Penggunaan Antiseptik untuk Mencegah Pin Site Infection pada Pasien Terpasang Eksternal Fiksator
Abstract
This study aims to review antiseptics that can be used in pin-site care to prevent pin-site infection in patients with external fixators. The research method is a systematic review, which begins with the article selection process through PRISMA, followed by an article review process to determine which articles can be reviewed. The results of a systematic review of six articles showed the benefits of using antiseptics for pin site care in preventing pin site infections. Combining chlorhexidine with other antiseptics such as alcohol and 1% silver sulphadiazine, single use of chlorhexidine, povidone iodine, emollient, and microbicidal liquid polymer has proven effective in preventing pin site infection. Chlorhexidine is considered to be used in low concentrations to minimize the risk of skin irritation. Povidone iodine has the advantage of being an antiseptic that can be easily found in hospitals and is cheap. In conclusion, antiseptics can be used to prevent pin site infections. Still, emollient skincare, a combination of 5% chlorhexidine - 1% silver sulphadiazine, and microbicidal liquid polymer still require further research due to the lack of literature and the use of ingredients that are not yet familiar.
Keywords: Antiseptic, Patient Installed External Fixator, Pin Site Infection
References
Chiewchalermsri, C., Sompornrattanaphan, M., Wongsa, C., & Thongngarm, T. (2020). Chlorhexidine Allergy: Current Challenges and Future Prospects. Journal of Asthma and Allergy, 13, 127–133. https://doi.org/10.2147/JAA.S207980
Cleminson, J., & McGuire, W. (2021). Topical Emollient for Preventing Infection in Preterm Infants. Cochrane Database of Systematic Reviews, 2021(5). https://doi.org/10.1002/14651858.CD001150.pub4
Eggers, M. (2019). Infectious Disease Management and Control with Povidone Iodine. Infectious Diseases and Therapy, 8(4), 581–593. https://doi.org/10.1007/s40121-019-00260-x
Ferguson, D., Harwood, P., Allgar, V., Roy, A., Foster, P., Taylor, M., Moulder, E., & Sharma, H. (2021). The PINS Trial: A Prospective Randomized Clinical Trial Comparing a Traditional Versus an Emollient Skincare Regimen for the Care of Pin-Sites in Patients with Circular Frames. Bone and Joint Journal, 103 B(2), 279–285. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0680.R1
Goswami, K., & Austin, M. S. (2019). Intraoperative Povidone-Iodine Irrigation for Infection Prevention. Arthroplasty Today, 5(3), 306–308. https://doi.org/10.1016/j.artd.2019.04.004
Guerado, E., Cano, J. R., & Fernandez-Sanchez, F. (2019). Pin Tract Infection Prophylaxis and Treatment. Injury, 50, S45–S49. https://doi.org/10.1016/j.injury.2019.03.044
Guha, K. (2021). How Emollients Can Treat Most of Your Skin Issues? https://skinkraft.com/blogs/articles/emollients-for-skin
Liu, K., Abulaiti, A., Liu, Y., Cai, F., Ren, P., & Yusufu, A. (2021). Risk Factors of Pin Tract Infection During Bone Transport Using Unilateral External Fixator in The Treatment of Bone Defects. BMC Surgery, 21(1), 1–9. https://doi.org/10.1186/s12893-021-01384-z
Ma, C. B., & Dugdale, D. C. (2022). Pin Care. https://medlineplus.gov/ency/patientinstructions/000481.htm
Makhdoom, A., Baloch, R. A., Sheikh, T., Khaskhali, J., Jokhio, M. F., Maheshwari, L. Das, & Ahmed, M. (2021). The Role of Chlorhexidine in the Prevention of Pin Tract Infection as Compared to Povidone-Iodine in Patients Managed by Ilizarov Circular Fixator. Pakistan Journal of Medical and Health Sciences, 15(5), 1751–1754. https://doi.org/10.53350/pjmhs211551751
