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PubMed2002

Use of 2% 2-phenoxyethanol and 0.1% octenidine as antiseptic in premature newborn infants of 23-26 weeks gestation.

In preterm newborn infants, topical iodine-containing antiseptics disturb thyroid hormone regulation while alcohol-based disinfectants may cause local burns. We therefore investigated the use of an aqueous solution containing 0.1% octenidine and 2% 2-phenoxyethanol for skin disinfection during the first seven days of life in premature newborns with a gestational age <27 weeks who were consecutively admitted to our level III neonatal intensive care unit between November 1, 2000 and December 31, 2001 (N=24). In boys. (N=13) the renal excretion of absorbed 2-phenoxyethanol and its metabolite 2-phenoxyacetic acid was quantitated by high-pressure liquid chromatography. In the most immature newborn (gestational age 23 6/7 weeks), a transient erythematous reaction was observed following application of the octenidine/phenoxyethanol solution prior to umbilical vessel catheterization. No other local reactions were observed. The urinary concentration of 2-phenoxyethanol was <2 ppm in all samples, while urinary 2-phenoxyacetic acid concentrations reached 5-95 ppm (median 24 ppm). One infant had a culture-proven septicaemia (Bacillus species) during the first seven days of life. We conclude that, in contrast to alcohol-based antiseptics, an aqueous solution of 0.1% octenidine and 2-phenoxyethanol does not cause major skin damage in premature newborn infants <27 weeks' gestation. 2-Phenoxyethanol is readily absorbed by the newborn's skin but apparently undergoes extensive oxidative metabolization to 2-phenoxyacetic acid.

Anti-Infective Agents, Local↗
PubMed2003

Inhibition of the anti-staphylococcal activity of the antiseptic polihexanide by mucin.

The antiseptic Lavasept (LS), containing the polymeric biguanide polihexanide (CAS 28757-48-4), possesses microbicidal activity against a broad spectrum of bacteria including Staphylococcus aureus. It is used for antiseptic wound care in concentrations corresponding to 0.2-0.4 mg polihexanide per ml. To obtain basic data on its ability to eradicate S. aureus colonizing the nasal mucosa, the influence of mucin on the anti-staphylococcal activity was investigated. A disk agar-diffusion method was applied. Two reference strains of S. aureus (methicillin-sensitive S. aureus ATCC 29213 and methicillin-resistant S. aureus ATCC 33591) and 20 fresh clinical isolates were used. In the absence of mucin, the growth of all strains was inhibited by polihexanide concentrations of 0.1 mg/ml. In the presence of 0.25% mucin in the test medium, a concentration of 0.4 mg/ml was necessary to inhibit all strains. Mucin concentrations of 0.5% and 1%, that are even lower than the mucin concentrations in healthy nasal secretions, abolished the activity of the therapeutic concentrations of polihexanide. It is concluded that the inactivation of LS by mucin obstructs a reliable clearance of nasal S. aureus carriage.

Anti-Infective Agents, Local↗
PubMed2001

Efficacy of cetylpyridinium chloride used as oropharyngeal antiseptic.

Cetylpyridinium chloride, (CPC, CAS 123-03-5) as active ingredient of antiseptic oral mouthrinses has a broad antimicrobial spectrum with a rapid bactericidal effect on gram-positive pathogens and a fungicide effect on yeasts in particular. There are gaps in its effectiveness against gram-negative pathogens and mycobacteria. Application of CPC at a concentration of 0.05% as a mouthrinse results in an immediate reduction in bacterial counts of 2.0 to 2.5 log steps (which is adequate to > 99%). This reverts to about 1 log step (= 90%) 1 h after application. The ability of CPC to inhibit plaque and thereby reduce gingivitis is assured. In comparison to chlorhexidine, CPC has a lower residual effect, and as a result a lesser effect against plaque and gingivitis. The efficacy of CPC against oropharyngeal candidiasis is assured. CPC mouthrinses can significantly reduce infectious aerosols in dental practice, thereby protecting both staff and the patient. The balance of intra-oral bacterial flora is not disturbed even in the case of relatively long-term use of CPC (up to six weeks). Taking these properties into consideration, CPC may be considered as an alternative active ingredient in the case of chlorhexidine intolerance in the treatment and prevention of bacterial or fungal disorders of the oropharyngeal cavity. It is also of interest as an element for combination in the development of new types of oropharyngeal antiseptics.

