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PubMed1999

Sequential irrigation with common detergents: a promising new method for decontaminating orthopedic wounds.

This investigation sought to determine the capacity of irrigation solutions in decontaminating orthopedic wounds challenged with a polymicrobial inoculum. Rats were divided into two groups, a control group and a treatment group. After creation of a dorsolumbar incision and placement of a wire through the spinous process, rats were inoculated with Staphylococcus aureus and Pseudomonas aeruginosa. Wounds were irrigated with control or treated solutions. At 2 weeks, cultures were obtained. There were statistically significant differences between groups regarding total number of culture positive sites (P < 0.001), culture-positive animals (P = 0.02), and quantitative cultures (P < 0.02). Sequential irrigation with surfactants lowers bacteria counts recovered from polymicrobial wounds.

Analysis of Variance↗
PubMedDate not supplied

Microwaves in the laboratory: effective decontamination.

OBJECTIVE: We hypothesize that microwave irradiation of certain contaminated materials typically used in a clinical laboratory or a home healthcare setting could produce efficient and effective sterilization when compared to standard autoclave methods. DESIGN: A standard household carousel microwave oven unit used at the High setting was employed to expose certain materials that had been contaminated with either bacteria or yeast to microwaves for specific intervals of time. Following each time interval, materials were checked for effectiveness of decontamination using standard culture techniques and colony counting. Additionally, powdered media was prepared and microwave irradiated for specific times. The media was then poured into plates and checked for microbial contamination; another set of plates was examined to determine the ability of the irradiated media to support bacterial growth. SETTING: This study was carried out at Texas Tech University Health Sciences Center in Lubbock TX. MAIN OUTCOME MEASURE: Standard culture and colony counting techniques were used to determine the efficacy of microwave sterilization. RESULTS: The study indicated that microwave irradiation provided effective and efficient sterilization of all materials tested. Of the bacteria studied, only E. coli survived beyond 30 seconds of microwave exposure. Yeast did not survive beyond 15 seconds of microwave exposure. Swabs and gauze contaminated with bacteria or yeast were completely sterilized after 30 seconds. After three minutes in the microwave oven, powdered, prepared media was free of contamination while able to support growth when inoculated with S. aureus. CONCLUSION: We conclude that a household carousel microwave oven unit can provide fast, effective sterilization of certain contaminated materials typically used in a clinical laboratory, student laboratory, or home healthcare setting.

Bacteria↗
PubMed1999

[Development of Escherichia coli strands resistant to quinolones in stools of patients with liver cirrhosis submitted to selective bowel decontamination].

BACKGROUND: Selective intestinal decontamination (SID) with norfloxacin in patients with cirrhosis may promote the development of quinolone-resistant (QR) gram-negative bacteria in stools. It is not known wether this fact may become a predisposing factor for the development of infections due to these bacteria. MATERIAL AND METHODS: We designed a prospective study to evaluate the incidence of Escherichia coli in stools at admission in patients with cirrhosis that had previously received norfloxacin as primary or secondary prophylaxis of spontaneous bacterial peritonitis (SBP) (group I, n = 28) vs those who did not (group II, n = 55). RESULTS: QR strains of E. coli were observed in 37.5 and in 1.47% of patients from groups I and II, respectively (p < 0.001). During admission, 36 patients underwent norfloxacin prophylaxis (group III), and 40 did not (group IV). Eleven patients from group III and one patient from group IV showed QR E. coli in stools. We observed 5 bacterial infections in group III and 14 in group IV (p = 0.0039). No patient with QR E. coli in stools developed infections due to this bacteria. CONCLUSION: The incidence of QR E. coli in stools of patients with cirrhosis is significantly increased in patients previously treated with prophylactic norfloxacin. However, this fact seems not to be associated with an increment in the prevalence of QR E. coli infections.

Aged↗
PubMed2000

Sorption of fluoroacetate (compound 1080) by Colestipol, activated charcoal and anion-exchange in resins in vitro and gastrointestinal decontamination in rats.

