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PubMed2003

Comparison of povidone iodine and DuraPrep, an iodophor-in-isopropyl alcohol solution, for skin disinfection prior to epidural catheter insertion in parturients.

BACKGROUND: Although rare, infectious sequelae of epidural analgesia can occur. A recently marketed antiseptic solution (DuraPrep) which contains an iodophor in isopropyl alcohol, may provide enhanced and longer-lasting antimicrobial activity and thus be useful in the obstetric setting. The purpose of this study was to evaluate the antisepsis achieved with DuraPrep compared with povidone iodine (PI). METHODS: Sixty women in active labor who requested epidural analgesia were randomly assigned to receive skin preparation with either PI or DuraPrep solution. A total of three cultures were obtained from each subject. The first was obtained just prior to skin disinfection, the second was obtained immediately following antisepsis, and the third was obtained just before removal of the catheter. In addition, the distal tip of the catheter was also submitted for culture. RESULTS: The clinical characteristics and the risk factors for infection were similar in the two groups. The proportion of subjects with positive skin cultures immediately after skin disinfection differed significantly between the PI and DuraPrep groups (30 3%, respectively, P = 0.01). The number of subjects with any positive skin cultures at the time of catheter removal was greater in the PI group as compared to the DuraPrep group (97 50%, respectively, P = 0.0001), as was the number of organisms cultured from skin (log CFU 1.93 +/- 0.40 0.90 +/- 0.23, respectively, P = 0.03). Six catheters, all from the PI group, yielded positive cultures by the roll-plate technique. CONCLUSION: As compared to PI, DuraPrep solution was found to provide a greater decrease in the number of positive skin cultures immediately after disinfection, as well as in bacterial regrowth and colonization of the epidural catheters.

2-Propanol↗
PubMed2002

Clinical study on the antiseptic effect of povidone-iodine solution for the surgical field of digestive tract operations.

Our previous study showed 10% povidone-iodine solution (Isodine) to be safe and effective for skin antisepsis in healthy young adults. The present study was carried out in 45 adult and old-age patients undergoing surgery (average age 62 years). 10% povidone-iodine solution was effective for skin antisepsis; however, after completion of the intra-abdominal procedures, contaminations were found due to the type II and IV operations with unprotected incision sites and wound walls. Diabetes was found to be one of the most important factors in surgical site infection. In conclusion, the antiseptic efficacy immediately after application of 10% povidone-iodine solution was evidenced in surgical patients with class II wounds. The solution was also effective for the prevention of postoperative skin wound infection.

Adult↗
PubMedDate not supplied

Influence of the antiseptic agents polyhexanide and octenidine on FL cells and on healing of experimental superficial aseptic wounds in piglets. A double-blind, randomised, stratified, controlled, parallel-group study.

The main target of the combination of octenidine with phenoxyethanol (Octenisept) is the antisepsis of acute wounds, whereas polyhexanide combined with polyethylene glycol in Ringer solution (Lavasept) is the agent of choice for antisepsis of chronic wounds and burns. Because comparative data for both agents on the effects on wound healing are lacking, we investigated the influence of preparations based on polyhexanide and octenidine versus placebo (Ringer solution) in experimental superficial aseptic skin wounds (n = 108) of 20 mm diameter, using a double-blind, randomised, stratified, controlled, parallel-group design in piglets. Computerised planimetry and histopathological methods were used for the assessment of wound healing. Histologically, no significant differences could be verified at any time between the 3 groups. However, in the early phase (day 9 after wounding), the octenidine-based product retarded wound contraction to a significantly greater extent than placebo and polyhexanide, whereas in the later phase (days 18 and 28), polyhexanide promoted contraction significantly more than did placebo and octenidine. The consequence is complete wound closure after 22.9 days using polyhexanide, in comparison to the placebo after 24.1 days (p < 0.05) and octenidine after 28.3 days (no statistical difference to placebo). This may be explained by the better tolerance of polyhexanide in vitro, which was demonstrated with dose and time dependence in cytotoxicity tests on human amnion cells.

