創傷治癒：参考文献

　創傷治療，消毒に関する参考文献を挙げます。なお，インターネットで検索できたものに関しては，Abstractも掲載しておきます。無料のインターネット文献検索サービスはこちらへ

創傷治癒全般，およびドレッシングについての総合的な書籍

『ドレッシング　新しい創傷管理』（穴澤　貞夫監修，へるす出版）
- 創傷治癒の基本的概念，基礎研究から被覆材の種類，使い方，実際の症例での使い方まで，創傷治癒とドレッシング材のすべてを網羅した名著。出版は1996年とやや古くなりましたが，未だにこの分野でこれを超える日本語の本はないと断言します。現在では改訂版となっています。
  ちなみに，改訂版では私も執筆者の末席を汚しております。

消毒薬は創傷治癒を阻害

Dilute povidone-iodine solutions inhibit human skin fibroblast growth.
- Author : Balin AK, Pratt L.
- Magazine : Dermatol Surg 2002 Mar;28(3):210-4
- Abstract :
  BACKGROUND: Povidone-iodine solutions are widely used and highly effective antiseptics. Although commonly used at full strength, this concentration appears to be toxic to the cells involved in wound healing. Few systematic studies of povidone-iodine toxicity have been reported. The effects of various dilutions of 10% povidone-iodine solution on the growth of human diploid fibroblasts were assessed using in vitro cell culture.
  OBJECTIVE: The purpose of this study was to systematically evaluate the toxicity of povidone-iodine on living cells using an in vitro model.
  METHODS: Adult skin fibroblasts and fetal lung fibroblasts were subcultivated at various seeding densities of 3000-10,000 cells/cm2 and grown in polystyrene tissue culture flasks under an atmosphere containing 5% O2, 5% CO2, and 90% N2. Cells were grown in a medium containing various concentrations of povidone-iodine (1%, 0.1%, 0.025%, 0.01%, and 0%). Cell attachment was reduced by 0.1% and 1% povidone-iodine in our initial studies; subsequent experiments were performed by changing the medium to contain the povidone-iodine 24 hours after seeding. Growth curves were performed by counting triplicate cultures every 48 hours for 250-300 hours.
  RESULTS: Fibroblast growth was progressively retarded at 0.01% and 0.025%, and totally inhibited by 0.1% and 1% povidone-iodine solutions. Partial recovery of cell growth after limited exposure of cultures to dilute solutions of povidone-iodine was noted.
  CONCLUSION: This study shows that even dilute solutions of povidone-iodine are toxic to human fibroblasts. The results indicate that caution should be used when povidone-iodine is placed on an open wound, and that prolonged contact with viable uncontaminated tissue should be avoided.
In Vitro and in vivo studies of local disinfection and wound healing.
- Author : Hagedorn M, Hauptmann S, et al.
- Magazine : Hautarzt 1995 May; 46(5): 319-24
Effect of povidone-iodine on wound healing: a review
- Author : Kramer, SA.
- Magazine : J. Vasc. Nurs. 1999 Mar; 17(1):17-23
The effects of chlorhexidine digluconate on human fibroblasts in vitoro.
- Author : Pucher, JJ. and Daniel, JC
- Magazine : J. Periodontal 1992, Jun; 63(6): 526-32

消毒薬と生理食塩水の比較

A comparison of wound irrigation solutions used in the emergency department
- Author : Dire, DJ. and Welsh, AP.
- Magazine : Ann Emerg Med 1990 Jun;19(6):704-8
Wound cleaning versus wound disinfection: a challenging dilemma.
- Author : Phillips, D. and Davey, C.
- Magazine : Perspectives 1997 winter;21(4):15-6

