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PubMed2001

In vitro and in vivo efficacy of catheters impregnated with antiseptics or antibiotics: evaluation of the risk of bacterial resistance to the antimicrobials in the catheters.

OBJECTIVE: To compare the efficacy of a new antiseptic catheter containing silver sulfadiazine and chlorhexidine on the external surface and chlorhexidine in the lumens to an antibiotic catheter impregnated with minocycline and rifampin on its external and luminal surfaces. DESIGN: Experimental trial. METHODS: Antimicrobial spectrum of catheters was determined by zones of inhibition. Resistance to luminal colonization was tested in vitro by locking catheter lumens with Staphylococcus epidermidis or Staphylococcus aureus culture after 7 days of perfusion. In vitro development of resistance to the antiseptic or antibiotic combination used in catheters was investigated. In vivo efficacy was tested (rat subcutaneous model) by challenge with sensitive or antibiotic-resistant bacteria. RESULTS: Antiseptic and antibiotic catheters exhibited broad-spectrum action. However, antibiotic catheters were not effective against Candida species and Pseudomonas aeruginosa. Both catheters prevented luminal colonization. Compared to controls, both test catheters resisted colonization when challenged with S aureus 7 and 14 days' postimplant (P<.05). Repeated in vitro exposure of S epidermidis culture to the antibiotic and antiseptic combinations led to small increases in the minimum inhibitory concentration (15 times and 2 times, respectively). Unlike the antibiotic catheter, the in vitro and in vivo activity of the antiseptic catheter was unaffected by the resistance profile of the test organism. Antiseptic catheters were more effective than antibiotic catheters in preventing colonization by rifampin-resistant S epidermidis in vivo (P<.05). CONCLUSIONS: Antiseptic and antibiotic catheters exhibit similar efficacy; however, when challenged with a rifampin-resistant strain, the antibiotic catheter appeared to be more susceptible to colonization than the antiseptic device.

Animals↗
PubMed1985

The pattern of adsorption of cationic antiseptics to polymethylmethacrylate.

Few studies have reported the maximum potential of surfaces to adsorb the cationic antiseptics and few comparisons between antiseptics have been carried out. The purpose of this investigation was to measure the maximum uptake of alexidine, cetyl pyridinium chloride, chlorhexidine gluconate and chlorhexidine acetate to polymethylmethacrylate and by the construction of adsorption isotherms determine the pattern of molecular attachment to the recipient surface. The mean maximum adsorption findings for these antiseptics demonstrated significantly greater uptake of cetyl pyridinium chloride than the other antiseptics and significantly less uptake of alexidine compared with the other antiseptics. All four antiseptics showed a Langmuir type adsorption isotherm consistent with the formation of a monolayer of molecules on the recipient surface. For chlorhexidine preliminary studies demonstrated that the pattern of adsorption was not altered by saliva pre-treatment of surfaces. No evidence of molecular multilayering was observed even at higher concentrations of the antiseptics. However, the maximum uptake on to the surface was significantly increased when no post-treatment washings were carried out. It was concluded that this increased uptake would be unlikely to play an important role in antiplaque activity because of its relative instability. The pH dependency for the adsorption of these antiseptics was demonstrated such that as previously observed for chlorhexidine gluconate at low pH adsorption is almost completely, or completely, prevented.

Adsorption↗
PubMed2004

The impact of topical antiseptics on skin microcirculation.

