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Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial.

OBJECTIVE: To compare the efficacy of handrubbing with an alcohol based solution versus conventional handwashing with antiseptic soap in reducing hand contamination during routine patient care. DESIGN: Randomised controlled trial during daily nursing sessions of 2 to 3 hours. SETTING: Three intensive care units in a French university hospital. PARTICIPANTS: 23 healthcare workers. INTERVENTIONS: Handrubbing with alcohol based solution (n=12) or handwashing with antiseptic soap (n=11) when hand hygiene was indicated before and after patient care. Imprints taken of fingertips and palm of dominant hand before and after hand hygiene procedure. Bacterial counts quantified blindly. MAIN OUTCOME MEASURES: Bacterial reduction of hand contamination. RESULTS: With handrubbing the median percentage reduction in bacterial contamination was significantly higher than with handwashing (83% v 58%, P=0.012), with a median difference in the percentage reduction of 26% (95% confidence interval 8% to 44%). The median duration of hand hygiene was 30 seconds in each group. CONCLUSIONS: During routine patient care handrubbing with an alcohol based solution is significantly more efficient in reducing hand contamination than handwashing with antiseptic soap.

Alcohols↗

Sensitivity of Providence to antiseptics and disinfectants.

Seventy isolates of Providence were obtained from urinary tract infections in patients from five hospitals. They were all identified as Providence B (Providencia stuartii). A typing system was devised for these organisms based on their production of and sensitivity to bacteriophage and bacteriocins. Using this system, 27 distinct strains were recognized, and it was clear that many patients had been infected with the same strain. The minimum inhibitory concentrations of six antiseptics and disinfectants for these strains were determined. Many of the strains were up to 300-fold more resistant to the cationic antiseptics chlorhexidine, cetrimide, and Resiguard than the control strain Escherichia coli NCTC 10418. The sensitivities of the Providence strains to Hycolin, glutaraldehyde, and phenyl mercuric nitrate, however, were similar to those of the control organism. There were significant correlations between the sensitivities of the strains to the three cationic antiseptics. The loss of chlorhexidine resistance from a Providence strain after exposure of the cells to N-methyl-N' nitro N nitrosoguanidine resulted in a concomitant loss of resistance to cetrimide and Resiguard, but there was no significant increase in the sensitivity of the mutants to the other three antibacterials.

Anti-Infective Agents, Local↗

Sensitivity of urine-grown cells of Providencia stuartii to antiseptics.

Urine-grown cultures of 23 clinical isolates of Gram-negative bacteria having a range of minimum inhibitory concentration values for chorhexidine were challenged with various concentrations of this antiseptic. The results suggest that cells of Providencia stuartii, in particular, exhibit a considerable degree of resistance to chlorhexidine under these conditions, concentrations of up to 10 000--20 000 microgram/ml of urine being necessary to produce complete loss of viability of such cultures. Of the other two antiseptics tested, phenoxyethanol proved to be the more effective, the recommended use concentration of 2% v/v producing reductions in viable counts of greater than six logarithms in all the strains examined. It is suggested that phenoxyethanol may be a suitable alternative to the cationic agents for use in antiseptic policies for bladder management of urinary tract infections with Providencia stuartii.

Anti-Infective Agents, Local↗

Antiseptic and antibiotic resistance in Gram-negative bacteria causing urinary tract infection.

A collection of 802 isolates of Gram-negative bacteria causing urinary tract infections was made from general practice, antenatal clinics, and local hospitals. The organisms were tested for their sensitivity to chlorhexidine, cetrimide, glutaraldehyde, phenyl mercuric nitrate, a phenolic formulation, and a proprietary antiseptic containing a mixture of picloxydine, octyl phenoxy polyethoxyethanol, and benzalkonium chloride. Escherichia coli, the major species isolated, proved to be uniformly sensitive to these agents. Approximately 10% of the total number of isolates, however, exhibited a degree of resistance to the cationic agents. These resistant organisms were members of the genera Proteus, Providencia, and Pseudomonas; they were also generally resistant to five, six, or seven antibiotics. It is proposed therefore that an antiseptic policy which involves the intensive use of cationic antiseptics might lead to the selection of a flora of notoriously drug-resistant species.

Anti-Bacterial Agents↗

Antiseptic efficacy of a low-dosed topical triclosan/chlorhexidine combination therapy in atopic dermatitis.