Anti-Infective Agents, Local↗
PubMed2000

Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic.

OBJECTIVE: The objective of the study was to improve health care workers' compliance with hand hygiene after patient contact by use of an alcohol-based hand antiseptic. DESIGN AND METHODS: Six commercially available alcohol-based hand antiseptics were evaluated. The one most pleasing to the evaluators' hands was selected for the study. Baseline handwashing rates were assessed on 2 medical wards. Alcohol dispensers were mounted by every door on the 2 wards. An educational campaign was conducted with 4 weekly visits to these floors to remind and reinstruct staff about the use of the alcohol dispensers and to address questions. After 2 months handwashing rates were reassessed. SETTING: The study was set in a university hospital. RESULTS: The baseline handwashing rate was 60% (76/126). Physicians were most compliant (83%), followed by nurses (60%), technologists (56%), and housekeepers (36%). Two months later overall hand hygiene rates had decreased to 52% (P = .26). Nurses were most compliant (67%), followed by technologists (57%), physicians (29%), and housekeepers (25%). Physician compliance was associated with compliance by attending physicians whose example was usually followed by all other physicians on rounds. CONCLUSIONS: A brief educational campaign and installation of dispensers containing a rapidly acting hand hygiene product near hospital rooms did not affect hand hygiene compliance. The behavior of attending physicians was predictive of handwashing rates for all others in the attending's retinue. Compliance with handwashing after half of all patient contacts was a result of perfect compliance by some and total noncompliance by others being observed.

Anti-Infective Agents, Local↗
PubMed2001

Methods for evaluating changes in skin condition due to the effects of antimicrobial hand cleansers: two studies comparing a new waterless chlorhexidine gluconate/ethanol-emollient antiseptic preparation with a conventional water-applied product.

BACKGROUND: Hand-cleansing products that are milder to the skin of health care personnel are being developed, but the available methodologies to appropriately evaluate these products and quantify differences are not generally being applied in well-controlled studies. METHODS: Two randomized, blinded, bilateral comparison studies evaluated skin condition during use of 2 antiseptic hand preparation products: a new 1% chlorhexidine gluconate (CHG)/61% wt/wt ethanol antiseptic hand preparation in a unique emollient system for waterless/brushless application and a conventional 4% CHG antimicrobial product that is applied with water and a scrub brush. Trained technicians applied treatments 6 times (for a surgical scrub study) or 24 times (for a personnel handwash study) daily to the hands of healthy volunteers during 5 days of controlled washing. An expert grader evaluated skin for dryness, erythema, and roughness. Subjects completed a self-assessment questionnaire on skin condition. Transepidermal water loss was measured by an evaporimeter, and the skin surface hydration level was measured by an electrical conductance meter. RESULTS: Fifty-eight subjects were enrolled in the 2 studies and received both treatments. In general, skin treated with the waterless CHG/ethanol product scored significantly (P <.004) better on evaluations of visual dryness and erythema and showed greater improvement in the level of hydration (P <.003). In the health care personnel handwash study, transepidermal water loss was less than that for skin treated with the conventional CHG product (P <.002). Subject assessments showed similar results (total score, P <.007). CONCLUSIONS: All 3 approaches of expert grader evaluation, subject assessment, and instrumentation were in concordance, demonstrating that the waterless CHG/ethanol product was gentler to skin than the conventional CHG product.

Adult↗
PubMed2006

Chest tube-related empyema due to methicillin-resistant Staphylococcus aureus: could the chest tube be coated with antiseptics?