AIM: Antiseptics are commonly used in clinical practice to disinfect tissue and to avoid infections. However, topical antiseptics are assumed to have an influence on skin microcirculation, per se. Thus, the aim of the study was to analyse the influence of topically applied antiseptics on the microcirculation of intact skin in vivo. MATERIALS AND METHODS: The investigation was carried out on ears of male hairless mice (SKH-1hr, n = 25). The influence of four antiseptics was examined. Sodium chloride 0.9% served as control. An alcohol-based solution with a mixture of ethanol, 2-propanol and purified water (Softasept), an antiseptic with octenidine dihydrochloride and phenoxyethanol as the main active agents (Octenisept), as well as hexamethylenbiguanide (Lavasept) and 70% ethanol were tested. Intravital fluorescence microscopy in combination with intravenous injection of the fluorescence dyes FITC-Dextran as plasma marker and Rhodamine 6G (leukocyte staining) allowed a quantitative analysis of standard microcirculatory parameters (vessel diameter, functional capillary density, red blood cell velocity, FITC-leakage and leukocyte endothelium interaction). Recordings of the microcirculation in several regions of interest (ROI) were made prior to application and after 10 min exposure time and 60 min after the baseline data. Data were evaluated off-line with aid of computer assisted analysis. RESULTS: The diameter of arterioles decreased after the treatment with the alcoholic solutions. The other two antiseptics (Octenisept and Lavasept) caused a significant increase. Functional capillary density (FCD) was significantly reduced after application of ethanol and Softasept. There was no reduction of FCD following application of Octenisept. After treatment with ethanol and Softasept there was a significant decrease in red blood cell velocity (RBCV). The use of Lavasept revealed a decrease of FCD and RBCV. In the Octenisept treated group RBCV shows a mild increase after 10 minutes. The application of ethanol, Softasept and Lavasept was characterized by a significant increase of leukocyte endothelium interaction (LEI). After treatment with saline and Octenisept LEI remained constant. All used antiseptics except of Octenisept caused a significant leakage of FITC-Dextran. CONCLUSION: The antiseptics used in this study all showed an influence on skin microcirculation. As expected, our findings show that the alcoholic solutions are most aggressive to skin microcirculation.

Administration, Topical↗
PubMed1984

[Verification of the effectiveness of neutralization in the in vivo study of antiseptics].

Well defined controls of the effectiveness of antiseptic neutralizing agents in vitro already exist (Afnor Standards for antiseptics and disinfectants). Conversely, there is currently no standard method for verifying how effectively such agents neutralize antiseptics which have been applied to the skin. We describe a method in which the neutralizing solution is first applied to the antiseptic-treated skin and then filtered to remove skin flora. The effect of the neutralizing agent is then checked using a test organism (Staphylococcus epidermidis ATCC 14990) in parallel with four controls: viability of the test organism (T1), activity of the untreated antiseptic (T2), non-bactericidal effect of the neutralizing agent (T3) and of skin secretions (4). Skin sampling was carried out using Gaschen's bag method for the hands and the Williamson and Kligman method modified by Fleurette for other sites. Twelve soaps and/or antiseptics were studied. In each case, activity of the antiseptic (T2) was confirmed, except when the product under study was a non-bactericidal soap. Bacterial counts obtained in controls T3 and T4 and in the neutralization test itself were always greater than 80% of the control value (T1). Occasionally, the counts in the neutralization test exceeded 100% of the T1 value, probably because of the dispersal effect of the triton X100 present in the neutralizing solution. This method thus offers a means of standardizing the study of antiseptics in vivo. In addition, the test organism, Staphylococcus epidermidis, is more representative of the skin flora than the bacterial strains recommended by Afnor for in vitro studies.

Anti-Infective Agents, Local↗
PubMed1999

Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection.