Animals↗
PubMed2004

Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer.

PURPOSE/OBJECTIVES: To review studies that have assessed the effectiveness of selected nursing interventions used in hospitals to prevent healthcare-associated infections in neutropenic patients with cancer. DATA SOURCES: Literature review of low microbial diets, protective clothing and environments, personal hygiene, and oral care in English-language articles from PubMed; the Cumulative Index of Nursing and Allied Health Literature; the National Guideline Clearinghouse, 1980-June 2003; and Cochrane Database of Systematic Reviews. DATA SYNTHESIS: Few studies have demonstrated the effectiveness of low microbial food and water and protective environments and clothing in reducing infections in neutropenic patients with cancer, and hospitals vary in these practices. Skin antisepsis reduces microbial counts, but data regarding the effect on infections are lacking. Many studies were characterized by insufficient sample sizes or use of multiple interventions. CONCLUSIONS: Major gaps exist in empirical evidence regarding which nursing interventions might be helpful in preventing or controlling healthcare-associated infections in neutropenic patients. IMPLICATIONS FOR NURSING: Although the evidence base for clinical practices such as a low microbial diet, protective environments and clothing, and special skin antisepsis regimens is weak, some of these practices seem prudent and reasonable. Until further evidence is available, clinicians can use consensus guidelines and should assist in identifying clinical practices that require additional research. Ultimately, interventions with little or no demonstrated efficacy should be examined systematically or abandoned. Additional studies of sufficient sample size regarding nursing practices such as the role of protective environments, room placement, antiseptic bathing, and prevention and treatment of oral complications are indicated. Because of difficulties in randomization and risk stratification, rigorous observational studies often may be an acceptable alternative to clinical trials.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Surgical pathophysiology and disease management during the centuries.

During the centuries the pathophysiological concept of illness underwent drastic changes, depending on medical discoveries and religious belief. There is evidences of surgical practice in Mesopotamia, Egypt, and Greece 2000 years B.C., but we have to wait the Roman Empire with Celso, Galeno, and most of all Asclepiade and Temisone to appreciate the endeavor to rationally understand diseases as an alteration among different body constituents and not only as divine will. During the Middle Ages, when medicine was disputed by clergy, Ugo and Teodorico Borgognone perceived by intuition the problem of sepsis in patient recovery. This problem was cleared up six centuries later by Semmelweis with his antisepsis. Discoveries of blood circulation, hemostasis, anesthesia, and antisepsis in the 17th and 19th centuries permitted better disease management and have promoted, since the 1950s, pathophysiology as an autonomous discipline. Now pathophysiological mechanisms are used for comprehension of several diseases, such as gallstone formation, peptic ulcers, cranial trauma, cardiovascular abnormalities, and many others, to suggest to us which are the better surgical or clinical trials to realize, while observing caution about their limits and consequences. By a multidisciplinary approach involving surgeons, physiologists, biologists, and physicians, we are able to facilitate patient recovery and to perform modern, scientific, high-quality disease management.

General Surgery↗
PubMed1999

[Clinical and experimental study on treatment of asthma with juanxiao tablet].

OBJECTIVE: To evaluate the therapeutic effect of Juanxiao Tablet (JXT) in treating asthma. METHODS: Clinical observation on 447 cases of asthma was done by double- or single-blind control method, and the therapeutic effect and safety of JXT were analysed. The effect of JXT in antiasthma, expectorant, antisepsis, hypoxia tolerance was studied, and its acute and chronic toxicity also examined. RESULTS: The clinical control rate in patients treated with JXT was 38.2%, its markedly effective rate 31.2% and total effective rate 93.4%, while in patients treated with Oleum Vitex Negundo, the respective data were 13.3%, 20.0% and 68.5%. Results of pulmonary function and IgE measurement were consistent with clinical effect. Experimental study showed that the JXT has the action of anti-asthma, expectorant, antisepsis and hypoxia tolerance enhancement, its LD50 was (40.48 +/- 5.17) g/kg. CONCLUSION: JXT is a new Chinese herbal preparation of good effect, less toxic-side reaction for asthma treatment.

