| Objective:This study applies different disinfectants(chlorhexidine gluconate alcohol disinfectant,iodine of Mao kang,75%alcohol,normal saline)to respectively give pin site care for the New Zealand white rabbits which were placed Ilizarov circle external fixator of four groups.Through observating the change of physical and chemical indicators(body weight,anal temperature,C-reaction protein,White blood cell count),the results of bacterial culture,the situation of pin site infection and the morphology change of surrounding tissue of pin sites,thus we analyze the effect of different disinfectants in preventing pin site infection after using Ilizarov external fixation technique to provide the evidence-based basis for choosing disinfectants in clinical pin site care.Methods:According to inclusion and exclusion criteria,we selected 32 healthy New Zealand white rabbits as the research object,which were placed lizarov3/4 circular external fixator after breeding a period of time.Then we divided them into four groups through random principle,each group of eight.After surgery,the four groups received pin site care which was carried out twice a day with different disinfectants,group A with chlorhexidine gluconate alcohol disinfectant,group B with iodine of Mao kang(iodine content of Mao kang compound iodine skin disinfectant),group C with 75%alcohol,group D with normal saline.After the operation,no dressings were covered around the pin sites,and a cotton swab was used to sterilize a pin site to keep it clean and dry in nursing process.After the operation,we observed and recorded the red,swelling and secretion of each pin site every day,and promptly made bacterial culture of the pin sites with secretions.The bacteria culture of each pin site was detected in the first day after operation and after operation 1 week,2 weeks,4 weeks and 6 weeks.In the first day after operation and after operation 1 week,2 weeks,4 weeks and 6 weeks,we measured body weight,anal temperature of New Zealand white rabbits after 7 a.m.,and phlebotomized blood samples for white blood cell count and determination of CRP value of each group.In postoperative 6 weeks,we randomly executed an animal from each group,and then took uninfected surrounding tissue of pin site,specimens with pin site as the center,which the size was about 1.5 cm×2.0 cm,three specimens of each group.Under light microscopy,we observed tissue morphology change of specimens after HE staining.Results:1.There was no statistically significant difference in red,swelling and secretion of pin sites based on Macroscopic observation between four groups(P>0.05).2.In the first day after operation and after operation 1 week,2 weeks,4 weeks and 6weeks,there was no statistically significant difference in results of bacterial culture between four groups(P>0.05).However,the positive rate of bacterial culture increased and the amount of positive pin sites increased over time.The time of positive bacterial and the amount of positive pin sites were relatively few in the group with chlorhexidine gluconate alcohol disinfectant.3.There was no statistically significant difference in anal temperature of New Zealand rabbits between the four groups(F=1.945,P=0.145).The anal temperature of different time points was statistically significant(F=63.225,P<0.001),indicating that the temperature of New Zealand white rabbits was different at different time points.The interaction between time and group was not statistically significant(F=0.488,P=0.830),indicating that the anal temperature of New Zealand white rabbits of the four groups showed no difference as the change of time.The anal temperature of New Zealand white rabbits of the four groups increased in different degrees after the operation,and the anal temperature began to decline after 4 weeks,but it was still higher than the preoperative anal temperature.4.The body weight of New Zealand white rabbits of the four groups was not statistically significant(F=0.257,P=0.856).The difference in body weight at different time points was statistically significant(F=84.513,P<0.001),indicating that the body weight of New Zealand white rabbits was different at different time points.The interaction between time and group was not statistically significant(F=1.086,P=0.380),indicating that the body weight of New Zealand white rabbits of the four groups showed no difference over time.The body weight of New Zealand white rabbits of the four groups reduced in different degrees after the operation,and the weight began to increase at 4 weeks after the operation,but the weight still lower than the preoperative level.5.The C-reaction protein values of New Zealand white rabbits of the four groups were statistically significant(F=11.707,P<0.001),which indicated that C-reaction protein values of four groups were different.The difference of C-reaction protein values at different time points was statistically significant(F=204.3,P<0.001),indicating that C-reaction protein values of New Zealand white rabbits of the four groups were different at different time points.The interaction between time and group was not statistically significant(F=1.821,P=0.062),indicating that the C-reaction protein values of New Zealand white rabbits of the four groups showed no difference over time.Multiple comparison results showed that,compared with group A,C-reaction protein values of group B,C,and D were statistically