CONTEXT: A recent randomized controlled trial and meta-analysis indicated that central venous catheters impregnated with an antiseptic combination of chlorhexidine and silver sulfadiazine are efficacious in reducing the incidence of catheter-related bloodstream infection (CR-BSI); however, the ultimate clinical and economic consequences of their use have not been formally evaluated. OBJECTIVE: To estimate the incremental clinical and economic outcomes associated with the use of antiseptic-impregnated vs standard catheters. DESIGN: Decision analytic model using data from randomized controlled trials, meta-analyses, and case-control studies, as well as safety data from the US Food and Drug Administration. SETTING AND PATIENTS: A hypothetical cohort of hospitalized patients at high risk for catheter-related infections (eg, patients in intensive care units, immunosuppressed patients, and patients receiving total parenteral nutrition) requiring use of a central venous catheter. INTERVENTION: Short-term use (2-10 days) of chlorhexidine-silver sulfadiazine-impregnated multilumen central venous catheters and nonimpregnated catheters. MAIN OUTCOME MEASURES: Expected incidence of CR-BSI and death attributable to antiseptic-impregnated and standard catheter use; direct medical costs for both types of catheters. RESULTS: In the base-case analysis, use of antiseptic-impregnated catheters resulted in a decrease in the incidence of CR-BSI of 2.2% (5.2% for standard vs 3.0% for antiseptic-impregnated catheters), a decrease in the incidence of death of 0.33% (0.78% for standard vs 0.45% for antiseptic-impregnated), and a decrease in costs of $196 per catheter used ($532 for standard vs $336 for antiseptic-impregnated). The decrease in CR-BSI ranged from 1.2% to 3.4%, the decrease in death ranged from 0.09% to 0.78%, and the costs saved ranged from $68 to $391 in a multivariate sensitivity analysis. CONCLUSION: Our analyses suggest that use of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in patients at high risk for catheter-related infections reduces the incidence of CR-BSI and death and provides significant saving in costs. Use of these catheters should be considered as part of a comprehensive nosocomial infection control program.

Anti-Infective Agents, Local↗
PubMedDate not supplied

The formation of stain on acrylic surfaces by the interaction of cationic antiseptic mouthwashes and tea.

Clinical and in vitro studies have implicated dietary components as major aetiological factors in staining of teeth and acrylic materials associated with chlorhexidine use, a local side effect not unique to this antiseptic. These experiments studied the precipitation and surface staining reactions of the cationic antiseptics alexidine, cetyl pyridinium chloride (CPC), chlorhexidine, and hexetidine, with the beverage tea. All of the antiseptics precipitated a standard tea solution and for alexidine and chlorhexidine acetate and gluconate, this was at concentrations greater than 100 mumol/L, for hexetidine greater than 200 mumol/L, and for CPC greater than 400 mumol/L. With the exception of CPC precipitation was reduced with decreasing pH and for chlorhexidine was inhibited below pH 3. The addition of polymethylmethacrylate (PMMA) to the antiseptic solutions increased the precipitation concentrations by an amount calculated to be adsorbed by polymer. Acrylic blocks treated with equimolar solutions of the antiseptics became progressively and significantly more stained by tea than control specimens over a 5-day period. Alexidine induced significantly greater staining and hexetidine significantly less than the other antiseptics. Staining was pH dependent and significantly reduced as the pH decreased. Both stain and precipitates were insoluble in strong acids and alkalis. It is concluded that staining observed clinically may represent a precipitation reaction with the complexing of antiseptics with dietary chromogenic material.

Acrylates↗
PubMed2005

Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit.

This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.

Anti-Infective Agents, Local↗
PubMed2000

Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients.

Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. In this study, we did a randomized clinical study to determine the efficacy by using antiseptic catheters for the prevention of central venous catheters-related infection in the intensive care units. A total of 204 patients with 235 central venous catheters were studied at the surgical intensive care units at National Taiwan University Hospital between November 1998 and June 1999. Participants received either a standard triple-lumen polyurethane catheter or an antiseptic catheter (Arrow International, Reading, Pennsylvania, USA). Both were indistinguishable from each other. Compared to standard polyurethane catheters, antiseptic catheters were less likely to be colonized by microorganisms when they were cultured at the removal (8.0 versus 20.0 colonized catheters per 100 catheters; relative risk 0.34 [95% CI, 0.15 to 0.74]; p<0.01). There was no significant differences between both groups in catheter-related infections (0.9 versus 4.9 infections per 100 catheters; relative risk 0.17 [95% CI, 0.03 to 1.15]; p = 0.07). Gram-positive cocci and fungi were more likely to colonize in the standard polyurethane catheters (p = 0.06 and 0.04, compared to antiseptic catheters respectively). Two of our cases in the control group died directly due to catheter-related candidemia. No adverse reactions such as hypersensitivity or leukopenia were found in the antiseptic catheter group. Our study showed that central venous catheters with antiseptic coating were safe and had less risk of colonization of bacteria and fungi than standard catheters in the critically ill patients.