The topical application of triclosan as an antistaphylogenic antiseptic has proven beneficial in atopic dermatitis. Especially in lipophilic carriers, triclosan is applied in a concentration range between 1 and 5%, usually 2%. However, as a phenol, triclosan is not undisputed and may result in local exacerbation of the disease by eliciting irritative secondary reactions, especially in high concentrations. Chlorhexidine is also an antiseptic which is very effective against Staphylococci and nearly equivalent to triclosan with respect to its antistaphylogenic efficacy. In light of this, the combination of the two active substances in very low concentrations offers a possible option of using the additive effects of the two substances to minimize the risk of side effects. In a uniform W/O emulsion carrier alternatively containing 0.3% triclosan combined with 0.34% chlorhexidine dihydrochloride or 2.0% triclosan, the antibacterial efficacy against Gram-positive skin bacteria could be proven in a preclinical comparison with a reference preparation containing fusidic acid. Subsequently, the pathogen-reducing effect was examined in a clinical study of the influence on clinical severity in patients with atopic dermatitis. Both investigation methods showed that the two test preparations were slightly inferior to the reference preparation, but result in the same degree of pathogen reduction and improvement in the severity of existing atopic dermatitis in direct comparison. The overall results support the conclusion that a combination of triclosan and chlorhexidine in low concentrations as well as the existing antiseptic standard of a 2% triclosan preparation are suitable for pathogen reduction and thus for improving atopic dermatitis.

Adolescent↗

Antiseptic effect of povidone-iodine solution on abdominal skin during surgery and on thyroid-gland-related substances.

No definite guidelines have been published concerning the suitable exposure time and frequency of skin antisepsis of the operative field. In the present study, the antiseptic effect of a single use (single-application group) of 10% povidoneiodine solution for skin antisepsis was compared with its triple use (triple-application group). The exposure time was 2 min for both groups. Moreover, the effects on blood levels of total iodine and thyroid-gland-related substances were evaluated. High antiseptic efficacy was obtained in both groups, indicating that our antiseptic method to disinfect the operative field is effective. Slightly better results were obtained from the triple-application group, although the difference was not statistically significant. Blood levels of total iodine and thyroid-gland-related substances remained within the normal range in all cases. However, in cases receiving a large amount of 10% povidone-iodine solution a transient elevation in blood total iodine was observed. Thus, the 10% povidone-iodine solution is considered to be safe and effective for skin antisepsis of the operative field when applied repeatedly in a small amount per dose with an exposure time of about 2 min.

Abdomen↗

Substrates and inhibitors of antiseptic resistance in Staphylococcus aureus.

The range of substrates of antiseptic resistance associated with the ebr gene is very wide and includes antiseptics, DNA-intercalating drugs and preservatives which have no quaternary ammonium group in methicillin-resistant Staphylococcus aureus. Antiseptic resistance was inhibited by calcium channel blockers and calmodulin inhibitors similarly to the resistance to multiple antitumor agents encoded by the mdr gene in human cells. These results show that the common properties of the mdr gene and the ebr gene may be shared by the mechanisms that are involved in the removal of toxic substances from the cell.

Anti-Infective Agents, Local↗

Frequency and genetic characterization of multidrug-resistant mutants of Staphylococcus aureus after selection with individual antiseptics and fluoroquinolones.

The frequency of generation of multidrug-resistant mutants of Staphylococcus aureus was examined by selection with various antiseptics and fluoroquinolones and the mutated genes were characterized. Multidrug-resistant mutants with mutation of the region between the promoter and structural regions of the norA gene were generated more frequently during selective pressure with antiseptics than during selective pressure with FQs. We also obtained evidence for the existence of at least one other gene related to resistance to antiseptics and fluoroquinolones on the chromosome of S. aureus in addition to norA gene.

Amino Acid Sequence↗

The effect of antiseptic solutions on microorganisms in venous leg ulcers.

The effect on the microbial ulcer flora of wet gauze dressings soaked in antiseptic solutions used for desloughing leg ulcers is not known. Quantitative cultures were therefore performed in 45 venous leg ulcers, before application and after 15 minutes' treatment with gauze dressings with four different antiseptic solutions: aluminium acetotartrate (Alsol) 1%, potassium permanganate 0.015%, acetic acid 0.25% and chloramine 0.25%. The percentage of ulcers with each type of microorganism did not differ before and after application of the antiseptic solutions. Staphylococcus aureus was found in 79% of the ulcers, gram-negative rods in 39%, S. epidermidis in 21%, Proteus spp in 21%, Pseudomonas spp in 14% and fungi in none. Potassium permanganate reduced the mean number of bacteria per ulcer from 4.4 x 10(6) to 0.9 x 10(6) (ns), chloramine from 2.7 x 10(6) to 2.2 x 10(6) (ns), Alsol from 1.2 x 10(7) to 3.5 x 10(6) (ns) and acetic acid from 6.3 x 10(6) to 2.6 x 10(5) (p = 0.007). S. aureus was reduced by acetic acid (p = 0.002), gram-negative rods by both chloramine (p = 0.03) and acetic acid (p = 0.03). The number of Pseudomonas, Proteus, S. epidermidis and Streptococcus haemolyticus group G was not reduced significantly (p > 0.05) by any of the solutions.