We reviewed the epidemiology, clinical manifestations, and outcomes of 3 cases of chest tube-related empyema due to methicillin-resistant Staphylococcus aureus (MRSA). Antiseptic-impregnated chest tubes were inserted in cultures containing MRSA isolates from these 3 patients, and zone of inhibition were measured. Chest tube-related MRSA empyema might complicate tube thoracostomy, and coating the chest tube with antiseptic agents could prevent this complication.

Aged↗
PubMed1989

Proteeae groin skin carriage among nursing home residents--resistance to antiseptics.

Proteeae carriage was evaluated in groin skin carriers following vigorous antiseptic application. Three Proteus mirabilis carriers were treated with 60% isopropyl alcohol or 4% chlorhexidine, observed to prevent skin contact, and then recultured; at four and eight hours P mirabilis numbers remained undiminished. Ten Proteeae carriers received a series of nine body baths with soap, chlorhexidine, and 0.75% povidone-iodine plus three cefazolin injections over 16 to 34 days; cumulative treatments failed to clear seven carriers. Within three months, all were again carriers. Proteeae carriers also had affinity for groin carriage of various aerobic gram-negative bacilli (AGNB) including cefazolin-resistant strains. In seven subjects, more than one AGNB species were recovered shortly after applying an antiseptic. Proteeae groin skin carriage appears to reflect a major change in the nature of resident bacteria on intact groin skin.

Aged↗
PubMed2003

Analysis of genomic diversity and evolution of the low-level antiseptic resistance gene smr in Staphylococcus aureus.

A multidrug efflux pump specified by the smr gene mediates low-level antiseptic resistance in staphylococci. We analyzed the genomic diversity of smr and its gene cassette, a structural unit containing smr and terminal direct repeats (DRs), in 22 clinical strains of Staphylococcus aureus isolated over 9 years in a Japanese hospital. Although open reading frames (ORFs) of all the smr genes examined were identical to those reported previously (e.g., qacD in pSK41), smr gene cassettes were classified into three groups (types 1, 2, and 3). The type 1 cassette had an identical genetic organization to that found in the plasmid pSK41, a putative prototype of the smr gene cassette, which contains DRs flanking smr. In the type 2 cassette, the rep gene and a putative replication nick site were found upstream of smr, between a SSOA (single-strand origin) sequence and DR1c, which are components of the type 1 cassette DR. In the type 3 cassette detected in a single strain, IS431 was located between the 3' end of smr and DR. It was suggested by genomic comparison that type 2 and type 3 cassettes might have been derived from the type 1 cassette via insertion of foreign DNA sequence, and that the type 2 cassette might be a precursor form of some previously reported smr cassettes, such as those in pSK108 and pNVH99. Although MICs of antiseptics and ethidium bromide were generally the same among strains having type 1, 2, or 3 smr gene cassette, the type 1 cassette was detected most frequently. Moreover, the copy number of the smr gene in the type 2 cassette was found to be much higher than that in the type 1 or type 3 cassette.

Anti-Bacterial Agents↗
PubMed1994

Prevention of bacterial colonization of intravenous catheters by antiseptic impregnation of polyurethane polymers.

The use of intravascular catheters is associated with infectious complications. Using plastic materials with antibacterial activity may reduce catheter-related bacterial colonization. A novel intravascular catheter impregnated with the antiseptics silver-sulphadiazine and chlorhexidine was tested in an in-vivo model using implantation of catheters into the internal jugular veins of rats. The rate and magnitude of bacterial colonization in groups with implantation of silver-sulphadiazine and chlorhexidine bonded (SSC) and control (C) catheters were assessed 3 and 7 days after intravenous implantation, and local challenge at the exit site by 10(7) cfu Staphylococcus epidermidis ATCC 35984. Significant reductions in the culture positivity of catheters were observed in the test compared with control groups. After 3 and 7 days, the magnitude of bacterial colonization of implanted catheter segments was significantly lower compared with control catheters (P < 0.01). These findings indicate that antiseptic-bonded catheters substantially reduce the incidence and magnitude of catheter-related bacterial colonization, and may subsequently reduce catheter-related infection.

Animals↗
PubMed1996

Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients.