Anti-Infective Agents, Local↗
PubMed2006

Impact of alcohol-based, waterless hand antiseptic on the incidence of infection and colonization with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci.

OBJECTIVE: Colonized and infected inpatients are major reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and transient carriage of these pathogens on the hands of healthcare workers remains the most common mechanism of patient-to-patient transmission. We hypothesized that use of alcohol-based, waterless hand antiseptic would lower the incidence of colonization and/or infection with MRSA and VRE. METHODS: On June 19, 2001, alcohol hand antiseptic was introduced at the University campus and not the nearby Memorial campus of the University of Massachusetts Medical School (Worcester, MA), allowing us to evaluate the impact of this antiseptic on the incidence of MRSA and VRE colonization and infection. From January 1 through December 31, 2001, the incidence of MRSA colonization or infection was compared between the 2 campuses before and after the hand antiseptic was introduced. Its effect on VRE colonization and infection was only studied in the medical intensive care unit at the University campus. RESULTS: At the University campus, the incidence of MRSA colonization or infection decreased from 1.26 cases/1,000 patient-days before the intervention to 0.75 cases/1,000 patient-days after the intervention, for a 1.46-fold decrease (95% confidence interval, 1.04-2.58; P = .037). At the Memorial campus, the incidence of MRSA colonization or infection remained virtually unchanged, from 0.34 cases/1,000 patient-days to 0.49 cases/1,000 patient-days during the same period. However, a separate analysis of the University campus data that controlled for proximity to prevalent cases did not show a significant improvement in the rates of infection or colonization. The incidence of nosocomial VRE colonization or infection before and after the hand antiseptic decreased from 12.0 cases/1,000 patient-days to 3.0 cases/1,000 patient-days, a 2.25-fold decrease (P = .018). Compliance with rectal surveillance for detection of VRE was 86% before and 84% after implementation of the hand antiseptic intervention. The prevalences of VRE cases during these 2 periods were 25% and 29%, respectively (P = .017). CONCLUSIONS: Alcohol hand antiseptic appears to be effective in controlling the transmission of VRE. However, after controlling for proximity to prevalent cases (ie, for clustering), it does not appear to be more effective than standard methods for controlling MRSA. Further controlled studies are needed to evaluate its effectiveness.

Alcohols↗
PubMed1997

Evaluation of bactericidal activity and lag of regrowth (postantibiotic effect) of five antiseptics on nine bacterial pathogens.

Lag of regrowth or postantibiotic effect (PAE) relates to suppression of bacterial regrowth following short exposure to an antimicrobial agent. A delay in regrowth has not yet been studied for antiseptics to any great extent. We therefore examined and compared the lag of regrowth and the bactericidal activity of five antiseptics (chloramine T, chlorhexidine, povidone-iodine, phenoxyethanol and mandelic-lactic acid) against nine bacterial pathogens. Delay in regrowth was determined by application of two concentration-time schedules: a test concentration at the MBC with a contact time of 1 h or using fixed suboptimum concentration of each antiseptic for 2 min (optimum concentrations sterilized the culture, impeding assessment of regrowth) followed by a neutralization-dilution step and subsequent viable counting to follow bacterial regrowth. Each antiseptic displayed a different spectrum of activity in terms of MIC or MBC, bactericidal effect and lag of regrowth. The delay in regrowth varied from 0 to 5.7 h with only a few discrepancies between the two treatment schedules. Mandelic-lactic acid and chloramine T induced a significantly longer lag as compared with the other agents, whereas phenoxyethanol produced the shortest lag values. No significant correlation between the killing rate and the lag of regrowth could be demonstrated. Information on bactericidal activity, as well as lag of regrowth, could be a useful screening method for the efficacy of antiseptics. Moreover, data on lag of regrowth could contribute to the choice of antiseptic and guide in determining the optimum interval between repeated applications of antiseptics.

