Pin Site Care Using Chlorhexidine; Case Study Report

Desak Wayan Suarsedewi

Abstract


ABSTRACT

 

Pin site infections were a common complication of external fixation that places a significant burden on the patient and healthcare system. Such infections increase the number of clinic visits required during a patient’s course of treatment, can result in the need for additional treatment including antibiotics and surgery, and most importantly can compromise patient outcomes should osteomyelitis or instability result from pin loosening or need for pin or complete construct removal.

Factors that may influence the development of pin site infections include patient-specific risk factors, surgical technique, pin design characteristics, use of prophylactic antibiotics, and the post-operative pin care protocol including cleansing, dressing changes, and showering. Despite numerous studies that work to derive evidence-based recommendations for prevention of pin site infections, substantial controversy exists in regard to the optimal protocol.

This review comprehensively evaluated the current literature to provide an overview of factors that may influence the incidence of pin site infections in patients undergoing treatment with external fixators, and concludes with a description of the preferred surgical and post-operative pin site protocols employed by the senior authors (ATF and SRR).

 Keywords: External fixation, Pin site, Pin tract/track, Infection, Prevention, Chlorexidine solution


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References


DAFTAR PUSTAKA

Amanti, A., Potalvio, G., Pelosi, F., Rende, R., & Cerulli, G. (2012). Randomized prospective study on the use of eufiss in the prevention of infections in patients treated with externalfixation. European journal of inflammation, 8(3), 189-192.

Bell et al, (2008). Care of pin sites. Nursing standard,22(33), 44-48.

Camathias, C., Valderrabano, V., & Oberli, H. (2012). Routine pin tract care in externalfixation is unnecessary: A randomised, prospective, blinded controlled study. Injury: International journal of the care of the injured, 1969-1973.

Lagerquist, D., Dabrowski, M., Dock, C., Fox, A., Daymond, M., Sanda, K.E., & Halm, M.(2012). Care of external fixator pin sites. American journal of critical care, 21(4), 288-293.

Lee, C.K., Chua, Y.P., & Saw, A. (2011). Antimicrobial gauze as a dressing reduces pin site infection: A randomized controlled trial. Clinical orthopaedics and related research, 470(2).

Lethaby, A., Temple, J., & Santy, J. (2011). Pin site care for preventing infections associatedwith external bone fixators and pins. Cochrane database of systematic reviews, (8).

Timms, A., Vincent, M., Santy-Tomlinson, J., & Hertz, K. (2011). Guidance on pin sitecare. Royal college of nursing, Retrieved from http://www.rcn.org.uk/__data/assets/pdf_file/0009/413982/004137.pdf

Timms, A., & Pugh, H. (2012). Pin site care: Guidance and key recommendations. Nursing standard, 27(1), 50-55.

Walker, J., (2011). Pin site infection in orthopaedic external fixation devices. British journal ofnursing, 21(3), 148-151.

Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, JenningsR, Marsh DR. Ilizarov principles of deformity correction, Ann R Coll Surg Engl 2010;92:101-5.

Royal College of Nursing (2011). Guidance on pin site care. Cavendish Square, London W1G 0RN. [Cited 2013 Sep12] Available from: http://www.rcn.org.uk/__data/assets/ pdf_file/0009/413982/004137.pdf.

MeSH, (2011). Medical subject headings (MeSH), National Library of Medicine. [Cited 2013 Sep 12] Availablefrom: http://www.nlm.nih.gov/mesh.

Çelik S, Kanan N. Efficiency of cleaning agents to preventinfection in patients with external fixation. İÜFN Hem Derg 2005; 13:37-42.

Eren A, Eralp L. Development of Ilizarov system in Turkeyand in the world. In: Çakmak M, Kocaoğlu M editors. Ilizarov surgery and principles. Istanbul: Doruk Graphics;1999. p. 1-4.

Santy J. Nursing the patient with an external fixator. NursStand 2000; 14:47-55. Santy J, Newton L. A survey of current practices in skeletal pin site management. J Orthop Nurs 2006; 10:198- 205.

Santy J, Temple J. A critical review of two research paperson skeletal pin site care. J Orthop Nurs 2004; 8:132-5.

Sims M, Saleh M. External fixation – the incidence of pin site infection: a prospective audit. J Orthop Nurs 2000; 4:59-63.

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.

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.

Holmes SB, Brown SJ; Pin Site Care Expert Panel. Skel etal pin site care: National Association of Orthopaedic-84 Acta Orthop Traumatol Turc Nurses guidelines for orthopaedic nursing. Orthop Nurs 2005; 24:99-107.

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 fixationin trauma and orthopaedics. London: Springer; 2000. p.97-103.

Sims M. External fixators: Royal College of Nursing Society of Orthopaedic Nursing. London: RCN Publishing;1999.

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.

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.

Havıtçıoğlu H. Indications of external fixators. In: Çakmak M, Kocaoğlu M, editors. Ilizarov surgery and principles.Istanbul: Doruk Graphics; 1999. p. 17-22.

W-Dahl A, Toksvig-Larsen S, Lindstrand A. No differencebetween daily and weekly pin site care: a randomized study of 50 patients with external fixation. Acta Orthop Scand 2003; 74:704-8.

Davis P. Skeletal pin traction: guidelines on postoperative care and support. Nurs Times 2003; 99:46-8.

Lee-Smith J, Santy J, Davis P, Jester R, Kneale J. Pin site management: toward a consensus. J Orthop Nurs 2001; 5: 37-42.

Ward P. Care of skeletal pins: a literature review. Nurs Stand 1998; 12: 34-8.

Oçgüder DA, Ozer H, Solak S, Onem RY, Ağaoğlu S. Functional results of the Ilizarov circular external fixatorin the treatment of open tibial fractures. Acta Orthop Traumatol Turc 2005; 39:156-62.

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.

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.

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.

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.

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.

Hay SM, Rickman M, Saleh M. Fracture of the tibial diaphysis treated by external fixation and the axial alignmentgrid: a single surgeon’s experience. Injury 1997; 28: 437-43.

Henry C. 1996. Pin sites: Do we need to clean them? Practice Nurs.7:12-7.


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