Pema, S. (2018). Retrospective Evaluation of Microbicidal Polymer Dressing For Reduction of Infection Following Post Deformity Correction Surgery. Journal of Drugs in Dermatology, 17(12), 1322–1324. https://pubmed.ncbi.nlm.nih.gov/30586265/
Pema, S. (2020). An Evaluation of the Use of a Novel Microbicidal Liquid Polymer for the Reduction of Pin-Tract Infection in External Fixation Procedures For Deformity Correction and Traumatic Provisional Fixation. Clinical Microbiology and Infectious Diseases, 5(3), 1–5. https://doi.org/10.15761/cmid.1000177
Poel, B. V. D., Saegeman, V., & Annette, S. (2022). Increasing Usage of Chlorhexidine in Health Care Settings: Blessing or Curse? A Narrative Review of the Risk of Chlorhexidine Resistance and The Implications for Infection Prevention and Control. European Journal Clinical Microbial Infect. https://doi.org/10.1007/s10096-022-04403-w
Priyanka, R. M. K., Anushka, D. V, Parimala, S., & Hariprasad, S. (2021). Microbiological Profile of Pin Tract Infections Due to External Fixators. Microbiology Section, 27–29. https://doi.org/10.7860/JCDR/2021/48410.14997
Rose, M. A., Garcez, T., Savic, S., & Garvey, L. H. (2019). Chlorhexidine Allergy in the Perioperative Setting: A Narrative Review. British Journal of Anaesthesia, 123(1), e95–e103. https://doi.org/10.1016/j.bja.2019.01.033
Sáenz-Jalón, M., Sarabia-Cobo, C. M., Roscales Bartolome, E., Santiago Fernández, M., Vélez, B., Escudero, M., Miguel, M. E., Artabe, P., Cabañas, I., Fernández, A., Garcés, C., & Couceiro, J. (2020). A Randomized Clinical Trial on the Use of Antiseptic Solutions for the Pin-Site Care of External Fixators: Chlorhexidine-Alcohol Versus Povidone-Iodine. Journal of Trauma Nursing : The Official Journal of the Society of Trauma Nurses, 27(3), 146–150. https://doi.org/10.1097/JTN.0000000000000503
Sahrudi, S., Waluyo, A., & Masfuri, M. (2019). Aplikasi Teori Virginia Henderson pada Pasien Neglected Fracture of Left Shaft Femur. Dunia Keperawatan, 7(2), 142-145. https://doi.org/10.20527/dk.v7i2.6892
Sayed, M. A. E., Mohammed, M. A., Mostafa, K. M., & Desouky, A. A. (2019). Effect of Nursing Management on Pin Site Infection Among Incidence Patients with External Fixators. Assiut Scientific Nursing Journal, 7(18), 13–21. https://www.semanticscholar.org/paper/Effect-of-Nursing-Management-on-Pin-Site-Infection-Sayed-Mohammed/c4579bc3d2ee2f83874210bed8fd18653cfa1e2c
Shabir, M., Afridi, H. U., Inam, M., Ali, A., & Shah, F. (2019). Comparison of 1% Silver Sulphadiazine and Chlorhexidine Dressing Combined Versus 5% Chlorhexidine Dressing Alone in Preventing Pin Tract Infection in External Fixators. Original Article, 122(3), 122–126. https://lilijohnkids.com.br/index.php/upload/article/view/341
Shah, F. A., Ali, M. A., Kumar, V., Alam, W., & Hasan, O. (2019). Does Pin Tract Infection after External Fixator Limits its Advantage as a Cost-Effective Solution for Open Fractures in Low-Middle Income Countries, A Prospective Cohort Study. JPMA. The Journal of the Pakistan Medical Association, 69 1)(1), S41–S45. https://core.ac.uk/download/pdf/212885377.pdf
Shields, D. W., Iliadis, A. D., Kelly, E., Heidari, N., & Jamal, B. (2022). Pin-site Infection: A Systematic Review of Prevention Strategies. Strategies in Trauma and Limb Reconstruction, 17(2), 93–104. https://doi.org/10.5005/jp-journals-10080-1562
Spada, F., Barnes, T. M., & Greive, K. A. (2019). Emollient Formulations Containing Antiseptics Reduce Effectively the Level of Staphylococcus Aureus on Skin. Clinical, Cosmetic and Investigational Dermatology, 12, 639–645. https://doi.org/10.2147/CCID.S215023
Tudu, L. M. (2019). Betadine Dressing Versus Surgical Spirit Dressing in Prevention of Pin Site Infection Among the Patients with External Skeletal Fixators. International Journal of Nursing Care, 7(1), 30. https://doi.org/10.5958/2320-8651.2019.00006.1