Anti-Infective Agents, Local↗
PubMed1981

Comparison of the in vivo and in vitro antibacterial properties of antiseptic mouthrinses containing chlorhexidine, alexidine, cetyl pyridinium chloride and hexetidine. Relevance to mode of action.

A study was carried out to compare the antibacterial properties of four cationic antiseptics, three of which are available as commercial mouthrinse preparations. Minimum inhibitory concentrations for alexidine, cetyl pyridinium chloride, chlorhexidine gluconate and hexetidine against a range of standard test organisms, were determined by tube dilution. Similar values for Oxford staphylococcus were then obtained in Dubos medium to which protein as yeast, or food extract, or serum was added in doubling dilutions to 16%. Salivary bacterial counts after a single rinse with the antiseptics or water throughout the day were measured in 10 subjects together with the duration of any residual antiseptic activity in the saliva. All antiseptics were effective at low concentrations against the organisms tested but the minimum inhibitory concentration values for hexetidine were the highest. Food extract and serum markedly increased the minimum inhibitory concentration values of all antiseptics, although alexidine and hexetidine were the least affected in percentage terms. The activity of a 1% povidone iodine preparation, used for comparison, was almost completely vitiated. An immediate significant fall in salivary bacterial counts was produced by the cationic antiseptics. Return to pre-rinse levels was seen for hexetidine after 90 min, cetyl pyridinium chloride after 3 hours, alexidine after 5 hours and chlorhexidine gluconate after 7 hours. Residual salivary antibacterial activity remained to 90 min for cetyl pyridinium chloride, to 3 hours for hexetidine and alexidine and to 5 hours for chlorhexidine gluconate. The antibacterial properties measured, in particular the duration of effect in vivo, may be relevant to the anti-plaque activity of cationic antiseptics.

Bacteria↗
PubMed2002

Comparison of four antiseptic preparations for skin in the prevention of contamination of percutaneously drawn blood cultures: a randomized trial.

A number of skin antiseptics have been used to prevent the contamination of blood cultures, but the comparative efficacies of these agents have not been extensively evaluated. We therefore sought to compare the efficacy of four skin antiseptics in preventing blood culture contamination in a randomized, crossover, investigator-blinded study conducted in an emergency department and the inpatient wards of a university hospital. The patient group included all patients from whom blood samples were obtained percutaneously for culture. Skin antisepsis was performed with 10% povidone-iodine, 70% isopropyl alcohol, tincture of iodine, or povidone-iodine with 70% ethyl alcohol (i.e., Persist). The blood culture contamination rate associated with each antiseptic was then determined. A total of 333 (2.62%) of 12,692 blood cultures were contaminated during the study period compared to 413 (3.21%) of 12,859 blood cultures obtained during the previous 12-month period (relative risk = 0.82; 95% confidence interval, 0.71 to 0.94; P = 0.006). During the study, the contamination rates were determined to be 2.93% with povidone-iodine, 2.58% with tincture of iodine, 2.50% with isopropyl alcohol, and 2.46% with Persist (P = 0.62). We detected no significant differences in the blood culture contamination rates among these four antiseptics, although there was some evidence suggesting greater efficacy among the alcohol-containing antiseptics. Among the evaluated antiseptics, isopropyl alcohol may be the optimal antiseptic for use prior to obtaining blood for culture, given its convenience, low cost, and tolerability.

2-Propanol↗
PubMed2000

Efficacy of common antiseptics against mycobacteria.

