Comparative Study On Three Disinfectants For Pin Site Care In External Fixation

Objective:To compare the clinical effectiveness, safety and cost-effectiveness of foaming skin disinfectant,0.5%iodine and75%alcohol for pin site care in external fixation, and to explore the significance of demographic variables and home care factors, thus providing the references for pin site care in external fixation to prevent infection.Methods:The study included90patients with congenital pseudoarthrosis of tibia or congenital talipes equinovarus from department of orthopaedics of Hunan Children’s Hospital between October2009and March2010. We randomly assigned90patients to receive foaming skin disinfectant,0.5%iodine or75%alcohol for pin site care in external fixation. We used self-designed questionnaire to collect patients’ basic data and the performance of home care, and recorded outcome of germiculture, prevalence, pain of pin site and the number of disinfectant used at week2, week8and the time of removing external fixation. Basic data of different groups’ patients were used descriptive statistical analysis and compared. Outcome of germiculture, prevalence and the influencing factors of pin tract infection were analyzed using generalized estimating equation (GEE). Differences among pain of3groups were analyzed by marginal proportion functions. Cost-effectiveness of3disinfectants was compared using cost-effectiveness ratio.Results:A total of85subjects completed the test, accounting for94.4%of all randomized patients. The demographic characteristics, base-line disease characteristics, compliance of treatment and pain sensitivity were similar in the three treatment groups (P>0.05). At week2, week8and the time of removing external fixation, the bacterium positive rates were1.7%,13.3%and25.8%in foaming skin disinfectant group,27.7%,36.1%and32.4%in0.5%iodine group,35.8%,39.3%and51.8%in75%alcohol group. After adjusting other variables,0.5%iodine group and75%alcohol group each had3.72and10.57times the risk of bacterium compared with foaming skin disinfectant group (P<0.05). At week2, week8and the time of removing external fixation, the prevalence of pin tract infection were3.9%,8.3%and8.9%in foaming skin disinfectant group,8.0%,17.6%and22.2%%in0.5%iodine group,16.7%,29.5%and31.3%in75%alcohol group. After adjusting other variables,0.5%iodine group and75%alcohol group each had4.37and12.89times the risk of infection compared with foaming skin disinfectant group (P<0.05). The pain of patients in foaming skin disinfectant group were lower than whose in0.5%iodine group and75%alcohol group (P<0.05). The least expensive option, foaming skin disinfectant, cost154yuan per patient with no infection outcome, while794yuan for0.5%iodine and977yuan for75%alcohol. Outcome of GEE showed that not using physiological saline tampon to clean secretion of pin site and scab before disinfection (OR=3.24, P<0.05), not disinfecting everyday (OR=2.50, P<0.05) and not changing sterile cloth twice or more a week (OR=2.48, P<0.05) were associated with more pin tract infection.Conclusion:As compared with0.5%iodine and75%alcohol, foaming skin disinfectant acted less pin tract infection, lower pain and cost-effectiveness ratio, which was a good disinfectant for pin tract care at home. Correctly performing each step of home pin tract care was necessary for preventing pin tract infection.