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Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion

  • Review
  • Intervention

Authors


Abstract

Background

Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood), severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective.

Objectives

To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient.

Search methods

For this first update we searched the Cochrane Wounds Group Specialised Register (searched 28 January 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library 2011, Issue 1; Ovid MEDLINE (2008 to January Week 2 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations January 25, 2011); Ovid EMBASE ( 2008 to 2011 Week 01); and EBSCO CINAHL ( 2008 to 28 January 2011).

Selection criteria

All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs.

Data collection and analysis

Two review authors independently assessed studies for inclusion.

Main results

No studies (RCTs or quasi RCTs) met the inclusion criteria.

Authors' conclusions

We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.

摘要

背景

比較捐血前單以酒精消毒皮膚或是酒精消毒皮膚再加上任一抗菌劑對於預防菌血症或是血品污染上的成效

輸血之血品可能會在捐血、收集血液、與輸血等任一時間點遭受感染,並且造成輸血者得到菌血症 (血中有細菌存在) 、其他嚴重疾病、甚至是死亡。而捐血者手臂上的皮膚正是可能污染源其中之ㄧ。所以在捐血前,我們常會以抗菌劑來清潔此處的皮膚。雖然以酒精為單一或酒精加上其他抗菌劑二步驟消毒方法都是常被使用的,但是至今仍無法確定何者成效較佳。

目標

評估比較預防輸血者得到菌血症或血品污染上以酒精為主之單一或是兩個步驟來消毒捐血者皮膚之成效。

搜尋策略

作者搜尋了以下的資料庫: Cochrane Wounds Group Specialised Register (2009五月10號); The Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library 2009, Issue 1; Ovid MEDLINE  (1950 至2009二月第四周); Ovid EMBASE  (1980 至 2009 第九周); and EBSCO CINAHL  (1982 至2009二月第四周) 。 除此之外, 也同時搜查了主要文章中的參考文獻。

選擇標準

本篇包括了所有比較以酒精 (單一步驟one step) 與酒精加上其他抗菌劑 (雙步驟two steps) 消毒捐血處皮膚的隨機對照試驗 (RCTs) 。當沒有任何隨機試驗符合時,其他類似隨機試驗的研究才會被選入。

資料收集與分析

由兩位獨立的作者評估,選入適合的研究。

主要結論

沒有任何隨機或是類似隨機對照試驗之研究符合本篇之選入條件

作者結論

因為本篇作者沒有尋找到符合選入條件之文獻,故無法斷定何者可以降低血品感染率與菌血症之風險。無法斷定酒精加上其他抗菌劑 (雙步驟two steps) 是否可以降低血品感染率與菌血症之風險。或者是說,酒精 (單一步驟one step) 是否會增加血品感染率與菌血症之風險。

翻譯人

本摘要由成功大學附設醫院林劭潔翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

當血品從捐血者捐出開始,收集血液、儲存與輸血等步驟都有可能遭受感染。血品污染可以造成輸血者得到菌血症 (血中有細菌存在) 、 其他嚴重疾病、甚至是死亡。而抽血時捐血者手臂上的皮膚正是污染源之ㄧ。所以在捐血前,我們常會以酒精為主的消毒法 (單獨使用或是再加上其他消毒劑) 來清潔皮膚。然而在降低捐血者手臂上菌落數的效度何者較佳這件事上卻無定論。作者嘗試搜尋比較在捐血前以酒精或是酒精加上其他抗菌劑消毒皮膚之文獻。可惜的是,並沒有任何符合條件的文獻存在。所以目前而言,對於捐血者皮膚消毒,何種策略步驟具優越性仍是未知數。

Plain language summary

Alcohol, with or without an antiseptic, for preparing the skin before blood collection, to prevent bacteraemia or contamination of blood for transfusion.

When blood is collected from blood donors for transfusion it may become contaminated during collection, storage or transfusion. Blood contamination can cause bacteraemia (the presence of bacteria in the blood), severe illness or even death in the blood recipient. When blood is being taken from donors, the skin on the arm of the donor is one potential source of contamination, so it is usual to cleanse the arm with an antiseptic first, and both one-step and two-step alcohol based regimens are commonly used, however there is uncertainty about which regimen is the most effective for reducing the microbial load (the number of microscopic bacterial organisms) on the donor arm. We looked for studies that compared the use of alcohol alone versus the use of alcohol followed by another antiseptic to clean the arm before the needle is inserted to draw blood, but we did not find any relevant studies. It is currently unclear whether donor skin cleansing with a one-step alcohol based regimen reduces the risk of blood contamination compared with a two-step alcohol based regimen during blood donation.