脳外科手術でも剃毛は必要ない

脳神経外科手術患者の無剃毛に関するエビデンスとケアの実際

tokimura_muteimou.pdf (1.20 MB)
The effect of hair on infection after cranial surgery.
- Author : Bekar A, Korfali E, Dogan S, Yilmazlar S, Baskan Z, Aksoy K.
- Magazine : Acta Neurochir (Wien) 2001;143(6):533-6; discussion 537
- Abstract :
  OBJECTIVE: Reports of large series of patients who had undergone successful cranial neurosurgery without hair removal led part of our team to abandon the practice of shaving patients' heads pre-operatively. The aim of this study was to assess whether this change in routine, which was implemented in 1992, has affected the rate of postoperative infection in our cranial surgery patients.
  METHODS: A group of patients whose heads were shaved pre-operatively was compared to a group whose hair was not shaved prior to cranial surgery. The latter patients had their hair washed with shampoo and 4% chlorhexidine within 24 hours of their operation. In the operating room, the surgical site was scrubbed for 8-10 minutes with 4% chlorhexidine diluted with water, and then cleansed with 10% povidone-iodine solution. Prophylactic antibiotics were administered for 3 days.
  RESULTS: We performed 1,038 cranial procedures without hair removal. The procedures included craniotomy for tumour, trauma, aneurysm, other vascular lesions and intracerebral haemorrhage (n = 847), stereotactic biopsy (n = 90), stereotactic craniotomy (n = 34), ventriculoperitoneal shunt placement (n = 27), surgical treatment of infection with aspiration of brain abscess or resection of infected tissue (n = 14), microvascular decompression for trigeminal neuralgia or hemifacial spasm (n = 11), and other miscellaneous procedures (n = 15). We observed 13 postoperative wound infections (1.25%), including 9 deep (0.87%) and 4 superficial infections (0.39%). There was no significant difference between the rate of infection in patients whose heads were shaven (12/980) and the rate in those whose hair was spared (13/1038) (p > 0.05). In addition. there were no other problems related to the surgical preparation technique in the latter group.
  CONCLUSION: Cranial surgery without hair removal is safe and does not increase the risk of surgical wound infection. Patients naturally prefer to keep their full head of hair. We believe that preoperative hair removal is not necessary in preparation for any type of cranial neurosurgery.