SETTING AND OBJECTIVE: Antiseptics are frequently used to prevent mycobacterial infection; however, the reported activities of a number of antiseptics against mycobacteria are not always consistent. The aim of this study was to determine those antiseptics that are useful against mycobacteria. DESIGN: Evaluation of antiseptic activity against mycobacteria in vitro. RESULTS: The effects of different antiseptics on mycobacteria (Mycobacterium avium, M. kansasii and M. tuberculosis) were examined. At concentrations of 0.05%, povidone-iodine (PVP-I) killed 99% or more of all strains tested within 15 seconds, while 0.5% chlorhexidine gluconate and 0.1% benzalkonium chloride showed no bactericidal activity against mycobacteria. M. kansasii and M. tuberculosis were killed after exposure to cresol for 60 seconds at concentrations of 1.0%, but M. avium was unaffected even after 60 seconds. While M. kansasii and M. tuberculosis were killed by treatment with 2.0% glutaraldehyde for 5 minutes, M. avium was highly resistant to this agent. CONCLUSION: PVP-I seems to be a useful antiseptic against mycobacteria. The measured activity of antiseptics should be interpreted carefully, due to the potential for interference by artifacts.

Anti-Infective Agents, Local↗
PubMed1989

[Antiseptic resistance of clinical strains of Staphylococcus aureus].

To evaluate the activity of antiseptics and the sensitivity-resistance of bacteria to antiseptics, a number of characteristics has been used, including the minimum inhibiting concentration for different strains, the frequency of statistical and clinical resistance, the antiseptic activity index. A wide spread of S. aureus strains isolated from patients with hospital infections has been revealed. Differences in the resistance of bacterial strains have been established, depending on the type of the antiseptic and the ecovar of bacteria: among hospital ecovars, resistant strains occur more frequently and can resist a wider range of antibiotics. In staphylococcal hospital ecovars the occurrence and level of resistance to a number of widely used antiseptics increase with time. In connection with a wide spread of staphylococcal hospital strains resistant to antiseptics, measures on the control of the circulation of such strains should be introduced into hospitals, and the data thus obtained should be used for the periodic reevaluation of antiseptics used in medical practice and for the choice of preparations to be used for individual therapeutic and prophylactic antisepsis.

Anti-Infective Agents, Local↗
PubMed1996

No difference in catheter sepsis between standard and antiseptic central venous catheters. A prospective randomized trial.

OBJECTIVE: To determine the efficacy of antiseptic compared with standard triple lumen central venous catheters (CVCs) in reducing the incidence of catheter sepsis and catheter site infection in patients with CVCs for total parenteral nutrition. DESIGN: A prospective, randomized, controlled trial. SETTING: Truman Medical Center, the public teaching hospital for University of Missouri, Kansas City, School of Medicine. PATIENTS: Seventy-two inpatients on the Metabolic Support Service received a CVC for the infusion of total parenteral nutrition. Diagnoses included pancreatic disease, cancer, bowel obstruction, and intestinal surgery, among others. Patients who had a higher risk for contamination during insertion, such as those with a catheter placed through an introducer, inserted in the emergency department, or changed over a guidewire were excluded from the study. INTERVENTION: The control group received a standard CVC without antiseptics. The treatment group received a CVC with a coating of silver sulfadiazine and chlorhexidine gluconate. Each CVC was inspected for infection or malfunction by the Metabolic Support Service 5 times per week. A transparent occlusive dressing was changed every 7 days or more often if there were signs of infection or nonocclusion. When the CVC was removed, the catheter tip, the blood, and the insertion site were cultured. MAIN OUTCOME MEASURES: Although 88 catheters were inserted, only 72 catheters were evaluable. There were 40 patients in the standard group and 32 in the antiseptic group. There were no statistically significant differences between the 2 groups for diagnosis, sex, age, length of stay, days with a CVC, or catheter location. The catheter sepsis rate in the standard group was 8% and in the antiseptic group it was 6%. There were no statistically significant differences between the 2 groups in frequency of site infections or catheter sepsis. CONCLUSIONS: In this study, there were no statistically significant differences in the incidence of catheter-related sepsis or catheter site infections between the standard and antiseptic groups. Future prospective, randomized controlled trials with a larger number of antiseptic catheters are encouraged to confirm or refute these results.

