in blue light and neon wards. From an environmental perspective, a higher incidence of plates with a CFU level below 25 CFU/plate threshold was found in blue light ward compared with the neon ward at 1 month (46.2% vs 33.3%, P = .26) and, significantly, at 5 months (68.3% vs 42.3%, P = .001). No difference was observed considering cultures executed at 1 year ( P = .17). On a clinical perspective, the overall number of infections/10000 DoH was lower in blue light ward (79.0 vs 45.1, P = .02, CI 95% 1.1-2.9), with a significantly reduced rate of wound infections in respect to neon ward (10.4 vs 41.1, P = .001, CI 95% 1.6-11.7).
CONCLUSION
Blue light systems may in a surgical setting may help in lowering bacterial colonization and clinically manifest infections.
背景与目的
关于蓝光系统对神经外科环境定植和围手术期感染的潜在影响，尚无相关数据。本研究的主要目的是分析一种新型蓝光系统对神经外科科室环境定植率和围手术期感染的临床疗效。
方法
在这项观察性前瞻性队列研究中，我们前瞻性纳入了意大利一家三级转诊中心的所有颅脑/脊柱神经外科患者（2023年1月至12月）。患者术后按照正常的机构规程在两个独立的神经外科病房接受随访。一个病房先前配备了INTEGRALIS®（Artemide®）蓝光（405纳米）作为主要光源，另一个病房配备普通霓虹灯。我们纵向评估两个病房的环境定植情况（接触平板、接触拭子和空气采样）以及临床明显的围手术期感染率（主要终点）。一份专门的问卷评估了患者和医护人员对新照明系统的满意度（次要终点）。
结果
蓝光病房和霓虹灯病房分别随访了977例患者（住院5765天）和1252例患者（住院6332天）。从环境角度来看，蓝光病房中CFU水平低于25 CFU/平板阈值的平板发生率在1个月时高于霓虹灯病房（46.2%对33.3%，P = 0.26），而在5个月时差异显著（68.3%对42.3%，P = 0.001）。在1年时进行的培养中未观察到差异（P = 0.17）。从临床角度来看，蓝光病房每10000住院日的感染总数较低（79.0对45.1，P = 0.02，95%CI 1.1 - 2.9），与霓虹灯病房相比，伤口感染率显著降低（10.4对41.1，P = 0.001，95%CI 1.6 - 11.7）。
结论
在手术环境中，蓝光系统可能有助于降低细菌定植和临床明显的感染。
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