为何推荐用2%洗必泰消毒穿刺点？

hzx

想请教各位专家：在导管相关性血流感染的预防中有一条：建议用2%洗必泰消毒深静脉穿刺点。我一直没想明白，洗必泰只是一种低水平消毒剂，而我们现在用的碘伏是中水平消毒剂，应该讲碘伏是一种很好的皮肤消毒剂，它克服了以往碘酊的弱点。这有循证学依据吗？

hzx

都过两天了，咋没人解答我的问题？我们来自基层，有些预防措施提出来，要通过我们向临床医护人员宣传，但自己不知所以然是无法让别人信服的。即便问题很简单，很多专家若觉得不值一答，我还是希望版主至少该搭理我一下吧？小女子这厢有礼了！！

樵夫

根据美国CDC关于“预防血管内导管相关血流感染指南”中推荐首选2%洗必泰，有循证医学方面的证据：
Chlorhexidine versus povidone-iodine for central venous catheter site care in children。J Pediatr Nurs. 2004 Feb;19(1):74-80


Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial。Pediatr Infect Dis J. 1995 Jun;14(6):510-6。

abstract：The purpose of the study was to compare the efficacy of 10% povidone-iodine with that of 0.5% chlorhexidine gluconate in 70% isopropyl alcohol for the prevention of peripheral intravenous catheter colonization in neonates. This was a multicenter, nonrandomized prospective study in a tertiary neonatal intensive care setting in which povidone-iodine and chlorhexidine gluconate were each used as antiseptic skin preparations over sequential 6-month periods. During the first 6 months of the study when povidone-iodine was in use 9.3% (38 of 408) of catheters were colonized. During the second 6 months of the study when chlorhexidine gluconate was in use, catheter colonization occurred in 4.7% (20 of 418, P = 0.01). Catheter-related bacteremia occurred during only 0.2% (2 of 826) of all catheterizations. Heavy skin colonization before catheter insertion (relative risk, 3.6; 95% confidence interval, 1.9, 7.0), catheterization > or = 72 hours (relative risk. 2.0; 95% confidence interval, 1.01, 3.8) and gestational age < or = 32 weeks (relative risk, 1.8; 95% confidence interval, 1.02, 3.3) increased colonization risk. Ampicillin infusion (relative risk, 0.4; 95% confidence interval, 0.2, 0.7) and 0.5% chlorhexidine gluconate cutaneous antisepsis (relative risk, 0.4; 95% confidence interval, 0.2, 0.8) were factors associated with decreased colonization risk. We conclude that 0.5% chlorhexidine gluconate in 70% isopropyl alcohol appears to be more efficacious than 10% povidone-iodine for the prevention of peripheral intravenous catheter colonization in neonates.

[ 本帖最后由 create_qiao 于 2009-1-11 09:52 编辑 ]

樵夫

Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters。
Lancet. 1991 Aug 10;338(8763):339-43
abstract：More than 90% of all intravascular device-related septicaemias are due to central venous or arterial catheters. To assess the efficacy of cutaneous antisepsis to prevent catheter-associated infection, we prospectively studied three antiseptics for disinfection of patients' central venous and arterial catheter insertion sites in a surgical intensive care unit. 668 catheters were randomised to 10% povidone-iodine, 70% alcohol, or 2% aqueous chlorhexidine disinfection of the site before insertion and for site care every other day thereafter. Chlorhexidine was associated with the lowest incidence of local catheter-related infection (2.3 per 100 catheters vs 7.1 and 9.3 for alcohol and povidone-iodine, respectively, p = 0.02) and catheter-related bacteraemia (0.5 vs 2.3 and 2.6). Of the 14 infusion-related bacteraemias (4 due to contaminated infusate or catheter hub, 10 due to infected catheters), 1 was in the chlorhexidine group and 13 were in the other two groups (odds ratio 0.16, p = 0.04). We conclude that use of 2% chlorhexidine, rather than 10% povidone-iodine or 70% alcohol, for cutaneous disinfection before insertion of an intravascular device and for post-insertion site care can substantially reduce the incidence of device-related infection.

樵夫

Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients
Crit Care Med. 1996 Nov;24(11):1818-23

OBJECTIVES: To compare the efficacy of a newly available antiseptic solution (composed of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzyl alcohol), with 10% povidone iodine, on the prevention of central venous or arterial catheter colonization and infection. DESIGN: Prospective, randomized clinical trial. SETTING: Surgical-trauma intensive care unit (ICU) in a university hospital. PATIENTS: All patients admitted to the ICU and requiring the insertion of a central venous and/or an arterial catheter from July 1, 1992 to October 31, 1993. INTERVENTIONS: Patients were randomly assigned to one of two groups according to the antiseptic solution used for insertion and catheter care. The same solution was used for skin disinfection from the time of catheter insertion to the time of removal of each catheter. MEASUREMENTS AND MAIN RESULTS: Catheter distal tips were quantitatively cultured when catheters were no longer necessary, if there was a suspicion of catheter-related infection, and routinely after 7 days of use for arterial catheters, or after 15 days of use for central venous catheters. The rate of significant catheter colonization (i.e., > or = 10(3) colony-forming units [cfu]/mL by quantitative culture), and catheter-related sepsis (as defined by sepsis abating following catheter removal per 1,000 catheter-days), were significantly lower in the chlorhexidine group (12 vs. 31 [relative risk 0.4, 95% confidence interval 0.1 to 0.9, p < .01] and 6 vs. 16 [relative risk 0.4, 95% confidence interval 0.1 to 1, p = 0.5], respectively). The rate of central venous catheter colonization and central venous catheter-related sepsis per 1,000 catheter-days were also significantly lower in the chlorhexidine group (8 vs. 31 [relative risk 0.3, 95% confidence interval 0.1 to 1, p = .03] and 5 vs. 19 [relative risk 0.3, 95% confidence interval 0.1 to 1, p = .02], respectively). Finally, the rate of arterial catheter colonization per 1,000 catheter-days was significantly lower in the chlorhexidine group (15 vs. 32 [relative risk 0.5, 95% confidence interval 0.1 to 1, p = .05]), whereas the rate of arterial catheter-related sepsis per 1,000 catheter-days was similar for the two study groups (8 in the chlorhexidine group vs. 10 in the povidone iodine group [relative risk 0.8, 95% confidence interval 0.1 to 2.2, p = .6]). The 0.25% chlorhexidine solution was superior to the 10% povidone iodine solution in preventing catheter colonizations and catheter-related sepsis due to Gram-positive bacteria (5 vs. 20 [p < .001], and 2 vs. 10 [p < .001], respectively), whereas the activity of the 0.25% chlorhexidine solution was nonsignificantly superior in preventing Gram-negative infections (7 vs. 4 [p = .5], and 4 vs. 2 [p = .8], respectively). CONCLUSIONS: The 4% alcohol-based solution of 0.25% chlorhexidine gluconate and 0.025% benzalkonium chloride was more effective than 10% povidone iodine for insertion site care of short-term central venous and arterial catheters. This effect appeared related to a more efficacious prevention of infections with Gram-positive bacteria.