水道水による傷の洗浄に関するもの

Wound irrigation in children: saline solution or tap water?
- Author: Valente JH, Forti RJ, Freundlich LF, Zandieh SO, Crain EF.
- Magazine: Ann Emerg Med. 2003 May;41(5):609-16.
- Abstract:
  STUDY OBJECTIVE: Irrigation, a critical component of wound management, is commonly performed with sterile normal saline solution. The purpose of this study was to compare the infection rates of wounds irrigated with normal saline solution versus those of wounds irrigated with running tap water.
  METHODS: A prospective trial was conducted in an urban pediatric emergency department. Tap water pressure and flow rates were measured, and cultures were obtained before the study and at 5 months after study initiation. Patients 1 to 17 years of age presenting to the pediatric ED with a simple laceration were eligible. Exclusion criteria included immunocompromise, complicated lacerations, or current use of or need for antibiotics. Patients were allocated to the running tap water group or the standard normal saline solution irrigation group. Wounds were closed in standard fashion. Patients returned to the pediatric ED in 48 to 72 hours for evaluation.
  RESULTS: Two hundred seventy-one patients were enrolled in the normal saline solution group and 259 in the tap water group. Tap water and normal saline solution pressures and flow rates differed. The groups did not differ in terms of patient demographic characteristics or wound characteristics. However, more wounds were located on the hand in the tap water group (21.3%; 95% confidence interval [CI] 16.3% to 27.1%) compared with those in the normal saline solution group (9.2%; 95% CI 5.9% to 13.4%). The wound infection rates were similar in the 2 groups (normal saline solution group: 2.8% [95% CI 1.1% to 5.7%] versus running tap water group: 2.9% [95% CI 1.2% to 5.9%]).
  CONCLUSION: There were no clinically important differences in infection rates between wounds irrigated with tap water or normal saline solution. Tap water might be an effective alternative to normal saline solution for wound irrigation in children.
Water for wound cleansing.
- Author: Fernandez R, Griffiths R, Ussia C.
- Magazine: Cochrane Database Syst Rev. 2002;(4):CD003861.
- Abstract:
  BACKGROUND: Various solutions have been recommended for cleansing wounds, however normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective, however, there is an unresolved debate about its use.
  OBJECTIVES: The objective of this review was to assess the effects of water compared to other solutions for wound cleansing.
  SEARCH STRATEGY: Randomised and quasi-randomised controlled trials were identified by electronic searches of Cochrane Wounds Group Specialised Trials Register, MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register. Primary authors, company representatives and content experts were contacted to identify eligible studies. Reference lists from included trials were also searched.
  SELECTION CRITERIA: Randomised and quasi randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing.
  DATA COLLECTION AND ANALYSIS: Trial selection, data extraction and quality assessment were carried out independently by two reviewers and checked by a third reviewer. Differences in opinion were settled by discussion. Some data were pooled using a random effects model.
  MAIN RESULTS: Three trials were identified that compared rates of infection and healing in wounds cleansed with water and normal saline, two compared cleansing with no cleansing and one compared procaine spirit with water. There were no standard criteria for the assessment of wound infection across the trials which limited the ability to pool the data. The major comparisons were water vs normal saline, and tap water vs no cleansing. For chronic wounds, the odds of developing an infection when cleansed with tap water compared with normal saline was 0.16, 95 % Confidence Interval (CI) 0.01, 2.96. Use of tap water to cleanse acute wounds was associated with a lower rate of infection than saline (OR 0.52, 95 % CI 0.28, 0.96). No statistically significant differences in infection rates were seen when wounds were cleansed with tap water or not cleansed at all (OR 1.06, 95 % CI 0.06, 17.47). Similarly there was no difference in the infection rate in wounds cleansed with water or procaine spirit and those cleansed with isotonic saline, distilled water and boiled water (OR 0.55, 95 % CI 0.18,1.62).
  REVIEWER'S CONCLUSIONS: Although the evidence is limited one trial has suggested that the use of tap water to cleanse acute wounds reduces the infection rate and other trials conclude that there is no difference in the infection and healing rates between wounds that were not cleansed and those cleansed with tap water and other solutions. However the quality of the tap water should be considered prior to its use and in the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.
Can tap water be used to irrigate wounds in A&E?
- Author : O'Neill D.
- Magazine : Nurs Times 2002 Apr 2-8;98(14):56-9
- Abstract : After critiquing the seven selected articles, it seems likely that tap water can be used as an irrigant and cleansing agent for soft-tissue wounds. However, the current research on tap water has involved human and rat wound studies and tap water culture studies (Dire, 1990; Riyat and Quinton, 1997; Moscati, 1998). The research is strong, but limitations in current research remain an issue for practice (Towler, 2000). The use of tap water is a cost and practicality issue, and changing current practice is always difficult, as it would seem that the use normal saline is more of a ritualistic process rather than one based on hard evidence (Glover, 1999). Two key conclusions could be drawn from the available research: The tap water tested was generally agreed to be safe from harmful bacteria and had no contaminating bacteria; Human and rat models showed a clear benefit in using tap water to cleanse soft tissue wounds, thus concluding tap water is safe for use on wounds (Towler, 2000). The financial benefits were also stated in the studies; tap water can have huge cost-saving potential for A&E departments. In an increasingly cost-conscious NHS this could be a major driving factor for changing practice. However, there were limitations in the methodologies of the selected articles in this critique. Most of the studies measured wound infection rates, but the various researchers did not take into account other factors affecting the likelihood of infection rates and wound progress which would ultimately affect wound infection rates by killing any bacteria in vivo.
