放置中心静脉导管前酒精手部消毒是否等效于外科刷手？

背景外科无水手消毒液（1％葡萄糖酸氯己定＋61％乙醇，爱护佳^TM；3M卫生保健，圣保罗，明尼苏达州）、单纯酒精清洁剂（62％乙醇）以及传统的术前消毒（使用无菌刷用4％氯己定肥皂擦洗5分钟用清水冲净），这些都是应用于手部清洁与消毒的技术。我们假设仅在置入中心静脉导管前使用含酒精的清洁剂以及无水手消毒液（爱护佳）与传统的外科刷手法同样有效。方法应用5种方法对手部进行清洁，将手指的采样标本进行24小时的人工培养：方法1：传统外科刷洗（n=49，取自14个受试者）；方法2：传统的术前消毒（使用无菌刷，用4％氯己定肥皂擦洗5分钟用清水冲净）间隔15分钟后，应用仅含酒精的清洁剂（62％乙醇）（n=49，取自14个受试者）；方法3：仅应用单纯酒精清洁剂（n=49，取自14个受试者）；方法4：应用单纯酒精清洁剂后间隔15分钟，应用传统的术前消毒（使用无菌刷用4％氯己定肥皂擦洗5分钟用清水冲净）（n=49，取自14个受试者）；方法5：单纯用外科无水手消毒液（爱护佳）（n=116，取自38个受试者）。采用15分钟时间间隔是为了使之短期再污染，并测试之前消毒方式的残余效应。结果仅应用单纯酒精清洁剂（方法3）效果显著差于传统术前消毒（方法1）（P〈0．001；82％培养皿生长）。外科无水手消毒液（爱护佳）（方法5）与传统的5分钟消毒法（方法1）相比没有显著性差异[95％可信区间（confidence interval，CI）：-14％-11％]（P=0．99；16％培养皿生长）。当传统的外科洗手后间隔15分钟的再污染后，方法2与参照（方法1）可观察到有6％的差异（95％CI：-10％-22％），方法4与之则观察不到差异（95％CI：-15％-15％）。结论作为初步的清洁方法，单纯酒精清洁法（方法3）效果显著差于传统的术前消毒法（方法1）（P〈0．001）。

BACKGROUND： Waterless antiseptic surgical hand scrub （1% chlorhexidine gluconate and 61% ethyl alcohol, Avagard^TM; 3M Health Care, St. Paul, MN）, alcohol-only cleanser （62% ethyl alcohol）, and traditional surgical scrub （5-minute scrub with 4% chlorhexidine soap using a sterilescrub brush with water） are techniques used for hand cleansing and disinfection. We hypothesized that alcohol-only cleanser and waterless antiseptic scrub （Avagard） would be as effective as a traditional surgical scrub for hand cleansing before placement of central venous catheters. METHODS： Fingers of subjects were plate-cultured for 24 hours after 5 methods of hand cleansing： method 1 ： traditional surgical scrub （n = 49 plates produced by 14 subjects）; method2： traditional surgical scrub （5-minute scrub with water, brush, and 4% chlorhexidine soap） followed by a 15-minute break, then alcohol-only cleanser （62% alcohol） （n = 49 plates produced by 14 subjects）; method 3： alcohol-only deanser alone （n = 49 plates produced by 14 subjects）; method 4： alcohol-only cleanser （62% alcohol）, followed by a 15-minute break, then traditional surgical scrub （5-minute scrub with brush, and 4% chlorhexidine soap with water） （n = 49 platesproduced by 14 subjects）; and method 5： waterless surgical scrub （Avagard） alone （n = 116plates produced by 38 subjects）. The 15-minute break was introduced to allow a short period of recontamination, and to test for residual effects from prior deansing. RESULTS： Alcohol-only cleanser alone （method 3 ） was significantly less effective than the traditional surgical scrub （method 1 ） （P 〈 0. 001 ; 82% plate growth）. Waterless surgical scrub （Avagard） （method 5 ） had a 0% observed difference （95 % confidence interval E CI ~ ： - 14% to 11% ） compared with the traditional 5-minute scrub （method 1 ） （P = 0.99; 16% plate growth）. When a traditional surgical scrub was used first followed by a 15-minute period of recontamination, there was a 6% observed difference in method 2 from reference （method 1 ） （95% CI： -10% to 22% ）, and0% observed difference in method 4 from reference （95% CI： - 15% to 15%）. CONCLUSIONS： As the initial cleansing method, the alcohol-only deanser （method 3） was significantly less effective than the traditional surgical scrub （method 1 ） （P 〈 0. 001）.