樵夫

Prospective randomized trial of 3 antiseptic solutions for prevention of catheter colonization in an intensive care unit for adult patients
Infect Control Hosp Epidemiol. 2008 Sep;29(9):847-53

OBJECTIVE: To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG). DESIGN: Prospective, randomized controlled trial. SETTING: Intensive care unit in a teaching hospital. METHODS: Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups. RESULTS: A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1% vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria. CONCLUSIONS: The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.

樵夫

Implementation of chlorhexidine gluconate for central venous catheter site care at Siriraj Hospital, Bangkok, Thailand
Am J Infect Control. 2007 Nov;35(9):585-8

BACKGROUND: A meta-analysis and cost-effectiveness analysis of randomized controlled trials comparing chlorhexidine gluconate with povidone-iodine solutions for venous catheter site care found that the use of chlorhexidine gluconate significantly reduced the risk for catheter-related bloodstream infections and that it was cost-effective. The objective of the study was to implement locally formulated chlorhexidine gluconate for central venous catheter (CVC) site care in intensive care units (ICUs) at Siriraj Hospital. METHODS: The study was conducted in 312 subjects who needed CVC insertions in 3 ICUs from January to July 2006. One hundred twenty subjects received 2% chlorhexidine gluconate in 70% alcohol, whereas 192 subjects received 10% povidone-iodine as the antiseptic solution for CVC site care. The patients were assessed for CVC-related infections and for any adverse effects of 2% chlorhexidine gluconate in 70% alcohol. RESULTS: The incidence of CRBSIs in the indwelling CVC subjects who received 2% chlorhexidine gluconate in 70% alcohol was less than those who received 10% povidone-iodine during the same period, 3.2 versus 5.6 episodes per 1000 CVC days, respectively (P= .06; OR, 3.26; 95% CI: 0.97-10.92). No adverse effects related to using 2% chlorhexidine gluconate in 70% alcohol were observed. CONCLUSION: The locally formulated 2% chlorhexidine gluconate in 70% alcohol was safe, effective, and efficient for CVC site care in ICUs at Siriraj Hospital.

水墨画

真心希望版主能有中文版的介绍！谢谢！
我们在去年11月份听香港老师讲课时也提到用“洗必泰消毒液”擦手，但价格有点贵的。很想了解这方面的知识，希望版主能赐教哦。:handshake :handshake

hzx

感谢版主提供的几篇文献，本人英文阅读速度较慢，刚消化。证明洗必泰对皮肤消毒是有效的，且2%与0.5%的差异也不明显。看来要请药剂科联系哪有买。

樵夫

对你有帮助就好:handshake

黑旋风

请问各位专家：洗必泰对不同对象的浓度是多少？
各位专家，大家好！

      有个问题想请教你们，请你们在百忙中给与回答！我深表万分感谢！最近我院进的洗必泰醇（醋酸氯己定含量为2.9～3.4g/L)（兴卫牌），它的使用范围是适用于外科术前洗手、手术部位和注射部位的皮肤消毒，预防性卫生洗手消毒；它没有讲到伤口创面消毒的怎么使用，电话与厂家咨询，8～10倍稀释（现配现用），记得我院原来进的洗必泰（醋酸氯己定含量也是为2.9～3.4g/L)，在说明书讲到伤口创面消毒10倍稀释用。可是我查了《消毒技术规范（2002版）》（P177）上面是这么讲的：“  ① 擦拭法。手术部位及注射部位的皮肤的消毒，用 5000mg/L醋酸氯己定-乙醇(70%)溶液局部擦拭 2 遍，作用 2min；对伤口创面消毒，用 5000mg/L 醋酸氯己定水溶液擦拭创面 2遍～3遍，作用 2min。外科洗手可用相同浓度和作用时间。② 冲洗法。对阴道、膀胱或伤口粘膜创面的消毒，用 500mg/L～1000mg/L醋酸氯己定水溶液冲洗，至冲洗液变清为止。”，我们的洗必泰产品中醋酸氯己定含量与消毒技术规范要求不一样怎么办？各位专家的医院的洗必泰的醋酸氯己定含量又是多少！按照规范对伤口创面消毒与手术部位及注射部位的皮肤的消毒浓度是一样的，你们医院对伤口创面消毒的浓度是多少？