手术患者皮肤准备循证实践

Evidence-based practice of skin preparation for patients in surgery

目的探讨手术患者皮肤准备方式及时间,预防手术部位感染的发生。方法运用循证的方法查找最新最可靠的科学证据,为手术患者提供最佳的备皮方法,即剪毛发和彻底清洁皮肤;如果不涉及到手术野,毛发可不去除;确需去除手术部位毛发时,在术前即刻或2h进行,使用剪毛方式;手术前采用含消毒性能的清洁剂彻底清除手术切口部位和周围皮肤的污染。结果有消毒性能的清洁剂进行术前沐浴或擦浴,可以彻底清除手术切口部位和周围皮肤的污染;应用不损伤毛囊的方式在手术前即刻去除手术部位毛发,达到卫生部《外科手术部位感染预防和控制技术指南(试行)》要求。结论充分进行手术患者的皮肤消毒沐浴和使用不损伤皮肤的去毛发方法,能最大程度减少并抑制手术部位的细菌菌落,降低手术部位感染率。

OBJECTIVE To explore the skin preparation approaches and time for the patients in surgery so as to prevent the surgical site infections. METHODS The evidence-based method was used to find the latest and most reliable scientific evidence for surgery patients and provide the best skin preparation method, namely shearing and cleaning the skin completely. If it did not involve the operation field, hair could not be removect. If it was really necessary to remove hair surgical site immediately or 2 hours before the surgery, the shearing way was used;the detergents containing the disinfection elements were used to remove the pollutants on the surgical sire and peripheral skins completely. RESULTS To perform the preoperative bathing or sponge bathing by using the detergents containing the disinfection ingredients could remove the pollutants on the surgical site and peripheral skins completely; to remove the hair on the surgical site immediately before the surgery by using the method without harmful to the hair follicle could meet the requirement of surgical site infection prevention and control technology guidance （for trial implementation） issued by the Ministry of Health. CONCLUSION To fully perform the bathing for skin disinfection and use the method without harmful to the skin can minimize and inhibit the bacterial colony counts of the surgical site so as to reduce the incidence of surgical site infections.