Adolescent↗
PubMed2002

Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.

These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery anesthesiology interventional radiology pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

Adult↗
PubMed2002

Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

Alcohols↗
PubMed1989

[Influence of antiseptic measures on the flora of the oral cavity. 2. In vivo examinations].

For prophylactic antisepsis of the oral cavity 12 antiseptic solutions and 4 antiseptically acting tablets were examined in vivo. A total of 720 samples were evaluated after indirect contact sampling and 80 after direct contact sampling. After the evaluation of the in vivo findings the following antiseptic agents can be recommended for prophylactic antisepsis of the oral cavity in stomatological practice: the 0.2% chlorhexidine solution, the 0.1% aqueous solution of Tosyl-chloramid-Sodium, and Sulfachin.

Anti-Infective Agents, Local↗
PubMed1986

[Schizophrenia syndromes caused by infection].

Out of 908 patients with sepsis treated at the Republican Antisepsis Center, 19 presented with different schizophrenia syndromes (2 with acute delirium, 3 with encephalic manifestations, 3 with the amentive-catatonic form, the remainder with the amentive-depressive form). In 6 patients, psychic disorders preceded fever, in 3 patients, both conditions occurred simultaneously, and 9 developed psychosis in the presence of fever. In all the patients, with the exception of one, the diagnosis of sepsis was supported by repeated isolation of hecocultures of S. epidermidis (14 cases) and S. aureus (4 cases). The patients received antisepsis treatment. Two patients died and the rest 17 patients were cured of sepsis. The schizophrenic syndrome disappeared. No relapses were recorded with the exception of one female patient, in whom both sepsis and psychic disorders recurred. Later on, however, she also recovered.

Acute Disease↗
PubMed1993

In vitro efficacy of povidone-iodine solution and cream against methicillin-resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged worldwide as a significant and difficult-to-treat source of nosocomial infection, emphasizing the ever-present need for reliable and effective antisepsis. Betadine Solution (10% povidone-iodine; PVP-I) and Betadine Cream (5% povidone-iodine) are broad-spectrum microbicides widely used for topical cleansing, wound treatment, and antisepsis. There have been no reports of bacterial resistance to Betadine preparations. In the present study in vitro killing times were determined for PVP-I solution and PVP-I cream against five hospital isolates of MRSA and one methicillin-sensitive strain (MSSA). Isolates were incubated for 24 hours in trypticase soy broth and 0.5 ml, containing 10(6)-10(7)/ml bacteria, was then removed and added to each test agent containing PVP-I. At intervals of 30 seconds, 1 min, 2 min, 3 min, 5 min, 10 min, and 15 min, 10 microliters aliquots were removed and added to 10 ml of culture broth containing 0.1% sodium thiosulphate, the neutralizing agent for PVP-I. After neutralization the samples were incubated for 48 hours and then observed for growth (turbidity) or its absence. PVP-I solution was effective against all isolates, killing each strain within 30 seconds. PVP-I cream killed four of the MRSA isolates within 30 seconds, and required a 2-3 minute killing time for one strain of MRSA and the strain of MSSA. These results are supported by four published in vitro studies which show that PVP-I is highly effective in killing MRSA. In addition, each study shows that PVP-I is more effective than chlorhexidine against MRSA.

Humans↗
PubMed2004

Prophylactic antibiotics for abdominal hysterectomy: indication for low-risk Canadian women.