The sorption of sodium fluoroacetate (FA) by activated charcoal (AC) and 5 anion exchange resins (AERs) was tested in 2 simulated gastrointestinal (GI) fluids. Each sorbent was incubated with FA in a shaker-water-bath at 37 C for 24 h. Supernatant was removed and filtered, and the concentration of FA was determined by gas chromatographic detection of the dichloroaniline derivative. Under simulated gastric conditions (0.1 M HCl at approximately pH 1.5), the sorbents removed the following proportions of FA from solution: Carbosorb AC, 87 +/- 2%; cholestyramine, 28 +/- 7%; colestipol, 96 +/- 0%; Amberlite IRA-96, 70 +/- 2%; DEAE-Sephadex, 7 +/- 4%; Chitosan, 66 +/- 2%. Under simulated intestinal conditions (0.05 M sodium phosphate at approximately pH 7.4), binding was as follows: Carbosorb AC, 68 +/- 4%; cholestyramine, 53 +/- 5%; colestipol, 46 +/- 2%; AmberliteIRA-96, 10 +/- 20%; DEAE-Sephadex, 64 +/- 7%; Chitosan, 5 +/- 2%. All findings differed significantly from control, with the exception of Amberlite IRA-96 and Chitosan in phosphate buffer, and DEAE-Sephadex in HCI. In a second study, rats were given 5 mg FA/kg, and then gavaged with 2 g/kg Carbosorb AC, colestipol or bentonite. Over 4 h, the area under the curve of serum FA versus time (AUC) decreased by 39% in the rats treated with colestipol and 42% in those treated with bentonite. In contrast, Carbosorb AC did not affect the AUC,yet increased Tmax In another study, mortality was assessed 96 h after rats were orally dosed with 5 mg FA/kg followed by gavage with 2 g/kg Carbosorb AC, colestipol or water immediatey or 30 min after dosing. When the sorbents were given immediately, mortality was the same as control (75%). Surprisingiy, the 30-min delay resulted in lower mortality in colestipol-treated rats, (approximately 38%) compared to 100% in the group treated with Carbosorb AC. Before any recommendation can be made regarding the use of colestipol as a GI decontaminant, the latter findings require confirmation in an intensive care setting. The potential for synergistic effects with 2 or more sorbents also warrant investigating.

Adsorption↗
PubMed2000

Efficacy of preoperative decontamination of the oral cavity.

This two-part study consisted of: (1) a survey to assess current practice patterns, and (2) an experiment designed to assess the results of varying intraoral preparations. A 48 percent response rate was obtained from the survey of the 318 active members of the American Society of Maxillofacial Surgeons. This survey demonstrated that significant controversy continues regarding the efficacy of preoperative decontamination of the oral cavity. This prospective, randomized experimental study of 30 patients (saline, 10; povidone-iodine, 10; no preparation, 10) demonstrates a significant and sustained reduction of both anaerobic and aerobic bacteria after intraoral preparation with povidone-iodine solution but not saline. The patient's age, use of preoperative intravenous cephalosporin, and type and length of procedure did not influence the postoperative bacterial counts. Although none of the patients in this study developed an infection, recommendations are provided for standardized preoperative treatment of the oral cavity.

Antibiotic Prophylaxis↗
PubMed2001

[Optimizing antibiotics policy in the Netherlands. VI. SWAB advice: no selective decontamination of intensive care patients on mechanical ventilation].

The Working Party on Antibiotic Policy (Dutch acronym is SWAB) has issued a guideline in which the pro and cons of the routine use of selective decontamination (SD) in patients in intensive care (IC) on mechanical ventilation are compared in order to decide whether SD is indicated. The effectiveness of SD in IC patients was evaluated in 28 prospective, randomized studies. In most studies a significant reduction in the incidence of pneumonia was demonstrated. The incidence of pneumonia in the control groups varied from 5 to 85%. The reduction in the incidence of pneumonia seems to have no effect on duration of mechanical ventilation and IC unit stay or the use of antibiotics. No effect on IC mortality was demonstrated. However, only major reductions could have been demonstrated with the size of the studies carried out so far. A significant reduction of about 20% was suggested in two meta-analyses. The validity of these meta-analyses is questionable. Based on the data available, it is not possible to reach the conclusion that SD will be cost-effective. The size of the studies is too small and the study duration too short to prove that the use of SD, if applied on a large scale, might not eventually lead to development of resistance. Selection of micro-organisms that are already intrinsically resistant or had already acquired resistance to one of the agents used, has been demonstrated. In the absence of clearly demonstrated advantages (decrease in mortality, reduction in the use of antibiotics, cost-effectiveness), the routine use of SD in IC patients on mechanical ventilation is not recommended.

Antibiotic Prophylaxis↗
PubMed2001

[Application of enteral detoxication and decontamination in acute ileus].

According to the experimental investigation data, conducted in 16 mongrel dogs in an acute ileus (AI), there are observed the colonization of proximal parts of small intestine (SI) by aerobic and anaerobic microorganisms, the power dependent processes of inhibition and activation of peroxidal oxidation of lipids in her mucosa, causing the disorders of her morphology. Conduction of intraoperative flowing intestinal lavage and the abdominal cavity sanation using betadin, diluted in 1:100 ratio, have promoted the pathological microorganisms quantity reduction and stimulation of power dependent processes in the SI mucosa. Application of enteral detoxication and decontamination in 86 patients with AI during performance and after the operation have permitted to reduce the intoxication severity, to restore the motor, evacuational, absorbtive function of SI, the postoperative complications frequency.

