【公告】无菌生理盐水是伤口冲洗的最佳选择！

阳光

查到一篇文献：
A multicenter comparison of tap water versus sterile saline for wound irrigation.
作者： Moscati RM；Mayrose J；Reardon RF；Janicke DM；Jehle DV ；
出处： Acad Emerg Med.2007V14N5 :404-9   
Keywords:wound irrigation;tap water;saline;infections
ObjectivesTo compare wound infection rates for irrigation with tap water versus sterile saline before closure of wounds in the emergency department.

MethodsThe study was a multicenter, prospective, randomized trial conducted at two Level 1 urban hospitals and a suburban community hospital. Subjects were a convenience sample of adults presenting with acute simple lacerations requiring sutures or staples. Subjects were randomized to irrigation in a sink with tap water or with normal saline using a sterile syringe. Wounds were closed in the standard fashion. Subjects were asked to return to the emergency department for suture removal. Those who did not return were contacted by telephone. Wounds were considered infected if there was early removal of sutures or staples, if there was irrigation and drainage of the wound, or if the subject needed to be placed on antibiotics. Equivalence of the groups was met if there was less than a doubling of the infection rate.

ResultsA total of 715 subjects were enrolled in the study. Follow-up data were obtained on 634 (88%) of enrolled subjects. Twelve (4%) of the 300 subjects in the tap water group had wound infections, compared with 11 (3.3%) of the 334 subjects in the saline group. The relative risk was 1.21 (95% confidence interval = 0.5 to 2.7).

ConclusionsEquivalent rates of wound infection were found using either irrigant. The results of this multicenter trial evaluating tap water as an irrigant agree with those from previous single institution trials.

一项分别在都市1级医院和城郊社区医院急诊科同时开展的多中心、前瞻性、随机试验，比较了用水龙头水与无菌生理盐水冲洗伤口的感染率。需要缝合伤口的单纯撕裂伤成年人被随机分配到用洗涤槽水龙头冲洗组或无菌注射用生理盐水冲洗组，伤口按标准操作关闭。受试者被要求回到急诊科拆线。如果提早拆线、或伤口需要再冲洗和引流、或需要用抗菌互则被视为有感染。组间感染率小于一倍则视为等效。结果显示：直接用水龙头冲洗组伤口感染率为4%，用无菌生理盐水冲洗组为3.3%，相对危险比（RR）1.21，可信区间（CI）0.5-2.7。
研究结论：急诊科伤口冲洗，无论是直接用水龙头水冲洗还是无菌盐水冲洗，在伤口闭合后的感染率无显著统计学差异。






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楚楚

阳光 发表于 2013-6-25 17:22
                               
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查到一篇文献：
A multicenter comparison of tap water versus sterile saline for wound irrigation.
作 ...

如果可以，阳光斑斑是否可以查查这项研究所在城市是海滨城市，还是内陆城市。如果是海滨城市，担心自来水被非结核分枝杆菌污染。另外，国外的自来水质量是不是达到了饮水质量标准？在我国采用自来水是否存在很大风险？欢迎大家提供证据参与讨论！

william

学习了，新理念，临床中慢慢灌输新知识，改变老观念。

阳光

本帖最后由 阳光 于 2013-6-26 10:46 编辑

楚楚 发表于 2013-6-25 22:15
                               
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如果可以，阳光斑斑是否可以查查这项研究所在城市是海滨城市，还是内陆城市。如果是海滨城市，担心自来水 ...

楚楚老师实在太慷慨了！
，同时也无比地钦佩您的批判性思维和扩展思维。硬着头皮用谷歌快速看了下原文。
本研究选取了2个不同城市的2家1级创伤中心，和一家郊区社区医院。原文如下：
A total of 715 subjects were enrolled in the study. There were 377 subjects enrolled at Erie County Medical Center from June 1999 to August 2003, 216 subjects enrolled at Hennepin County Medical Center from August 1999 to December 2000, and 122 subjects enrolled at Millard Fillmore Suburban Hospital between September 2000 and December 2002.
百度了一下这几家医院所在城市的地理位置如下：
伊利县医疗中心：伊利县（Erie County, Pennsylvania）是美国宾夕法尼亚州西北部的一个县，地处美国东北部著名五大淡水湖群的伊利湖畔。属美国东海岸大陆性气候。
亨内平县医疗中心：明尼阿波利斯（英语：Minneapolis）是美国明尼苏达州最大的城市，该州东南部亨内平县的县治。位于密西西比河的两岸,明尼阿波利斯的历史与经济发展都与水密切相关，明尼阿波利斯的水域面积为58.4平方英里（151.3平方公里），冬季严寒并且干燥，而夏季温暖，有时炎热，而且常常很潮湿。属于夏季温暖的湿润性大陆气候。
米勒德·菲尔莫尔郊区医院：没有找到直接的，看了一些资料，猜测是在纽约州，布法罗布法罗(Buffalo)，是美国纽约州西部伊利湖东岸的港口城市，位于尼亚加拉河南口，西与加拿大伊利堡隔尼亚加拉河相望。
以上查到的内容不知有无错误之处。

还有您所提及的关于两国自来水质量标准的问题，这个还是期待其它老师来参与解答吧。原文中有这么一段话：
It has been proven that wounds become infected when they contain more than 105（5是上标） bacteria per gram of tissue.Drinking-quality TW contains an insufficient number of bacteria to cause wound infection. The few bacteria isolated from TW are not skin pathogens.This makes it unlikely that exposure to TW would itself cause infection.

在本文中，关于用自来水冲洗伤口的问题，提到了一个很重要的变量，就是冲洗的压力。

另外，本文从成本效益方面进行了分析，包括生理盐水、注射器、用于冲洗的延长管、用于个人防护的防溅罩等等，最终的结论是，自来水冲洗更具成本效益，并且似乎是同样安全和有效的。

感控小荷

学习了，《消规》“口腔黏膜及创面消毒，用含有效碘1000mg/L～2000mg/L 的碘伏擦拭”想知道门诊换药室应选用怎么样的消毒液更合适呢？（尤其对于感染伤口、拆线）

青柠檬

学习了，在医院宣传一下哦，对外科医生很有帮助呀

小秦

谢谢楚楚老师能从你这儿学到新知识

幺妹

又学到了新的知识，感谢楚楚老师的分享！