OBJECTIVE: To determine whether prophylactic antibiotics decrease the risk of infectious morbidity after total abdominal hysterectomy (TAH) in women at low risk for infection. METHODS: An analysis of data from 1570 women undergoing planned TAH at 15 secondary and tertiary hospitals in Nova Scotia, Ontario, and Quebec, who agreed to participate in a centrally randomized controlled trial of vaginal antisepsis with povidone-iodine gel compared to no gel after the standard preoperative vaginal preparation with povidone-iodine solution. RESULTS: Prophylactic antibiotics were used in 993 of 1570 women (63%). Appropriately timed prophylactic antibiotics decreased infectious morbidity (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.50-0.85; P < .002). After controlling for risk factors for infection and study centre, the protective effect was even more pronounced (adjusted OR, 0.51; 95% CI, 0.36-0.73). Prophylactic antibiotics were associated with decreases in abdominal wound infection (OR, 0.45; 95% CI, 0.30-0.66) and pelvic infection (OR, 0.49; 95% CI, 0.26-0.92). CONCLUSION: Women who did not receive prophylactic antibiotics had a higher surgical infection rate. Prophylactic antibiotics should be recommended for all women undergoing TAH.

Anti-Infective Agents, Local↗
PubMed1977

[Surgical and hospital hygiene (author's transl)].

The decades-old rules of surgical asepsis and antisepsis are more valid than ever before. The responsibility for hygiene must be clearly established: in his particular area, the surgeon, and he alone, is responsible. Patients with an increased susceptibility to infection as well as human and personnel inadequacies represent the greatest stumbling blocks in efforts to improve the status of hygiene.

Antisepsis↗
PubMed1985

[Polyvinylpyrrolidone iodine in accident surgery].

Indications and contraindications of local application of PVP-iodine in accident surgery were obtained on account of own investigations and the study of literature. For disinfection aqueous solutions of PVP-iodine do not have a complete antimicrobial spectrum. Only alcoholic PVP-iodine-solutions have complete spectra. Using alcoholic PVP-iodine-solutions to disinfect usually hands for surgery or hygiene the resorption of iodine is evident. This may cause disturbances of the thyroid gland. Disinfecting the area of surgery in one patient the resorption of iodine is tolerable. In contrary PVP-iodine today is needed for antisepsis especially in purulent situations. Additionally PVP-iodine is still the antiseptic of choice in the treatment of burn injuries. But because of the resorption of iodine the danger of hyperthyroidism in the group of patients with high risk must be kept in mind. Contraindications for the antiseptic therapy with PVP-iodine result from the investigations concerning the cytotoxicity and resorption of iodine. The application of PVP-iodine to rinsing fluids during aseptic operations, in the treatment of peritonitis or in suction drainages are not recommended any more.

Administration, Topical↗
PubMed2003

The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters.

OBJECTIVE: Short-term, noncuffed, percutaneously inserted central venous catheters (CVCs) are widely used and cause more than 250,000 bloodstream infections (BSIs) in hospitals each year in the United States. We report a prospective study undertaken to determine the pathogenesis of CVC-related BSI. DESIGN AND SETTING: Prospective cohort study in a university hospital 24-bed medical-surgical intensive care unit. PATIENTS AND PARTICIPANTS: Patients participating in two randomized trials during 1998-2000-one studying the efficacy of a 1% chlorhexidine-75% alcohol solution for cutaneous antisepsis and the other a novel chlorhexidine-impregnated sponge dressing-formed the study population; CVC-related BSIs were considered to be extraluminally acquired if concordance was identified solely between isolates from catheter segments, skin, and blood cultures and intraluminally acquired if concordance was demonstrated only between hub or infusate and blood culture isolates, as confirmed by DNA subtyping of isolates from blood and catheter sites or infusate. RESULTS: Of 1,263 catheters (6075 CVC days) prospectively studied, 35 (2.7%) caused BSI (5.9 per 1000 CVC days); 27 were caused by coagulase-negative staphylococci. Overall, 45% of infections were extraluminally acquired, 26% were intraluminally derived, and the mechanism of infection was indeterminate in 29%. In the pooled control groups of the two trials, 25 CVC-related BSIs occurred (7.0 per 1000 CVC days), of which 60% of infections were extraluminally acquired, 12% were intraluminally derived and 28% were indeterminate. In contrast, CVC-related BSIs in the treatment groups were most often intraluminally derived (60%, p=0.006). CONCLUSIONS: Most catheter-related BSIs with short-term percutaneously inserted, noncuffed CVCs were extraluminally acquired and derived from the cutaneous microflora. Strategies achieving successful suppression of cutaneous colonization can substantially reduce the risk of catheter-related BSI with short-term CVCs.

