Lütfiye PİRBUDAK, Sevgi UÇAR, Yasemin ZER, Ayşe MIZRAK, HÜLYA ÇİÇEK

Epidural kateter ucu kontaminasyonunda iki farklı antiseptiğin etkinliğinin karşılaştırılması

Amaç: Bu çalışmada, cilt antiseptiklerinden %10 povidon iyot ile benzalkonyum klorür+2-propanol'ün epidural kateter ucu kontaminasyonunu önlemedeki etkinliğinin karşılaştırılması amaçlandı.Gereç ve Yöntem: Sefazolin ile antibiyotik proflaksisi uygulanan, yaşları 18-65 arası, ASA I-II risk grubundaki 160 hasta çalışmaya dahil edildi. Hastalar randomize iki gruba ayrılarak Grup P'deki (n=80) hastalara epidural kateter takılmadan önce cilt antiseptiği olarak %10 povidon iyot; Grup B'deki (n=80) hastalara ise benzalkonyum klorür+2-propanol kullanıldı. Cilt yüzeyinden antiseptik kullanımından önce ve sonra swab ile sürüntü alınarak kültüre gönderildi. Epidural kateter takıldıktan 48 saat sonra, daha önce kullanılan cilt antiseptiği ile kateter bölgesindeki cilt temizlendikten sonra kateter çekildi, kateterin proksimal ucundan steril koşullarda 2-3 cm'lik bir parça kesilerek, mikrobiyoloji laboratuvarına gönderildi. Operasyon öncesi ve sonrası tam kan sayımı, vücut ısısı ve ameliyat sonrası epidural kateter bölgesinde lokal deri enfeksiyonunun belirtileri kaydedildi.Bulgular: Lökosit, nötrofil, lenfosit sayısı operasyon öncesi ve sonrası dönemde tüm hastalarda normal sınırlar arasındaydı. Antiseptik uygulamasından sonra alınan cilt sürüntüsü kültüründe Grup P 'de altı hastada üreme oldu, bunların beşinde koagülaz negatif Stafilokok, birinde E.coli üredi, Grup B'de ise üreme görülmedi. İki grup arasındaki bu fark istatistiksel olarak anlamlı bulundu (p=0.013). Her iki grupta da kültüre gönderilen epidural kateterlerde üreme olmadı.Sonuç: Çalışmamızda epidural kateter takılma yerindeki cilt florasını azaltmada benzalkonyum klorür+2-propanol kombinasyonunun daha etkin olduğu sonucuna varıldı.

Comparison of two different antiseptics on contamination of epidural catheter tip

Objectives: The aim of the present study was to compare preventive effects of 10% povidone-iodine, and combination of 2-propanol and benzalkonium chloride skin antiseptics on contamination of epidural catheter tip.Methods: Included were 160 patients aged 18-65 years with American Society of Anesthesiologists (ASA) physical status classifications of I-II. Patients were randomized. Povidone-iodine was administered to group P (n=80) prior to insertion of antibiotic prophylaxis catheter; 2-propanol and benzalkonium chloride was administered to group B. Swabs obtained before and after administration of antiseptics were sent for culture. Antiseptics were applied to skin prior to catheter removal, as well as 48 hours after insertion. In sterile conditions, 2-3 cm pieces of catheter tips were sent to laboratory. Preoperative and postoperative complete blood count, body temperature, and signs of postoperative localized skin infection were recorded.Results: Leukocyte, neutrophil, and lymphocyte counts were all within normal ranges in preoperative and postoperative. Swab cultures obtained following use of antiseptics were positive in 6 group P patients; coagulase-negative Staphylococcus was found in 5 patients, E. coli in 1, and were negative in group B. Difference between groups was statistically significant (p=0.013). Epidural catheter tip cultures were negative.Conclusion: Combination of 2-propanol and benzalkonium chloride was determined to be more effective in reducing skin flora around epidural catheter insertion site.

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