OBJECTIVES: To compare the efficacy of a newly available antiseptic solution (composed of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzyl alcohol), with 10% povidone iodine, on the prevention of central venous or arterial catheter colonization and infection. DESIGN: Prospective, randomized clinical trial. SETTING: Surgical-trauma intensive care unit (ICU) in a university hospital. PATIENTS: All patients admitted to the ICU and requiring the insertion of a central venous and/or an arterial catheter from July 1, 1992 to October 31, 1993. INTERVENTIONS: Patients were randomly assigned to one of two groups according to the antiseptic solution used for insertion and catheter care. The same solution was used for skin disinfection from the time of catheter insertion to the time of removal of each catheter. MEASUREMENTS AND MAIN RESULTS: Catheter distal tips were quantitatively cultured when catheters were no longer necessary, if there was a suspicion of catheter-related infection, and routinely after 7 days of use for arterial catheters, or after 15 days of use for central venous catheters. The rate of significant catheter colonization (i.e., > or = 10(3) colony-forming units [cfu]/mL by quantitative culture), and catheter-related sepsis (as defined by sepsis abating following catheter removal per 1,000 catheter-days), were significantly lower in the chlorhexidine group (12 vs. 31 [relative risk 0.4, 95% confidence interval 0.1 to 0.9, p < .01] and 6 vs. 16 [relative risk 0.4, 95% confidence interval 0.1 to 1, p = 0.5], respectively). The rate of central venous catheter colonization and central venous catheter-related sepsis per 1,000 catheter-days were also significantly lower in the chlorhexidine group (8 vs. 31 [relative risk 0.3, 95% confidence interval 0.1 to 1, p = .03] and 5 vs. 19 [relative risk 0.3, 95% confidence interval 0.1 to 1, p = .02], respectively). Finally, the rate of arterial catheter colonization per 1,000 catheter-days was significantly lower in the chlorhexidine group (15 vs. 32 [relative risk 0.5, 95% confidence interval 0.1 to 1, p = .05]), whereas the rate of arterial catheter-related sepsis per 1,000 catheter-days was similar for the two study groups (8 in the chlorhexidine group vs. 10 in the povidone iodine group [relative risk 0.8, 95% confidence interval 0.1 to 2.2, p = .6]). The 0.25% chlorhexidine solution was superior to the 10% povidone iodine solution in preventing catheter colonizations and catheter-related sepsis due to Gram-positive bacteria (5 vs. 20 [p < .001], and 2 vs. 10 [p < .001], respectively), whereas the activity of the 0.25% chlorhexidine solution was nonsignificantly superior in preventing Gram-negative infections (7 vs. 4 [p = .5], and 4 vs. 2 [p = .8], respectively). CONCLUSIONS: The 4% alcohol-based solution of 0.25% chlorhexidine gluconate and 0.025% benzalkonium chloride was more effective than 10% povidone iodine for insertion site care of short-term central venous and arterial catheters. This effect appeared related to a more efficacious prevention of infections with Gram-positive bacteria.

Adult↗
PubMed2003

Antiseptic chamber-containing hub reduces central venous catheter-related infection: a prospective, randomized study.

OBJECTIVE: The hub connecting the catheter and the infusion equipment is a common portal of entry for bacteria causing catheter-related sepsis. We assessed the efficacy of a new hub model (Segur-Lock) that incorporates an antiseptic chamber filled with 3% iodinated alcohol in preventing endoluminal catheter contamination and catheter-related bloodstream infection arising at the hub. DESIGN: Prospective, randomized, multicenter study. SETTING: Seven medical and surgical adult intensive care units in Spain. PATIENTS: A total of 230 patients aged 18 yrs or older requiring the insertion of a nontunneled central venous catheter for >or=6 days from January 1, 1998, to April 30, 1999. INTERVENTIONS: Patients were randomized at the time of catheter insertion to receive catheters with standard Luer-lock connector (control group, n = 114) or catheters with the new hub model (n = 116). MEASUREMENTS AND MAIN RESULTS: Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or due to suspicion of sepsis, in which case peripheral blood and infusate cultures were simultaneously taken. Catheter-related bloodstream infection was diagnosed in 19 (8.3%) patients. Catheters were more often withdrawn because of suspicion of infection in the control group (43.8%) than in the new hub model group (30.1%, p <.035). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (14.4% vs. 4.3%, p <.001). Catheter-related bloodstream infection from the catheter hub also occurred more frequently in controls than in patients assigned to the new hub model (7% vs. 1.7%; p <.049; relative risk, 4.14; 95% confidence interval, 0.8-19). CONCLUSIONS: This new antiseptic chamber-containing hub has proved to be effective in preventing endoluminal bacterial colonization and catheter-related bloodstream infection from hub contamination in intensive care unit patients with central venous catheters inserted for >or=6 days.