Wade, R. G., Burr, N. E., Mccauley, G., Bourke, G., & Efthimiou, O. (2021). The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-Iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis. Annals of Surgery, 274(6), E481–E488. https://doi.org/10.1097/SLA.0000000000004076
Wei, J., He, L., Weng, F., Huang, F., & Teng, P. (2021). Effectiveness of Chlorhexidine in Preventing Infections Among Patients Undergoing Cardiac Surgeries: a Meta-Analysis and Systematic Review. Antimicrobial Resistance and Infection Control, 10(1), 1–10. https://doi.org/10.1186/s13756-021-01009-3
Zhong, Y., Samuel, M., van Bever, H., & Tham, E. H. (2022). Emollients in Infancy to Prevent Atopic Dermatitis: A Systematic Review and Meta-Analysis. Allergy, 77(6), 1685–1699. https://doi.org/10.1111/all.15116
Cleminson, J., & McGuire, W. (2021). Topical Emollient for Preventing Infection in Preterm Infants. Cochrane Database of Systematic Reviews, 2021(5). https://doi.org/10.1002/14651858.CD001150.pub4
Eggers, M. (2019). Infectious Disease Management and Control with Povidone Iodine. Infectious Diseases and Therapy, 8(4), 581–593. https://doi.org/10.1007/s40121-019-00260-x
Ferguson, D., Harwood, P., Allgar, V., Roy, A., Foster, P., Taylor, M., Moulder, E., & Sharma, H. (2021). The PINS Trial: A Prospective Randomized Clinical Trial Comparing a Traditional Versus an Emollient Skincare Regimen for the Care of Pin-Sites in Patients with Circular Frames. Bone and Joint Journal, 103 B(2), 279–285. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0680.R1
Goswami, K., & Austin, M. S. (2019). Intraoperative Povidone-Iodine Irrigation for Infection Prevention. Arthroplasty Today, 5(3), 306–308. https://doi.org/10.1016/j.artd.2019.04.004
Guerado, E., Cano, J. R., & Fernandez-Sanchez, F. (2019). Pin Tract Infection Prophylaxis and Treatment. Injury, 50, S45–S49. https://doi.org/10.1016/j.injury.2019.03.044
Guha, K. (2021). How Emollients Can Treat Most of Your Skin Issues? https://skinkraft.com/blogs/articles/emollients-for-skin
Liu, K., Abulaiti, A., Liu, Y., Cai, F., Ren, P., & Yusufu, A. (2021). Risk Factors of Pin Tract Infection During Bone Transport Using Unilateral External Fixator in The Treatment of Bone Defects. BMC Surgery, 21(1), 1–9. https://doi.org/10.1186/s12893-021-01384-z
Ma, C. B., & Dugdale, D. C. (2022). Pin Care. https://medlineplus.gov/ency/patientinstructions/000481.htm
Makhdoom, A., Baloch, R. A., Sheikh, T., Khaskhali, J., Jokhio, M. F., Maheshwari, L. Das, & Ahmed, M. (2021). The Role of Chlorhexidine in the Prevention of Pin Tract Infection as Compared to Povidone-Iodine in Patients Managed by Ilizarov Circular Fixator. Pakistan Journal of Medical and Health Sciences, 15(5), 1751–1754. https://doi.org/10.53350/pjmhs211551751
Pema, S. (2018). Retrospective Evaluation of Microbicidal Polymer Dressing For Reduction of Infection Following Post Deformity Correction Surgery. Journal of Drugs in Dermatology, 17(12), 1322–1324. https://pubmed.ncbi.nlm.nih.gov/30586265/
Pema, S. (2020). An Evaluation of the Use of a Novel Microbicidal Liquid Polymer for the Reduction of Pin-Tract Infection in External Fixation Procedures For Deformity Correction and Traumatic Provisional Fixation. Clinical Microbiology and Infectious Diseases, 5(3), 1–5. https://doi.org/10.15761/cmid.1000177
Poel, B. V. D., Saegeman, V., & Annette, S. (2022). Increasing Usage of Chlorhexidine in Health Care Settings: Blessing or Curse? A Narrative Review of the Risk of Chlorhexidine Resistance and The Implications for Infection Prevention and Control. European Journal Clinical Microbial Infect. https://doi.org/10.1007/s10096-022-04403-w
