A Research Of The Effects In Tibiofibula External Fixation Related To Three Disinfectants

Objective:By comparing the clinical effects,safety,and cost-effectiveness of different disinfectants (75%alcohol,0.5% iodine and 2% chlorhexidine gluconate solution) for pin site care in external fixation is commonly used in clinical. Thus selecting the best material of the comprehensive properties for clinical application to prevent infection.Methods:According to the choose requirements of the subjects, sixty patients coming from department of orthopedics of the affiliated hospital of Binzhou medical university, f whom 42 males and 18 females,age from 16 to 56 years old,average 34.5 years,between November 2013 and December 2015, randomly divided into three groups,respectively was disinfected with different disinfectants (75%alcohol,0.5% iodine and 2% chlorhexidine gluconate solution) for pin site care in external fixation.The pin nails of group A was wiped with 75% alcohol bid, group B wiped with 0.5% iodine bid and group C with 2% chlorhexidine gluconate solution bid. We designed questionnaire for patients using family treatment and to collect patients,basic data and the performance. At the postoperative week 2, 4, 8, 12 and the time of removing external fixation, we recorded the infection status,(according to checketts-otterbumus),bacterial culture results,surrounding skin of pin nails,pain score of pin site and the number of disinfectant used. Basic data of different patients were used d statistical description and comparison. Outcome of prevalence and results of bacterial culture were analyzed using chi-square test. Differences among pain score of 3 groups were analyzed by ANOVA. Cost-effectiveness of 3 groups disinfectants was compared using cost-effectiveness ratio.Results:There were 56 cases of 60 selected patients to complete the test, accounting for 93.3% . Three groups of the patients, age, gender, nutritional status, days in hospital,fracture type, fixed time were no statistically differences (P>0.05).1. At postoperative week 2,4,8,12 and the time of removing external fixation, the results of bacterium culture were 32.4%, 37.1%, 40.7%, 43.6% and 50% in 75%alcohol group, 26.1%, 37.1%, 32.4%, 33.8%, and 38.0% in 0.5% iodine group, 8.6%,13.2%, 17.1%, 19.2%, and 24% in 2% chlorhexidine gluconate solution group. After adjusting other variable, 75% alcohol group and 0.5% iodine group each had 3.591 and 2.496 times the chance of bacterium infect compared with 2% chlorhexidine gluconate solution group (P<0.05). In terms of result of germiculture, the relative risk in a lower ratio of positive rate, when 2% chlorhexidine gluconate solution group compared to 0.5% iodine group and 75% alcohol group,respectively was 0.053,0.606.2.At postoperative week 2,4,8,12,and the time of removing external fixation, the prevalence of pin tract infection were 7.6%, 9.90%, 12.7%, 14.8%, and 17.6% in 75%alcohol group, 15.5%, 17.9%, 20.7%, 25.0%, and 30.7% in 0.5% iodine group, 3.95%,4.11%, 5.48%, 6.85%, and 8.90% in 2% chlorhexidine gluconate solution group. After adjusting other variables 75% alcohol group and 0.5% iodine group each had 4.406 and 2.284 times the risk of infection compared with 2% chlorhexidine gluconate solution group (P < 0.05). In terms of result of bacteria infection,the relative risk in a lower ratio of positive rate, when 2% chlorhexidine gluconate solution group compared to 0.5% iodine group and 75% alcohol group,respectively was 0.529,0.728.3. The pain score of patients in 2% chlorhexidine gluconate solution group were lower than whose in 0.5% iodine group and 75% alcohol group (P<0.05).The degree of skin irritation, the 75% alcohol group was largest, 2% chlorhexidine gluconate solution group was lightest.4. The least cost option of every patient with no infection result in different disinfectants group,respectively was about 0.83yuan?1.05yuan and 1.25yuan.Conclusion:As compared with 0.5% iodine and 75% alcohol , 2% chlorhexidine gluconate less skin irritation , lower risk of bacteria infect, so was a good disinfectant of high safety and economic effective for pin tract care at home,was worthy promoting to clinic application.