Çivi bölgesi bakımında kullanılan iki farklı solüsyonun enfeksiyon gelişimine etkisi

Öz

Amaç: Bu araştırmada, eksternal fiksatörlü hastaların çivi bölgesi bakımında kullanılan iki farklı solüsyonun çivi dibi enfeksiyonu gelişimi üzerine olan etkisinin incelemeyi amaçlanmıştır. Çalışma planı: Araştırmada 18 hastadaki 133 çivi değerlendirildi. Veri toplama araçları olarak hasta tanıtım formu, çivi bölgesi bakımı uygulama formu ve Checketts ve ark. tarafından geliştirilen çivi dibi enfeksiyonu değerlendirme formu kullanıldı. Bir hastada bulunan çivi sayısına denk olacak şekilde 68 çivi dibinin bakımında %10’luk povidon-iyot solüsyonu, 65 çivi dibinin bakımında 2 mg/ml klorheksidin kullanıldı. Oluşan çivi dibi bölgesi enfeksiyonları derecelendirilip kaydedildi. Çivi dibi bölgesi bakımı günlük olarak hasta taburcu oluncaya kadar uygulandı. Bulgular: Povidon-iyot grubundaki hastaların 68 çivisinden 19’unda (%27.9) çivi dibi enfeksiyonu geliştiği belirlendi. Klorheksidin grubundaki hastaların 65 çivisinden 6’sında (%9.2) çivi dibi enfeksiyonu geliştiği izlendi. Çıkarımlar: Bu çalışma ile çivi bölgesi bakımında 2 mg/ml klorheksidin kullanımının çivi dibi enfeksiyonu görülme sıklığını azalttığı belirlendi.

Anahtar Kelimeler

• Bakım; çivi dibi enfeksiyonu; eksternal fiksatör; kırık; solüsyon.

Effects of two different solutions used in pin site care on the development of infection

Abstract

Objective: The aim of this study was to compare the effects of two different solutions used for pin site care in patients with external fixators on the incidence of pin site infection. Methods: The study included 133 pins of 18 patients. The patient identification form, pin site care application form and the pin tract infection assessment form developed by Checketts et al. were used as data collection tools. On the condition that it would be evenly applied on the number of pins available in a patient, a 10% povidone-iodine solution was used in the care of 68 pin sites and 2 mg/ml chlorhexidine was applied at 65 pin sites. Infections developing in the pin sites were graded and recorded. Pin site care was applied routinely on a daily basis until the patient was discharged. Results: Infection was observed in 19 (27.9%) of the 68 pins of patients in the povidone-iodine group. Infection developed in only 6 (9.2%) of 65 pins in the chlorhexidine group. Conclusion: Use of 2 mg/ml chlorhexidine in pin site care appears to decrease the prevalence of pin tract infection.

Keywords

• Care
• external fixators
• fracture
• pin tract infection
• solution

References

1. Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR. Ilizarov principles of deformity correction. Ann R Coll Surg Engl 2010;92:101-5. CrossRef
2. Royal College of Nursing 2011. Guidance on pin site care. Cavendish Square, London W1G 0RN. [Cited 2013 Sep 12] Available from: http://www.rcn.org.uk/__data/assets/pdf_file/0009/413982/004137.pdf.
3. MeSH (2011) Medical subject headings (MeSH), National Library of Medicine. [Cited 2013 Sep 12] Available from: http://www.nlm.nih.gov/mesh.
4. Çelik S, Kanan N. Efficiency of cleaning agents to prevent infection in patients with external fixation. İÜFN Hem Derg 2005;13:37-42.
5. Eren A, Eralp L. Development of Ilizarov system in Turkey and in the world. In: Çakmak M, Kocaoğlu M editors. Ilizarov surgery and principles. Istanbul: Doruk Graphics; 19 p. 1-4. Santy J. Nursing the patient with an external fixator. Nurs Stand 2000;14:47-55. CrossRef
6. Santy J, Newton L. A survey of current practices in skeletal pin site management. J Orthop Nurs 2006;10:19820 CrossRef
7. Santy J, Temple J. A critical review of two research papers on skeletal pin site care. J Orthop Nurs 2004;8:132-5.
8. Sims M, Saleh M. External fixation – the incidence of pin site infection: a prospective audit. J Orthop Nurs 2000;4:59-63. CrossRef