Evidence-based practice: tap water cleansing of leg ulcers in the community.
- Author : Selim P, Bashford C, Grossman C.
- Magazine : J Clin Nurs. 2001 May;10(3):372-9.
- Abstract : To establish and encourage wound management practices based on evidence, a Community Nursing Organization in metropolitan Adelaide began a series of research initiatives in 1997. Based on the results of a wound management survey, and through the processes of participatory action research with clinicians, many wound management practice changes were instigated throughout the Community Nursing Organization. One question remains unanswered: What is the evidence for the use of sterile saline or clean tap water for cleansing of leg ulcers in the community? In this paper we describe a project where we applied the three principles of planning, action and evaluation. Application of these principles enabled clinicians to collaborate in the search for evidence to support or refute tap water cleansing of leg ulcers. To conclude, we report on a pilot research project undertaken to obtain further evidence either to support or refute the use of tap water cleansing for leg ulcers in the community.
Wound irrigation with tap water.
- Author : Moscati RM, Reardon RF, Lerner EB, Mayrose J.
- Magazine : Acad Emerg Med 1998 Nov;5(11):1076-80
- Abstract :
  OBJECTIVE: The study hypothesis was that irrigation with tap water is as efficacious as irrigation with sterile saline in removing bacteria from simple lacerations in preparation for wound closure.
  METHODS: The study was conducted in a laboratory rat model previously described in the literature for evaluating wound irrigation techniques. The study used a randomized, blinded crossover design using 10 animals. Two full-thickness skin lacerations were made on each animal and each wound was inoculated with standardized concentrations of a Staphylococcus aureus broth. Wounds were irrigated for 4 minutes with normal saline from a syringe or 4 minutes with tap water from a faucet. Tissue specimens were sampled from each laceration prior to and following irrigation. Bacterial counts per gram of tissue were determined for each specimen and compared pre- and postirrigation.
  RESULTS: Preirrigation bacterial counts were not significantly different for saline vs tap water specimens. The wounds irrigated with saline had a mean reduction in bacterial count of 54.7% (SD=+/-28%), while the wounds irrigated with tap water had a mean reduction in bacterial count of 80.6% (SD=+/-20%) (p<0.05, 2-tailed, paired t-test).
  CONCLUSIONS: In this animal model, bacterial decontamination of simple lacerations was not compromised, and was actually improved using tap water irrigation. This is most likely due to the mechanical differences in the types of irrigation. In certain instances, such as with upper-extremity lacerations, tap water irrigation would likely be cheaper and less labor-intensive than irrigation with normal saline from a syringe.
Comparison of normal saline with tap water for wound irrigation.
- Author : Moscati R, Mayrose J, Fincher L, Jehle D.
- Magazine : Am J Emerg Med 1998 Jul;16(4):379-81
- Abstract : This study compared irrigation with tap water versus saline for removing bacteria from simple skin lacerations. The study was conducted in an animal model with a randomized, nonblinded crossover design using 10 500-g laboratory rats. Two full-thickness skin lacerations were made on each animal and inoculated with standardized concentrations of Staphylococcus aureus broth. Tissue specimens were removed before and after irrigation with 250 cc of either normal saline from a sterile syringe or water from a faucet. Bacterial counts were determined for each specimen and compared before and after irrigation. There was a mean reduction in bacterial counts of 81.6% with saline and 65.3% with tap water (P = .34). One tap water specimen had markedly aberrant bacterial counts compared with others. Excluding this specimen, the mean reduction for tap water was 80.2%. In this model, reduction in bacterial contamination of simple lacerations was not different comparing tap water with normal saline as an irrigant.
Tap water as a wound cleansing agent in accident and emergency.
- Author : Riyat MS, Quinton DN.
- Magazine : J Accid Emerg Med 1997 May;14(3):165-6
- Abstract :
  OBJECTIVE: To investigate the bacterial cleanliness of tap water in a large accident and emergency (A&E) department for its possible use in the cleansing and irrigation of open traumatic wounds.
  METHODS: Tap water samples were collected from different areas within the department and analysed on two separate occasions for coliforms, S aureus, clostridia, pseudomonas, and beta haemolytic streptococci.
  RESULTS: Pathogenic bacteria were not isolated from the tap water samples within the A&E department.
  CONCLUSIONS: Tap water of drinking quality can be used to irrigate open traumatic wounds.
Comparison between sterile saline and tap water for the cleaning of acute traumatic soft tissue wounds.
- Author : Angeras MH, Brandberg A, Falk A, Seeman T.
- Magazine : Eur J Surg 1992 Jun-Jul;158(6-7):347-50
- Abstract :
  OBJECTIVE--To find out if there were any differences in infection rates if acute traumatic soft tissue wounds were cleaned with tap water instead of sterile saline.
  DESIGN--Randomised study.
  SETTING--Emergency department at one city hospital.
  SUBJECTS--705 consecutive patient with soft tissue wounds less than six hours old that did not penetrate a viscus, cavity, or joint and could be treated by primary suture.
  INTERVENTIONS--Randomly allocated to have the wound cleaned with either sterile saline or tap water in addition to debridement.
  MAIN OUTCOME MEASURE--Rate of wound infection, the presence of which was indicated by pus in the wound and prolonged healing.
  RESULTS--The infection rate in wounds cleaned with sterile saline was 10.3% compared with 5.4% in wounds cleaned with tap water (p less than 0.05). Infected wounds were significantly larger than uninfected ones (p less than 0.05) and more likely to be located on a lower extremity (p less than 0.05). There were no microbiological differences between the two groups, and no bacterial species grown from tap water was subsequently grown from an infected wound.
  CONCLUSION--Sterile saline should be replaced by tap water for the cleaning of acute traumatic superficial soft tissue wounds.