Adult↗
PubMed2004

Preoperative skin antiseptics for preventing surgical wound infections after clean surgery.

BACKGROUND: Approximately 15% of elective surgery patients and 30% of patients receiving contaminated or dirty surgery are estimated to develop post-operative wound infections. The costs of surgical wound infection can be considerable in financial as well as social terms. Preoperative skin antisepsis is performed to reduce the risk of post-operative wound infections by removing soil and transient organisms from the skin. Antiseptics are thought to be both toxic to bacteria and aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however it is unclear whether preoperative skin antisepsis actually reduces post-operative wound infection and if so which antiseptic is most effective. OBJECTIVES: To determine whether preoperative skin antisepsis reduces post-operative surgical wound infection. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Trials Register and the Cochrane Central Register of Controlled Trials in April 2004. In addition we handsearched journals, conference proceedings and bibliographies. SELECTION CRITERIA: Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There were no restrictions based on language, date or publication status. DATA COLLECTION AND ANALYSIS: Three reviewers independently undertook data extraction and assessment of study quality. Pooling was inappropriate and trials are discussed in a narrative review. MAIN RESULTS: We identified six eligible RCTs evaluating preoperative antiseptics. There was significant heterogeneity in the comparisons and the results could not be pooled. In one study, infection rates were significantly lower when skin was prepared using chlorhexidine compared with iodine. There was no evidence of a benefit in four trials associated with the use of iodophor impregnated drapes. REVIEWERS' CONCLUSIONS: There is insufficient research examining the effects of preoperative skin antiseptics to allow conclusions to be drawn regarding their effects on post-operative surgical wound infections. Further research is needed.

Anti-Infective Agents, Local↗
PubMed1994

[Local antiseptics in surgery--rebirth and advances].

The history of antisepsis is marked by names such as Pringle, Lister, Billroth, Koch, Kocher, von Volkmann, von Nussbaum, Schloffer and Carrel. The revolutionary initial success of Lister's method was followed by severe setbacks because persisting biological intolerance of the chemical and physical antiseptics prevented the main purpose of application: killing bacteria without damaging cells. Until the discovery of penicillin the predominantly used antiseptics were perubalsam (balsamum peruvianum), azo-dyes (Rivanol), and sulphonamides (Cibazol). The dawn of the "antibiotic age" demonstrated once more the limits of locally applied therapeutic effectiveness of these substances (antiseptics, antibiotics) and was often outweighed by the damage caused. For the same reason systemicly applied substances frequently lack satisfactory effectiveness in the area of tissue damage. Experiences with intraoperative and postoperative wound lavage have shown that favourable results achieved by this surgical procedure are more likely due to the mechanical cleaning process than to the effectiveness of the locally applied substances being limited by the restricted duration of influence and the restricted depth of tissue penetration. Taking into account earlier studies and long-term experiences, antiseptic solutions were tested in view of their tissue compatibility, their biologic availability, and their effectiveness in close cooperation of clinic, bacteriology and laboratory medicine. The coordinated investigations resulted in a solution of biguanid (Lavasept) which is free from iodine, quicksilver, PVP and aldehyde. It can be applied for local treatment of wounds liable to infection, as an adjuvant for wound treatment in cases of acute tissue infections, as well as in the surgival practise to take care of acute and chronic infections of soft tissue. Sofar locally applied antiseptics in surgery have proved to be less satisfactory than considered in the course of their history due to side effects, e.g. tissue damage. Coordinated investigations now present an antiseptic solution of biguanid which can be used in various cases of wound treatment to prevent or counteract infections.

Administration, Topical↗
PubMed1983

Surgical antiseptics.

The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.

Anti-Infective Agents, Local↗