Background

Although there is a rationale supporting that preoperative showering with 2% or 4% chlorhexidine gluconate (CHG) would decrease skin bacterial colonization, there is no consensus that this practice reduces the risk of surgical site infection (SSI).

Objectives

Analyze the skin concentration of CHG after preoperative showering associated with the traditional skin preparation with CHG 4% for breast surgery.

Methods

Randomized controlled trial that included 45 patients, all candidates for augmentation mammaplasty, allocated into three groups (A: no preoperative showering; B: one preoperative showering; C: two preoperative showering with CHG 4%) in a 1:1:1 ratio. Skin swabs collection was performed right before the surgical incision. The samples were, then, sent to spectrophotometry in order to determine the skin concentration of CHG at the beginning of surgery.

Results

The age ranged from 18 to 61 years, with a mean of 37 years old. Group C had the lowest median concentration (0.057) followed by group B (0.060) and group A (0.072), however, with no statistical significance. The areola was the place with the lowest median concentration level (0.045), followed by the axilla (0.061) and the inframammary fold (IMF) (0.069). Still, when comparing the distribution of the sites, a statistically significant difference was found only between the axilla and the areola (p = 0.022).

Conclusion

Preoperative showering with CHG 4% did not increase the concentration of this agent on the skin surface right before the surgical incision.

Level of evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

中文翻译：

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乳房手术术前手术部位准备后皮肤上氯己定浓度的评估——一项随机对照试验

背景

尽管有理由支持术前用 2% 或 4% 的葡萄糖酸洗必泰 (CHG) 淋浴会减少皮肤细菌定植，但对于这种做法会降低手术部位感染 (SSI) 的风险尚无共识。

目标

分析与传统皮肤准备相关的术前淋浴后 CHG 的皮肤浓度，CHG 4% 用于乳房手术。

方法

随机对照试验包括 45 名患者，所有患者都是隆乳术的候选者，按 1:1:1 的比例分为三组（A：术前不淋浴；B：术前淋浴 1 次；C：术前淋浴 2 次，使用 CHG 4%）。皮肤拭子收集是在手术切口之前进行的。然后，将样品送至分光光度法以确定手术开始时 CHG 的皮肤浓度。

结果

年龄18～61岁，平均37岁。C 组的中值浓度最低 (0.057)，其次是 B 组 (0.060) 和 A 组 (0.072)，但没有统计学意义。乳晕是中值浓度水平最低的地方 (0.045)，其次是腋窝 (0.061) 和乳房下皱襞 (IMF) (0.069)。尽管如此，在比较这些部位的分布时，仅在腋窝和乳晕之间发现了统计学上的显着差异 ( p = 0.022)。

结论

术前用 4% 的 CHG 淋浴并没有增加手术切口前皮肤表面这种药物的浓度。

证据等级 IV

该期刊要求作者为每篇文章分配一定程度的证据。有关这些循证医学评级的完整说明，请参阅目录或在线作者须知 www.springer.com/00266。