洗浄の方法，洗浄の圧力について

Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection
- Author : Cervantes-Sanchez CR, et et.
- Magazine : World J. Surg., 2000 Jan; 24(1): 38-41, duscussion 41-2
Low-versus high-pressure irrigation techniques in Staphylococcus aureus-inoculated wounds
- Author : Pronchik, D. et al.
- Magazine : Am J Emerg Med, 1999 Mar; 17(2): 121-4

インシュリン注射の際，皮膚の消毒は不要

Is skin preparation ncessary before insulin injection ?
- Author : Veikko A. Koivisto et al.
- Magazine : The Lancet,May20,1978 1072-1073
The safety of injecting insulin through clothing
- Author : Doris R. Fleming et al
- Magazine : Diabetes Care,volume20,Number3,March 1997,244-247

術前の手洗いでブラシ洗いは必要か？

Hand-Rubbing With an Aqueous Alcoholic Solution vs Traditional Surgical Hand-Scrubbing and 30-Day Surgical Site Infection Rates
- Author : Jean Jacques Parienti, MD, DTM&H; Pascal Thibon, MD; Remy Heller, PharmD, PhD; Yannick Le Roux, MD, DCh; Peter von Theobald, MD, DCh; Herve Bensadoun, MD, DCh; Alain Bouvet, MD; Francois Lemarchand, MD, DCh; Xavier Le Coutour, MD; for Members of the Antisepsie Chirurgicale des Mains Study Group
- Magazine : JAMA 2002 Aug 14;288(6):722-7
- Abstract : Context Surgical site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and a source of excess medical costs. Clinical studies comparing the risk of nosocomial infection after different hand antisepsis protocols are scarce.
  Objective To compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice.
  Design Randomized equivalence trial.
  Setting Six surgical services from teaching and nonteaching hospitals in France.
  Patients A total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1, 2000, and May 1, 2001.
  Interventions Surgical services used 2 hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic preparation containing 4% povidone iodine or 4% chlorhexidine gluconate.
  Main Outcome Measures Thirty-day surgical site infection rates were the primary end point; operating department teams' tolerance of and compliance with hand antisepsis were secondary end points.
  Results The 2 protocols were comparable in regard to surgical site infection risk factors. Surgical site infection rates were 55 of 2252 (2.44%) in the hand-rubbing protocol and 53 of 2135 (2.48%) in the hand-scrubbing protocol, for a difference of 0.04% (95% confidence interval, -0.88% to 0.96%). Based on subsets of personnel, compliance with the recommended duration of hand antisepsis was better in the hand-rubbing protocol of the study compared with the hand-scrubbing protocol (44% vs 28%, respectively; P = .008), as was tolerance, with less skin dryness and less skin irritation after aqueous solution use.
  Conclusions Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon's first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections. The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines. Hand-rubbing with liquid aqueous alcoholic solution can thus be safely used as an alternative to traditional surgical hand-scrubbing.