significant(P=0.003,P<0.001,P<0.001).Compared with group B,there was no significant difference in C-reaction protein values of group C and D(P=0.061,P=0.067).Compared with group C,there was no significant difference in C-reaction protein values of group D(P=0.961).The C-reaction protein values of the group with chlorhexidine gluconate alcohol disinfectant were lower than the other three groups.Multiple comparison results showed that,compared with pre-operation,the C-reaction protein values of the first day after operation and after operation 1week,2 weeks,4 weeks and 6 weeks were statistically significant(P<0.001).Com-pared with the first day after surgery,the C-reaction protein values after operation1 week,2 weeks,4 weeks and 6 weeks were statistically significant(P<0.001).Compared with C-reaction protein values after operation 1 week,there was signi-ficant difference in C-reaction protein values after operation 2 weeks,4 weeks and6 weeks(P=0.045,P<0.001,P<0.001).Compared with C-reaction protein values after operation 2 weeks,there was significant difference in C-reaction protein values after operation 4 weeks and 6 weeks(P=0.041,P=0.001).Compared with C-reaction protein values after operation 4 weeks,there was significant difference in C-reaction protein values after operation 6 weeks(P=0.006).The C-reaction pro-tein values of New Zealand white rabbits of the four groups increased with time.6.The white blood cell values of New Zealand white rabbits of the four groups were statistically significant(F=4.137,P=0.015),which indicated that the white blood cell values of four groups were different.The difference of white blood cell values at different time points was statistically significant(F=133.988,P<0.001),indicating that white blood cell values of New Zealand white rabbits of the four groups were different at different time points.The interaction between time and group was not statistically significant(F=1.935,P=0.078),indicating that the white blood cell values of New Zealand white rabbits of the four groups sho-wed no difference over time.Multiple comparison results showed that,compared with group A,white blood cell values of group B,C,and D were statistically significant(P=0.033,P=0.005,P=0.005).Compared with group B,there was no significant difference in white blood cell values of group C and D(P=0.443,P=0.421).Compared with group C,there was no significant difference in white blood cell values of group D(P=0.970).The white blood cell values of the group with chlorhexidine gluconate alcohol disinfectant were lower than other three groups.Multiple comparison results showed that there were statistically significant differences in the white blood cell values at different time points(P<0.001).The white blood cell values of New Zealand white rabbits of the four groups increase-ed with time.7.Comparison of PSI incidence between the four groups of New Zealand white rabbits was statistically significant(P=0.033).It indicated that the infection rate of the four groups was not the same.Among them,the infection rate of group A was 12.5%,and the infection rate of group B,group C and D was 75%.Multiple comparison results showed that,compared with group A,the infection rates of group B,C,and D were statistically significant(P=0.041).There was no statistically significant difference between group B,group C,and group D(P=1.000),and PSI incidence in the group with chlorhexidine gluconate alcohol disinfectant was lower than that in the other three groups.There was no statistically significant difference between the four groups of classification of PSI(c~2=9.080,P=0.554).There was no difference in the degree of pin site infection between the four groups of New Zealand rabbits.Among 19 cases of infection of New Zealand white rabbits,infection first appeared in normal saline group(after operation 1week),and in iodine of Mao kang group and 75%alcohol group next.Infection appeared in chlorhexidine gluconate alcohol disinfectant group at the latest(after operation 6weeks).8.After operation 6 weeks,we observed surrounding tissue changes of pin site of four groups under light microscopy and pathology examination seen:there was a small amount of inflammatory cells(mainly neutrophils)infiltration around surrounding tissue of pin sites of four groups,and no fibrotic hyperplasia and no necrotic tissue were observed.At high magnification(400 eyes)compared pathological inflammatory cells of four groups,the difference was statistically significant(F=65.414,P<0.001),which showed that the number of inflammatory cells of the four groups was different.Multiple comparison results showed that compared with group A,the number of inflammatory cells of group B,group C and group D was statistically significant(P<0.001).Compared between group B,group C and group D,there was no statistically significant difference in the number of inflammatory cells(P>0.05).The number of inflammatory cells of the group with chlorhexidine gluconate alcohol disinfectant was lower than the other three groups.Conclusion:1.During the placement of Ilizarov circle external fixator,New Zealand white rabbits of four groups had pin site infection,which was mainly minor infection.2.Compared with iodine of Mao kang,75%alcohol and normal saline,the chlorhexidine gluconate alcohol disinfectant had better effect in preventing pin site infection. |
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