Alcohols↗
PubMed2006

Addition of local antiseptic spray to parenteral antibiotic regimen reduces the incidence of stomal infection following percutaneous endoscopic gastrostomy: A randomized controlled trial.

OBJECTIVE: To study the effectiveness of local antiseptic spray with or without a three-dose antibiotic regimen in the prevention of stomal infection following percutaneous endoscopic gastrostomy. METHODS: Ninety-six patients were randomized into three groups: A, intravenous cefuroxime 750 mg just before the procedure followed by two further doses every 8 h; B, single application of povidone-iodine (Betadine) antiseptic spray; C, combination of A and B. The stomal site was examined at midweek and at the end of week 1 for evidence of infection using a validated scoring system. Fisher's exact test was used for analysis of primary end point, namely, stomal infection at midweek and at the end of week 1. Logistic regression models were used for secondary analysis to consider the effects of diabetes, acid suppressants, steroids, age and sex on outcome. RESULTS: Group A had 34 patients, group B had 28 and group C had 34. Age, sex and indications in groups A, B and C are broadly comparable. Stomal infection was 32% in group B vs. groups A (6%) and C (9%) (P = 0.0114) at midweek, and 3% in group C vs. 32% each in groups A and B (P = 0.0013) at the end of week 1. Cumulative infections (n) at the end of week 1 were lower in group C (3) (9%) than in groups A (11) (32%) and B (12) (43%) (P = 0.003). No significant difference was observed between the three groups in terms of the number of patients who were given antibiotics for other indications (P = 0.363). By logistic regression only diabetes, but not other covariates, seems to have a significant effect on stomal infection (odds ratio, 33.34; 95% CI, 4.33-256.7). CONCLUSION: A combination of cefuroxime and Betadine spray significantly reduces stomal infection following percutaneous endoscopic gastrostomy at the end of week 1. Both the antibiotic group (A) and the combined group (C) did well compared with the Betadine only group (B) at midweek.

Aged↗
PubMed1997

Susceptibilities of Actinobacillus actinomycetemcomitans biofilms to oral antiseptics.

The susceptibilities of Actinobacillus actinomycetemcomitans cultures, grown as 1- or 3-day-old biofilms or as planktonic suspensions, to concentrations of chlorhexidine digluconate, cetylpyridinium chloride or triclosan used in commercial mouthwashes were compared. Three-day biofilms were the most resistant form of the organism and chlorhexidine was the most active antiseptic. Comparison of solutions of the pure antibacterial agent with commercial products containing the same concentration of antiseptic showed little difference in in-vitro activities. The results emphasise that the testing of antimicrobial mouthwashes should be performed on bacteria grown as biofilms.

Aggregatibacter actinomycetemcomitans↗
PubMed1990

A double-blind, randomized, prospective trial of a topical antiseptic versus a topical antibiotic in the treatment of otorrhoea.

The clinical efficacy was assessed of a topical antiseptic (aluminium acetate) and a topical antibiotic (gentamicin sulphate) for the initial treatment of otorrhoea. Evidence of resistant organisms developing to either treatments after 9 and 21 days was also examined. 139 affected ears were entered into the trial and of these, 102 (74%) completed the study. Improvement in the otorrhoea occurred in 68% of ears treated with gentamicin and 67% of ears treated with aluminium acetate, with no significant difference between the two treatments. No resistant organisms to aluminium acetate were encountered. Twelve gentamicin-treated ears had gentamicin-resistant organisms at presentation and one patient developed a gentamicin-resistant Pseudomonas during treatment. We therefore recommend a topical antiseptic such as aluminium acetate rather than a topical antibiotic in the initial treatment of otorrhoea on the grounds of cost, avoidance of resistance and toxicity.