9. Arazi M, Kutlu A, Tarakçıoğlu N, Mutlu M. The applications of Selçuk type pelvic external fixator in the treatment of unstable pelvic ring injuries: clinical and biomechanical study. [Article in Turkish] Acta Orthop Traumatol Turc 1995;29:299-305.
10. Altay T, Karapinar L, Kaya A, Oztürk H. Treatment of two-part proximal humeral fractures with external fixators. Ulus Travma Acil Cerrahi Derg 2005;11:153-6.
11. Holmes SB, Brown SJ; Pin Site Care Expert Panel. Skeletal pin site care: National Association of Orthopaedic Nurses guidelines for orthopaedic nursing. Orthop Nurs 2005;24:99-107. CrossRef
12. Checketts RG, MacEachern AG, Otterburn M. Pin track infection and principles of pin site care. In: Bastiani GA, Apley G, Goldberg A, editors. Orthofix external fixation in trauma and orthopaedics. London: Springer; 2000. p. 97CrossRef
13. Sims M. External fixators: Royal College of Nursing Society of Orthopaedic Nursing. London: RCN Publishing; 19 Grant S, Kerr D, Wallis M, Pitchford D. Comparison of povidone–iodine solution and soft white paraffin ointment in the management of skeletal pin-sites: a pilot study. Orthop Nurs 2005;9:218-25. CrossRef
14. Aynacı O, Yıldız M, Aydın H, Kerimoğlu S. Our external fixator applications in humerus fractures. [Article in Turkish] Hacettepe Ortopedi Dergisi 2000;10:137-40.
15. Havıtçıoğlu H. Indications of external fixators. In: Çakmak M, Kocaoğlu M, editors. Ilizarov surgery and principles. Istanbul: Doruk Graphics; 1999. p. 17-22.
16. W-Dahl A, Toksvig-Larsen S, Lindstrand A. No difference between daily and weekly pin site care: a randomized study of 50 patients with external fixation. Acta Orthop Scand 2003;74:704-8. CrossRef
17. Davis P. Skeletal pin traction: guidelines on postoperative care and support. Nurs Times 2003;99:46-8.
18. Lee-Smith J, Santy J, Davis P, Jester R, Kneale J. Pin site management: toward a consensus. J Orthop Nurs 2001;5:37-42. CrossRef
19. Ward P. Care of skeletal pins: a literature review. Nurs Stand 1998;12:34-8. CrossRef
20. Oçgüder DA, Ozer H, Solak S, Onem RY, Ağaoğlu S. Functional results of the Ilizarov circular external fixator in the treatment of open tibial fractures. Acta Orthop Traumatol Turc 2005;39:156-62.
21. Yılmaz C. Application of external fixator in patients with intertrochanteric femur fractures having high surgical risk and our results. Dissertation. İstanbul: Ministry of Health, Şişli Etfal Training and Research Hospital; 2005. W-Dahl A, Toksvig-Larsen S. Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent. Arch Orthop Trauma Surg 2004;124:555-8.
22. Ozdemir H, Urgüden M, Dabak TK, Söyüncü Y. Treatment of intertrochanteric femoral fractures with the use of a modular axial fixator device. [Article in Turkish] Acta Orthop Traumatol Turc 2002;36:375-83.
23. Arazi M, Memik R, Ogün TC, Yel M. Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Joint Surg Br 2001;83:663-7. CrossRef
24. Kesemenli CC, Subaşı M, Kırkgöz T, Necmioğlu S, Kapukaya A. Comparison of external fixation and pelvipedal cast treatments in closed femur fractures of children. [Article in Turkish] Acta Orthop Traumatol Turc 2000;34:40-4.
25. Arazi M, Kutlu M. Place of external fixation in the treatment of pelvic injuries: indications and current trends. [Article in Turkish] Turkish Journal of Arthroplasty Arthroscopic Surgery 2000;11:104-10.
26. Hay SM, Rickman M, Saleh M. Fracture of the tibial diaphysis treated by external fixation and the axial alignment grid: a single surgeon’s experience. Injury 1997;28:437-43. Henry C. Pin sites: Do we need to clean them? Practice Nurs 1996;7:12-7.