Acetates↗

[The beneficial cytotoxicity of antiseptics. The controversial paradox of cutaneous ulcer treatment].

The pathogeny of cutaneous ulcers is complex. The role of a critical bacterial contamination is controversial. The use of topical antibiotics is unwise, and that of antiseptics is still a matter of debate. Some authors contend that antiseptics mitigate wound healing through a toxic effect upon keratinocytes and fibroblasts. Other researchers bring forward sound arguments to support the concept of beneficial cytotoxicity of antiseptics in the treatment of chronic cutaneous ulcers.

Anti-Bacterial Agents↗

[Current disinfecting and antiseptic agents in anesthesiology and resuscitation].

Prevention of nosocomial infection includes, along with other factors, measures aimed at maintenance of aseptic and antiseptic conditions by means of modern effective antiseptics and disinfectants. Efficacy of skin antiseptics (plivasept tincture, plivasept blue, plivasept foamy), disinfectants for instruments, surfaces, equipment (plivasept with and without PAV, aldesol, isosan G) manufactured by Pliva (Croatia) is assessed at Surgical Center. All these agents are recommended for improving the epidemiological situation in intensive care departments.

Anesthesiology↗

[Iodine status and the used of iodized antiseptics in the mother-newborn pair].

Iodine status was evaluated by assessment of urinary iodine excretion in 221 mothers and their 223 newborns. During the first month after childbirth, 59.3 per cent of the mothers and 26.5 per cent of the newborns received applications of iodized antiseptic containing Polyvidone-iodine. 50.2 per cent of the newborns and 24.9 per cent of the mothers had a urinary iodine of more than 20 micrograms/dl (iodine excess). For the mothers and the newborns who had received applications of iodized antiseptic, 38.2 per cent and 74.6 per cent had an iodine excess, respectively. This iodine excess is directly related to use of iodized antiseptic. Such high iodine levels may contribute to the risk of thyroid disorders, and particularly to transient congenital hypothyroidism at a critical age for normal development of the nervous system.

Adolescent↗

[Antiseptics].

Antiseptics are chemical products which are applied on live tissues in order to eliminate microorganisms potentially pathogenic, or to inhibit their growth. The selection of the antiseptic must be done according to the properties and the recommended uses of the product. This article describes the main antiseptics used in the clinical practice, paying attention to its range of activity, recommended uses and toxicity.

Anti-Infective Agents, Local↗

[Antiseptic agents: chlorhexidine].

Chlorhexidine is a broad spectrum antiseptic widely used in clinical practice. This antiseptic works rapidly and its effects last for six hours. Since it is not absorbed through the skin nor through mucus, its systematic toxicity is minimum. It keeps on working in contact with organic matter and, since it is transparent, it does not hide the evolution of injuries. In this article, the authors review the properties and indications for this antiseptic; they also comment on some studies having lesser known indications.

Anti-Infective Agents, Local↗

Antiseptics and antibiotics as chemotherapeutic agents for periodontitis management.

Antiseptics and antibiotics have both been used to treat periodontal infections. Although antiseptics and antibiotics have antibacterial properties, they represent two distinct and separate categories for agents. Sustained-release delivery systems have made it possible to use these agents to augment the beneficial effects of mechanical periodontal therapy. This article provides an overview of antiseptics and antibiotics, and compares and makes recommendations for the use of these agents in periodontics. The objective of this article is to provide an understanding of the distinct properties of each of these categories of antimicrobial agents.

Anti-Bacterial Agents↗

[Efficacity of antiseptic products].

Chemical antiseptics are used in specified conditions. This work studied the actual standards to evaluate the activity of antiseptics. Afterward, the main indications of antiseptics are summarized.

Anti-Bacterial Agents↗

[Should antiseptics be used for chronic wounds?].

Using antiseptics is common, it is adequate on safe skin, but no scientific study allow their use on break skin. Then, cicatrisation is a complex process with a physiological bacteriocycle. Usual antiseptics are responsible of fibroblasts destruction and only a short effect on bacteries. So, it is logical not to use antiseptics on break skin.

Anti-Infective Agents, Local↗

Influence of the retention of antiseptic solution dyes on the translucence of glass-ionomer cements.

Due to the great importance that antiseptic solutions have on the control and prevention of oral diseases and their influence on the translucence of esthetic restorative materials, the present study evaluated the effect of antiseptic solutions on the translucence of two glass-ionomer cements, Vidrion R and Chelon Fil, at eight time periods. Four antiseptic solutions were used: Listerine, Malvona, Flogoral and Plax. Vidrion R was less translucent than Chelon Fil. Translucence decreased with longer observation time and Malvona caused the lowest translucence.

Anti-Infective Agents, Local↗