Aged↗
PubMed1976

A critical study of Lister's work on antiseptic surgery.

The work of Pasteur on alcoholic and lactic acid fermentation demonstrated that minute organisms (germs) caused these fermentative changes. Lister applied these basic findings in the introduction of his antiseptic system. Its principles were based on the destruction of germs by antiseptics (carbolic acid) to prevent their entering the wound or spreading after surgery. Lister's work on antisepsis was therefore based on the germ theory of disease. The believers of the germ theory defended Lister's theories whereas the nonbelievers of the germ theory created an atmosphere of resistance to Listerism. The work of Koch in 1878 on the etiology of traumatic infective diseases contributed greatly to the acceptance of Lister's antiseptic principles. By the mid 1880s there was a rapid increase in the use of antiseptic technics, soon followed by the introduction of aseptic methods and rapid progress in surgery.

Antisepsis↗
PubMed2006

Comparison of two alcohol-based surgical scrub solutions with an iodine-based scrub brush for presurgical antiseptic effectiveness in a community hospital.

The antiseptic effectiveness and acceptability of a commercial alcohol-based waterless (ABWL) and an alcohol-based water-aided (ABWA) scrub solution were compared with a brush-based iodine solution (BBIS) under conditions encountered in community hospital operating rooms. This randomized partially blinded study was based on guidelines from the American Society for Testing and Methods. The three scrub solutions were compared for antimicrobial efficacy, using criteria within the Food and Drug Administration's Tentative Final Monograph for Healthcare Antiseptic Products (FDA-TFM), and for participants' acceptance of the products. Volunteer surgical staff that worked daily in the same operating room for the entire duration of the study were enrolled. In total, 1126 surgical scrub procedures were performed over the duration of the study. Only the ABWL met all of the FDA-TFM criteria. The BBIS performed better than both of the alcohol-based solutions at the end of Day 1 (P=0.03), but the ABWL was more efficacious than the ABWA and the BBIS at the end of Days 2 and 5 (P=0.02 and 0.01, respectively). When colony-count reductions were compared over the entire duration of the study, there was no significant difference between the three solutions (P=0.2). The participants found the ABWL easiest to use (P<0.001), with the fewest adverse effects on skin (P=0.007), and it was their preferred product (P<0.001). Although both of the commercially available alcohol-based solutions may be considered as acceptable alternatives to the BBIS for presurgical antisepsis, the ABWL was found to have significantly higher user acceptability.

Anti-Infective Agents, Local↗
PubMed2006

Critical care medicine: landmarks and legends.

Critical care medicine was born from the selective pressures of human disease, and with the perseverance and foresight of a select few pioneers, has become an independent field of medicine. This introduction travels back in time to evaluate those visionaries and their landmark contributions. Advancements in caring for the critically ill and organ failure occurred during the wars of the twentieth century. Landmark advances in the management of respiratory paralysis occurred in the polio epidemic of the 1940s. It was during this era that the world's first ICU was developed. Contemporary critical care differs considerably from that which marked its birth. Much of the technology we currently employ is assumed: invasive hemodynamic monitoring, mechanical ventilation, antisepsis, and antibiotics.

Antisepsis↗