دوره 36، شماره 498: هفته دوم آذر ماه 1397:1165-1174

بررسی تأثیر درپ برشی بر میزان بروز عفونت محل جراحی بعد از اعمال جراحی ستون فقرات کمری

محمدرضا زارعی , همایون تابش , حسین فاضلی , اکرم اعرابی

DOI: 10.22122/jims.v36i498.10704

چکیده


مقدمه: این مطالعه با هدف بررسی تأثیر درپ برشی بر میزان بروز عفونت محل جراحی بعد از اعمال جراحی ستون فقرات کمری انجام شد.

روش‌ها: این مطالعه، به صورت نیمه تجربی بر روی 88 بیمار کاندیدای جراحی ستون فقرات کمری در بیمارستان الزهرای (س) اصفهان انجام شد. بیماران به صورت تصادفی در یکی از دو گروه مساوی با درپ برشی (مورد) و بدون درپ برشی (شاهد) قرار گرفتند. محل عمل بیماران از نظر بروز عفونت سطحی و عمقی در روزهای 2، 14 و 30 پس از عمل جراحی، بر اساس معیارهای تعریف شده در راهنماهای مرکز کنترل و پیش‌گیری از بیماری آمریکا بررسی شدند. از بیماران مشکوک به عفونت آزمایش‌های C-reactive protein (CRP) و Erythrocyte sedimentation rate (ESR) و از ترشحات خروجی از زخم بیمار، کشت باکتریایی تهیه شد.

یافته‌ها: از میان 44 بیمار گروه مورد، تنها 3 نفر (8/6 درصد) و در گروه شاهد، تنها 2 نفر (5/4 درصد) در روز دوم پس از عمل جراحی دچار عفونت سطحی شدند. فراوانی بروز عفونت بین دو گروه مورد و شاهد تفاوت معنی‌داری نداشت (50/0 = P). همچنین، در روزهای 14 و 30 در هیچ یک از دو گروه عفونتی مشاهده نشد.

نتیجه‌گیری: هیچ تفاوت معنی‌داری در فراوانی بروز عفونت محل جراحی در بین دو گروه با و بدون درپ برشی وجود ندارد و تصمیم‌گیری قطعی در خصوص استفاده یا عدم استفاده از درپ برشی، به مطالعات بیشتری نیاز دارد.


واژگان کلیدی


درپ‌های جراحی؛ عفونت محل جراحی؛ ستون فقرات کمری؛ جراحی

تمام متن:

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مراجع


Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O. Postoperative infections of the lumbar spine: Presentation and management. Int Orthop 2012; 36(2): 439-44.

Soltani Arabshahi S, Haji Nasrollah E, Beyhaghi A. A survey on the risk factors of surgical wound infection. Razi J Med Sci 2005; 12(46): 313-21. [In Persian].

Garner BH, Anderson DJ. Surgical site infections: An update. Infect Dis Clin North Am 2016; 30(4): 909-29.

Zinn J, Jenkins JB, Swofford V, Harrelson B, McCarter S. Intraoperative patient skin prep agents: is there a difference? AORN J 2010; 92(6): 662-74.

Casey AL, Karpanen TJ, Nightingale P, Conway BR, Elliott TS. Antimicrobial activity and skin permeation of iodine present in an iodine-impregnated surgical incise drape. J Antimicrob Chemother 2015; 70(8): 2255-60.

Grove GL, Eyberg CI. Comparison of two preoperative skin antiseptic preparations and resultant surgical incise drape adhesion to skin in healthy volunteers. J Bone Joint Surg Am 2012; 94(13): 1187-92.

Talbot TR. Surgical site infections and antimicrobial prophylaxis. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Toronto, ON, Canada: Elsevier; 2015. p. 3492-504.

Lilly HA, Lowbury EJ, London PS, Porter MF. Effects of adhesive drapes on contamination of operation wounds. Lancet 1970; 2(7670): 431-2.

Falk-Brynhildsen K, Soderquist B, Friberg O, Nilsson UG. Bacterial recolonization of the skin and wound contamination during cardiac surgery: A randomized controlled trial of the use of plastic adhesive drape compared with bare skin. J Hosp Infect 2013; 84(2): 151-8.

Ward HR, Jennings OG, Potgieter P, Lombard CJ. Do plastic adhesive drapes prevent post caesarean wound infection? J Hosp Infect 2001; 47(3): 230-4.

Anderson B. The Netter collection of medical illustrations - integumentary system. 2nd ed. Philadelphia, PA: Saunders; 2012.

Alijanipour P, Karam J, Llinas A, Vince KG, Zalavras C, Austin M, et al. Operative environment. J Orthop Res 2014; 32(Suppl 1): S60-S80.