Priyanka, R. M. K., Anushka, D. V, Parimala, S., & Hariprasad, S. (2021). Microbiological Profile of Pin Tract Infections Due to External Fixators. Microbiology Section, 27–29. https://doi.org/10.7860/JCDR/2021/48410.14997
Rose, M. A., Garcez, T., Savic, S., & Garvey, L. H. (2019). Chlorhexidine Allergy in the Perioperative Setting: A Narrative Review. British Journal of Anaesthesia, 123(1), e95–e103. https://doi.org/10.1016/j.bja.2019.01.033
Sáenz-Jalón, M., Sarabia-Cobo, C. M., Roscales Bartolome, E., Santiago Fernández, M., Vélez, B., Escudero, M., Miguel, M. E., Artabe, P., Cabañas, I., Fernández, A., Garcés, C., & Couceiro, J. (2020). A Randomized Clinical Trial on the Use of Antiseptic Solutions for the Pin-Site Care of External Fixators: Chlorhexidine-Alcohol Versus Povidone-Iodine. Journal of Trauma Nursing : The Official Journal of the Society of Trauma Nurses, 27(3), 146–150. https://doi.org/10.1097/JTN.0000000000000503
Sahrudi, S., Waluyo, A., & Masfuri, M. (2019). Aplikasi Teori Virginia Henderson pada Pasien Neglected Fracture of Left Shaft Femur. Dunia Keperawatan, 7(2), 142-145. https://doi.org/10.20527/dk.v7i2.6892
Sayed, M. A. E., Mohammed, M. A., Mostafa, K. M., & Desouky, A. A. (2019). Effect of Nursing Management on Pin Site Infection Among Incidence Patients with External Fixators. Assiut Scientific Nursing Journal, 7(18), 13–21. https://www.semanticscholar.org/paper/Effect-of-Nursing-Management-on-Pin-Site-Infection-Sayed-Mohammed/c4579bc3d2ee2f83874210bed8fd18653cfa1e2c
Shabir, M., Afridi, H. U., Inam, M., Ali, A., & Shah, F. (2019). Comparison of 1% Silver Sulphadiazine and Chlorhexidine Dressing Combined Versus 5% Chlorhexidine Dressing Alone in Preventing Pin Tract Infection in External Fixators. Original Article, 122(3), 122–126. https://lilijohnkids.com.br/index.php/upload/article/view/341
Shah, F. A., Ali, M. A., Kumar, V., Alam, W., & Hasan, O. (2019). Does Pin Tract Infection after External Fixator Limits its Advantage as a Cost-Effective Solution for Open Fractures in Low-Middle Income Countries, A Prospective Cohort Study. JPMA. The Journal of the Pakistan Medical Association, 69 1)(1), S41–S45. https://core.ac.uk/download/pdf/212885377.pdf
Shields, D. W., Iliadis, A. D., Kelly, E., Heidari, N., & Jamal, B. (2022). Pin-site Infection: A Systematic Review of Prevention Strategies. Strategies in Trauma and Limb Reconstruction, 17(2), 93–104. https://doi.org/10.5005/jp-journals-10080-1562
Spada, F., Barnes, T. M., & Greive, K. A. (2019). Emollient Formulations Containing Antiseptics Reduce Effectively the Level of Staphylococcus Aureus on Skin. Clinical, Cosmetic and Investigational Dermatology, 12, 639–645. https://doi.org/10.2147/CCID.S215023
Tudu, L. M. (2019). Betadine Dressing Versus Surgical Spirit Dressing in Prevention of Pin Site Infection Among the Patients with External Skeletal Fixators. International Journal of Nursing Care, 7(1), 30. https://doi.org/10.5958/2320-8651.2019.00006.1
Wade, R. G., Burr, N. E., Mccauley, G., Bourke, G., & Efthimiou, O. (2021). The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-Iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis. Annals of Surgery, 274(6), E481–E488. https://doi.org/10.1097/SLA.0000000000004076
Wei, J., He, L., Weng, F., Huang, F., & Teng, P. (2021). Effectiveness of Chlorhexidine in Preventing Infections Among Patients Undergoing Cardiac Surgeries: a Meta-Analysis and Systematic Review. Antimicrobial Resistance and Infection Control, 10(1), 1–10. https://doi.org/10.1186/s13756-021-01009-3
Zhong, Y., Samuel, M., van Bever, H., & Tham, E. H. (2022). Emollients in Infancy to Prevent Atopic Dermatitis: A Systematic Review and Meta-Analysis. Allergy, 77(6), 1685–1699. https://doi.org/10.1111/all.15116
