Staaf Karin, Scheer Vendela, Serrander Lena, Fernström Anders, Uhlin Fredrik
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Nephrology, Linköping University Hospital, Region Östergötland, Linköping, Sweden.
BMC Nephrol. 2025 Jul 19;26(1):402. doi: 10.1186/s12882-025-04230-z.
A patient's normal skin flora is most often the origin of arteriovenous fistula (AVF) infections. When the buttonhole cannulation technique is used, the risk of these types of infections increases. The most effective disinfectant should be used to prevent AVF infections, but evidence on which to choose is lacking. The present study assessed whether chlorhexidine is more effective than ethanol in patients treated with haemodialysis via AVF.
In this randomized, cross-over, clinical trial, we compared 5 mg/mL chlorhexidine in 70% ethanol to 70% ethanol alone with and without arm washing using serial sampling of normal skin flora directly before disinfection, immediately after the disinfectant effect time, and 2 and 4 h after disinfection during four different dialysis treatments. Scabs from the buttonhole tracks were collected and the type of bacteria in the scabs compared to the patient's normal skin flora. All participants were sampled during all four interventions. The CFU/mL and types of bacteria were compared between intervention groups.
Compared to ethanol, chlorhexidine resulted in fewer positive haematin plates directly after disinfection (1.4% vs. 10.8% p = 0.032). After 2 and 4 h, ethanol in combination with arm washing showed an increased regrowth of bacteria compared to chlorhexidine without arm washing (60 vs. 170 CFU/mL, p = 0.046 and 160 vs. 338 CFU/mL, p = 0.022). Scabs from the buttonhole track contained normal skin flora (Cohen's kappa = 0.97).
Disinfection with chlorhexidine is more effective than ethanol when the buttonhole cannulation technique is used for AVF.
The study was registered June 12, 2023 in Clinical Trials Information System (CTIS) identification number: 2023-505935-11-00.
患者正常的皮肤菌群通常是动静脉内瘘（AVF）感染的源头。采用扣眼穿刺技术时，这类感染的风险会增加。应使用最有效的消毒剂来预防AVF感染，但缺乏可供选择的依据。本研究评估了在接受AVF血液透析治疗的患者中，氯己定是否比乙醇更有效。
在这项随机、交叉临床试验中，我们将70%乙醇中的5mg/mL氯己定与单纯70%乙醇进行了比较，在四种不同的透析治疗期间，在消毒前、消毒剂作用时间结束后立即以及消毒后2小时和4小时对正常皮肤菌群进行连续采样，比较有无手臂清洗的情况。收集扣眼穿刺部位的痂皮，并将痂皮中的细菌类型与患者正常的皮肤菌群进行比较。所有参与者在所有四种干预措施期间均进行采样。比较干预组之间每毫升菌落形成单位（CFU/mL）和细菌类型。
与乙醇相比，氯己定在消毒后直接导致阳性血平板数量更少（1.4%对10.8%，p = 0.032）。2小时和4小时后，与未进行手臂清洗的氯己定相比，乙醇联合手臂清洗显示细菌再生长增加（60对170 CFU/mL，p = 0.046；160对338 CFU/mL，p = 0.022）。扣眼穿刺部位的痂皮含有正常皮肤菌群（科恩kappa系数 = 0.97）。
当采用扣眼穿刺技术进行AVF穿刺时，氯己定消毒比乙醇更有效。
该研究于2023年6月12日在临床试验信息系统（CTIS）注册，识别号：2023 - 505935 - 11 - 00。