アルギン酸塩被覆材の止血能力，および体内に遺残させた場合の変化

Comparison of absorbable materials for surgical haemostasis.
- Author: Blair SD, Backhouse CM, Harper R, Matthews J and McCollum CN
- Magazine: Br. J. Surg. 1988, Vol. 75, 969-971
- Abstract:The haemostatic effect of two new materials has been compared with surgical gauze and oxidized cellulose using a standardized liver laceration in New Zealand White rabbits. Following excision of a 3 cm2 disc of tissue from the liver, 42 rabbits were randomized to the use of gauze swabs (n = 6), oxidized cellulose (Surgicel) (n = 12), porcine collagen (Medistat) (n = 12) or calcium alginate (Kaltostat) (n = 12) to control the resulting haemorrhage. Blood loss and time to haemostasis were accurately recorded. The absorbable materials were left in situ and animals killed between 2 weeks and 6 months later to examine speed of absorption and resulting adhesions. Calcium alginate stopped bleeding in less than 3 min in all animals compared with a mean (+/- s.e.m.) of 5.7 +/- 0.75 min for porcine collagen, 12.5 +/- 0.9 min for oxidized cellulose and greater than 15 min with gauze (P less than 0.001). Oxidized cellulose and calcium alginate reabsorbed within 3 months leaving a fibrous scar, but a vigorous foreign body reaction was seen with porcine collagen which caused intestinal obstruction in 5 out of 12 animals within 3 months.