Acetates↗
PubMed1995

Dental properties of antiseptic throat lozenges formulated with sugars or Lycasin.

Thirteen different formulations of throat lozenges were examined for their acidity, demineralizing action on hydroxylapatite, and fermentability by human dental plaque micro-organisms. Their flavouring acids gave them low pH values in the range 2.6-3.7, leading to the dissolution of calcium and phosphorus from hydroxylapatite. The combination of antiseptics and flavouring acids in the lozenges inhibited microbial growth and metabolism. In the absence of any antiseptics and flavouring acids, the growth and metabolic activity of cultures of plaque micro-organisms were significantly greater on sucrose+glucose lozenges than on a new Lycasin formulation.

Administration, Oral↗
PubMed1990

Antibiotic compared with antiseptic prophylaxis for prostatic surgery.

Two different regimens of cephalosporin antibiotic prophylaxis were compared with antiseptic lubricating jelly to try to prevent infection and complications in 196 men after prostatic surgery. Pre-operative urine was cultured and prostatic chips (170 cases) were also cultured to define the source of any infection. The use of antibiotics was associated with a reduced risk of postoperative bacteriuria. No serious complications occurred, although 1 patient in the antiseptic treated group developed rigors; 79 of 170 patients (46%) had positive prostatic chip cultures, of whom 74 had sterile pre-operative urine. There was no association between the result of chip culture and the presence of a pre-operative catheter. Culture positive patients had an increased risk of post-operative urine infection, although the same organism was found in the prostate and urine in only 36% of cases of post-operative bacteriuria and in 43 (54%) the organism cultured from the prostate was Staphylococcus albus. This study provides further evidence of the benefit of true prophylactic antibiotic therapy for transurethral prostatic surgery and the prostatic chip data suggest that some of the risk is due to pre-operative contamination of the prostate in the absence of per-operative urinary infection or catheterisation.

Aged↗
PubMed1998

Distribution of the antiseptic-resistance genes qacE and qacE delta 1 in gram-negative bacteria.

The distribution of the antiseptic-resistance genes qacE and qacE delta 1 was studied in a large number of Gram-negative bacteria by a method that included the polymerase chain reaction (PCR). A total of 117 strains of Gram-negative bacteria, isolated from clinical or environmental sources, was used in this analysis. We demonstrated the presence of these genes in 48 of 78 strains of Pseudomonas, in 20 of 26 strains of Vibrio, and in four of 13 strains of other species. These results indicate that the antiseptic-resistance genes are present in a broad range of species of Gram-negative bacteria.

Anti-Infective Agents, Local↗
PubMed1998

Distribution of the antiseptic-resistance gene qacE delta 1 in gram-positive bacteria.

The distribution of the antiseptic-resistance genes qacE and qacE delta 1, originally isolated from Gram-negative bacteria, was studied in a large number of Gram-positive bacteria by a method that included the polymerase chain reaction. A total of 151 strains of Staphylococcus and Enterococcus, isolated from clinical sources and obtained from the Japanese Collection of Microorganisms, was used in this analysis. We found the qacE delta 1 gene in 36 of 103 strains of Staphylococcus and in nine of 48 strains of Enterococcus. All of the strains in which we detected the qacE delta 1 gene were clinical isolates. The qacE gene was not detected in any of the strains examined in this study. The nucleotide sequences of the qacE delta 1 genes from the strains of Staphylococcus and Enterococcus were identical to that of the gene located on integron InC in Pseudomonas aeruginosa. These results indicate that the antiseptic-resistance gene qacE delta 1 is present in Gram-positive, as well as Gram-negative, bacteria.

Anti-Infective Agents, Local↗