World Health Organization. Global guidelines for the prevention of surgical site infection. Geneva, Switzerland: WHO; 2016.

Yoshimura Y, Kubo S, Hirohashi K, Ogawa M, Morimoto K, Shirata K, et al. Plastic iodophor drape during liver surgery operative use of the iodophor-impregnated adhesive drape to prevent wound infection during high risk surgery. World J Surg 2003; 27(6): 685-8.

Rezapoor M, Tan TL, Maltenfort MG, Parvizi J. Incise draping reduces the rate of contamination of the surgical site during hip surgery: A Prospective, randomized trial. J Arthroplasty 2018; 33(6): 1891-5.

Webster J, Alghamdi A. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev 2015; (4): CD006353.

Allegranzi B, Bischoff P, de JS, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16(12): e276-e287.

Anderson DJ, Podgorny K, Berrios-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35(6): 605-27.

Leaper D, Burman-Roy S, Palanca A, Cullen K, Worster D, Gautam-Aitken E, et al. Prevention and treatment of surgical site infection: summary of NICE guidance. BMJ 2008; 337: a1924.

Kainth K, Hunt MA, Haines SJ. The use and misuse of antibiotics in neurosurgery. In: Winn RH, editor. Youmans and Winn Neurological Surgery. 7th ed. China. NY: Elsevier Health Sciences; 2017. p. 340-9.

Dubory A, Giorgi H, Walter A, Bouyer B, Vassal M, Zairi F, et al. Surgical-site infection in spinal injury: Incidence and risk factors in a prospective cohort of 518 patients. Eur Spine J 2015; 24(3): 543-54.

Artz CP, Conn JH, Howard HS. Protection of the surgical wound with a new plastic film. JAMA 1960; 174: 1865-8.

Bejko J, Tarzia V, Carrozzini M, Gallo M, Bortolussi G, Comisso M, et al. Comparison of Efficacy and Cost of Iodine Impregnated Drape vs. Standard Drape in Cardiac Surgery: Study in 5100 Patients. J Cardiovasc Transl Res 2015; 8(7): 431-7.

Ho VP, Eachempati SR, Barie PS. Surgical site infections. In: Moore LJ, Turner KL and Todd SR, editors. Common problems in acute care surgery. New York, NY: Springer; 2013. p. 139-54.

Fairclough JA, Johnson D, Mackie I. The prevention of wound contamination by skin organisms by the pre-operative application of an iodophor impregnated plastic adhesive drape. J Int Med Res 1986; 14(2): 105-9.

Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017; 152(8): 784-91.

Ata A, Lee J, Bestle SL, Desemone J, Stain SC. Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg 2010; 145(9): 858-64.

Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 2008; 90(1): 62-9.

Nicholson M, Beal M, Shofer F, Brown DC. Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats. Vet Surg 2002; 31(6): 577-81.

Schimmel JJ, Horsting PP, de Kleuver M, Wonders G, van Limbeek J. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 2010; 19(10): 1711-9.

Lonjon G, Dauzac C, Fourniols E, Guigui P, Bonnomet F, Bonnevialle P. Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. Orthop Traumatol Surg Res 2012; 98(7): 788-94.

Owen LJ, Gines JA, Knowles TG, Holt PE. Efficacy of adhesive incise drapes in preventing bacterial contamination of clean canine surgical wounds. Vet Surg 2009; 38(6): 732-7.

Radcliff KE, Rasouli MR, Neusner A, Kepler CK, Albert TJ, Rihn JA, et al. Preoperative delay of more than 1 hour increases the risk of surgical site infection. Spine (Phila Pa 1976) 2013; 38(15): 1318-23.

Vijay MR, Michael AF, Meic HS and Andrew TD. Postoperative Infections of the Spine. In: Winn RH, editor. Youmans and Winn neurological surgery. 7th ed. Beijing, China: Elsevier Health Sciences; 2017. p. 331-9.

Gerometta A, Rodriguez Olaverri JC, Bitan F. Infections in spinal instrumentation. Int Orthop 2012; 36(2): 457-64.

Brown EM, Pople IK, de Louvois J, Hedges A, Bayston R, Eisenstein SM, et al. Spine update: prevention of postoperative infection in patients undergoing spinal surgery. Spine (Phila Pa 1976) 2004; 29(8): 938-45.

Pahlavan S, Lee YP, Bhatia NN, editors. Postoperative spinal infections. In: Garfin SR, Eismont FJ, Bell GR, Bono CM, Fischgrund J, editors. Rothman-Simeone the spine e-book7th ed. Philadelphia, PA: Elsevier; 2017. P. 1807-25.




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