痛くない局所麻酔の打ち方

Buffered versus plain lidocaine for digital nerve blocks.
- Author: Bartfield JM, Ford DT, Homer PJ.
- Magazine: Ann Emerg Med 1993 Feb;22(2):216-9
- Abstract:
  STUDY OBJECTIVES: To test whether buffered lidocaine is less painful to administer as a digital nerve block than plain lidocaine.
  DESIGN: Randomized, double-blind, prospective clinical trial. SETTING: University hospital emergency department.
  PARTICIPANTS: Adults not allergic to lidocaine requiring a digital nerve block.
  INTERVENTIONS: Subjects received digital nerve blocks by injection of buffered lidocaine on one side and plain lidocaine on the other in a predetermined, randomized order. Pain of infiltration was assessed. Scores were compared using a two-tailed t-test. Standard 1% lidocaine was used if additional anesthetic was required.
  MEASUREMENTS AND MAIN RESULTS: Thirty-one patients were enrolled. Buffered lidocaine was significantly less painful to administer than plain lidocaine (P < .001; t = 4.21). Supplemental anesthesia was required less often for buffered lidocaine (two times) compared with plain lidocaine (six times), although this difference was not statistically significant.
  CONCLUSION: Because it causes less pain and is equally efficacious, buffered lidocaine is preferable to plain lidocaine for digital nerve blocks in adults.
Buffered lidocaine as a local anesthetic: an investigation of shelf life.
- Author: Bartfield JM, Homer PJ, Ford DT, Sternklar P.
- Magazine: Ann Emerg Med 1992 Jan;21(1):16-9
- Abstract:
  STUDY OBJECTIVE: To determine whether buffered lidocaine must be prepared just before use.
  DESIGN: Randomized, double-blind, prospective trial.
  SETTING: University hospital. PARTICIPANTS: Twenty-four adult volunteers.
  INTERVENTIONS: Three buffered lidocaine solutions prepared seven days, one day, and just before use were compared with a control solution. Subjects received 0.5 mL intradermal injections of each solution. Pain of infiltration and extent and duration of anesthesia were measured.
  MEASUREMENTS AND MAIN RESULTS: Pain of infiltration was less with all buffered solutions than control (P less than .0001). Mean maximum diameter of anesthesia ranged from 29 to 33 mm for the buffered solutions compared with 31 mm for control. Mean duration of anesthesia was 33 minutes for control and 30 minutes for all of the buffered solutions. There was no statistically significant difference in extent or duration of anesthesia for any of the solutions (P greater than .5, beta = .15 for delta = 10%).
  CONCLUSION: Buffered lidocaine stays effective for up to one week after preparation. It is therefore convenient to use in emergency settings.
Pain of local anesthetics: rate of administration and buffering.
- Author: Scarfone RJ, Jasani M, Gracely EJ.
- Magazine: Ann Emerg Med 1998 Jan;31(1):36-40
- Abstract:
  STUDY OBJECTIVE: To determine the impact of administration rate and buffering on the pain associated with subcutaneous infiltration of lidocaine.
  METHODS: Forty-two adult volunteers employed at a tertiary care center participated in this prospective, single-blinded study. Each subject received four lidocaine injections prepared and administered as follows: slow, buffered (SB); slow, unbuffered (SU); rapid, buffered (RB); rapid, unbuffered (RU). Buffering was accomplished by mixing 1% lidocaine with 8.4% sodium bicarbonate in a 9:1 ratio. Slow administration was 30 seconds and rapid was 5 seconds. Needle size (27-gauge), injection depth (.25 inch), lidocaine volume (1.0 mL), and temperature (room) were the same for each of the four injections. In all four conditions, the needle remained in the forearm for 30 seconds, to ensure blinding. The main outcome measure was the mean pain score for each condition, as recorded on a 10-cm visual analog scale.
  RESULTS: The lowest pain scores (mean +/- SE) were recorded for the SU and SB conditions at 1.49 +/- 29 and 1.48 +/- 26, respectively, and they were significantly lower than the scores for RB (2.34 +/- 28; P < .01) or RU (3.11 +/- 33; P < .001). Each of the slow conditions was reported to be the "least painful" of the four significantly more often than either rapid condition.
  CONCLUSION: This is the largest blinded study to assess administration rate and the pain of a local anesthetic. We found that administration rate had a greater impact on the perceived pain of lidocaine infiltration than did buffering.

手の外傷は縫合しなくてもいい？

Suturing versus conservative management of lacerations of the hand: randomised controlled trial
- Author: James Quinn, associate clinical professor a, Steven Cummings, professor b, Michael Callaham, professor a, Karen Sellers, registered nurse a.
- Magazine: BMJ 2002;325:299 ( 10 August )

手術の手洗いは滅菌水でなくてもよい

手術時手洗いにおける滅菌水と水道水の効果の比較
- Author: 藤井昭ほか
- Magazine: 日本手術医学会誌. 23;2002,2-9

酸性水は本当に有効なのか？

創傷治療における酸性水とポビドンヨードの消毒効果の比較

Author: 上地正美ほか
Magazine: 動物臨床医学 9(1): 7-12, 2000.
Abstract: 酸性水の臨床応用における基礎的検討を行った。酸性水は，ボトルに空気が入らないように充填し，室温にて保存することによって塩素濃度の低下を防ぐことができた。酸性水は，40℃に加温した直後であればその性質にほとんど影響がない。酸性水の塩素濃度は，有機物によって低下する。緑膿菌の実験感染創に対して酸性水，ポビドンヨードならびに蒸留水を用いて洗浄消毒した結果，各消毒法に差は認められなかった。また，創傷の治療経過を観察したところ，蒸留水洗浄は酸性水洗浄ならびにポビドンヨード洗浄に比較して治癒が速い傾向が見られた。
uechi-sanseisui.pdf (1.30 MB)

胃瘻が完成したらガーゼ保護は不要

Careing for people with PEG in community.
- Author: Reeves J, Cubbs H.
- Magazine: Community Nurse 2000; May: 21-22.
- Abstract:

滅菌手袋と未滅菌手袋では，感染率に有意差はない

Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: A randomized controlled tria
- Author: Perelman VS, Francis GJ, Rutledge T, Foote J, Martino F, Dranitsaris G.
- Magazine: Annals of Emergency Medicine (March 2004 Volume 43 Number 3)
- Abstract: Study objective Although sterile technique for laceration management continues to be recommended, studies supporting this practice are lacking. Using clean nonsterile gloves rather than individually packaged sterile gloves for uncomplicated wound repair in the emergency department may result in cost and time savings. This study is designed to determine whether the rate of infection after repair of uncomplicated lacerations in immunocompetent patients is comparable using clean nonsterile gloves versus sterile gloves.
  METHODS: A prospective multicenter trial enrolled 816 individuals who were randomized to have their wounds repaired by using sterile or clean nonsterile gloves. The attending physician or resident completed a checklist describing patient, wound, and management characteristics. The patients were provided with a questionnaire to be completed by the physician who removed their sutures at the prescribed time and indicated the presence or absence of infection. When follow-up forms were not returned, a telephone call was made to the patient to determine whether he or she had experienced any wound complications.
  RESULTS: Follow-up was obtained for 98% of the sterile gloves group and 96.6% of the clean gloves group. There was no statistically significant difference in the incidence of infection between the 2 groups. The infection rate in the sterile gloves group was 6.1% (95% confidence interval [CI] 3.8% to 8.4%) and was 4.4% in the clean gloves group (95% CI 2.4% to 6.4%). The relative risk of infection was 1.37 (95% CI 0.75 to 2.52).
  CONCLUSION: This study demonstrated that there is no clinically important difference in infection rates between using clean nonsterile gloves and sterile gloves during the repair of uncomplicated traumatic lacerations.
Clean versus sterile gloves: which to use for postoperative dressing changes?
- Author: St Clair K, Larrabee JH.
- Magazine: Outcomes Manag. 2002 Jan-Mar;6(1):17-21.
- Abstract: Staff nurses have a key role in ensuring that practice is evidenced-based. This article discusses the application of a model for evidence-based practice change by staff nurses in an acute care setting who examined the practice of using sterile gloves for postoperative wound dressing changes. This initiative was in response to the challenge that it was unnecessary to use sterile instead of nonsterile gloves. Extensive literature search revealed insufficient evidence to justify a practice change to nonsterile gloves.
The use of sterile versus nonsterile gloves during out-patient exodontia.
- Author: Giglio JA, Rowland RW, Laskin DM, Grenevicki L, Roland RW.
- Magazine: Quintessence Int 1995 Aug;26(8):533.
- Abstract: One hundred twenty-four patients who showed no clinical evidence of acute infection, were not taking antibiotics, and were to undergo routine removal of erupted teeth were studied. Patients were alternately assigned to surgeons who were wearing sterile or nonsterile, but clean, gloves. Surgery was performed in the usual manner and no postoperative antibiotics were prescribed. None of the patients was found to be infected postoperatively. Results of this prospective study suggest that routine exodontia can be safely performed by a surgeon wearing nonsterile, but surgically clean, gloves without increasing the risk of postoperative infection.

皮下注射前のアルコール消毒は必要ない？

皮下注射前のアルコール消毒は必要か　－予防接種におけるランダム化比較試験ー

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