Acute Disease↗
PubMedDate not supplied

[Evolution of fecal microflora in a "heteroxenic" infant maintained in a plastic isolator and trial on decontamination by antibiotherapy (author's transl)].

This work deals with the bacteriological study of an immunodeficient infant, delivered by aseptic cesarean section, and subsequently maintained in a plastic isolator. After a short period of germfree maintenance, several strains of bacteria were fortuitously introduced into the isolator, and became established in the infants' gastrointestinal tract. The qualitative and quantitative evolution of the fecal flora of this "heteroxenic" infant was followed for 170 days. Decontamination of the gastrointestinal tract was accomplished with a mixture of antibiotics, and the conditions of maintenance of sterility under antibiotic treatment were studied.

Age Factors↗
PubMed2000

[Value of intestinal decontamination by traditional Chinese medicine-X in the prevention of bacterial translocation complicated by severe acute pancreatitis in rats].

This study was designed to evaluate the efficacy of traditional Chinese Medicine-X in preventing the necrotic infection of the pancreas in severe acute pancreatitis (SAP). Sixty rats were randomly divided into five groups with 12 rats in each one: (1) normal control, (2) SAP + 0.9% normal saline (1 ml x 100 g-1 x 24 h-1), (3) SAP + gentamycin (2000 u x 100 g-1 x 24 h-1), (4) SAP + TCM-X (1.0 g x 100 g-1 x 24 h-1), and (5) SAP + gentamycin (2000 u x 100 g-1 x 24 h-1) + TCM-X (1.0 g x 100 g-1 x 24 h-1). The medicines were given by way of gastrotube, once every 24 hours, twice in all. Pancreatitis was induced by a single intraperitoneal injection of 500 mg.100 g-1 of L-arginine. Serum endotoxin were observed and the clone forming units from mesenteric lymphnode and pancreas were obtained after 48 hours treatment. 96 hours after the experiment, the bacteria found in the mesenteric lymphnodes and pancreas in groups three, four and five were reduced as compared to that in group two; the levels of serum endotoxin were reduced, too. These data indicate that TCM-X and gentamycin in decontamination by way of gastrotube are effective in preventing bacterial translocation complicated by SAP, and the effect of TCM-X is stronger than that of gentamycin.

Acute Disease↗
PubMed2004

[Chemicals for disinfection and decontamination used and being designed for eliminating the aftermaths of biological contamination].

The efficiency of the key classes of disinfecting and decontaminating chemicals, used to eliminate a biological contamination of the human habitat, was analyzed in the paper. It is underlined that, should any biological agents with unknown properties (biological terror, military threat) be detected, it is advisable to choose the ecologically less hazardous disinfectants based on hydrogen peroxide, aldehydes and chlorine-containing compounds.

Aldehydes↗
PubMedDate not supplied

Evaluation of decontamination procedures used in primary care.

This study examined decontamination and infection control procedures in general practice. Four primary care trusts participated with a response rate of 80 per cent. The study showed evidence of poor compliance with national standards and examples of unsafe practice.

Cross Infection↗
PubMed2005

An evaluation of thermo-assisted drying and decontamination for the elimination of porcine reproductive and respiratory syndrome virus from contaminated livestock transport vehicles.

The purpose of this report is to validate a new protocol, the thermo-assisted drying and decontamination (TADD) system, for eliminating porcine reproductive and respiratory syndrome virus (PRRSV) from contaminated transport vehicles. Scale models of weaned pig trailers were used. The principle of TADD is to raise the interior temperature of trailers to 71 degrees C for 30 min to promote drying and degradation of PRRSV. Trailer interiors were artificially contaminated with 5 x 10(5) TCID50 of PRRSV strain MN 30-100, then treated with 1 of 4 treatments: 1) TADD; 2) air only (no supplemental heat); 3) overnight (8 h) drying; and 4) washing only. Following treatment, swabs were collected from the trailer interiors at 0, 10, 20, and 30 min post-treatment and from the overnight group after 8 h. Swabs were tested for PRRSV-RNA by polymerase chain reaction (PCR). As a measure of the presence of infectious PRRSV, sentinel pigs were housed in treated trailers for 2 h post-treatment and supernatants from swabs were injected IM into naive pigs (bioassay), the recipient pigs were then tested for PRRSV infection. All trailers were PRRSV positive by PCR immediately after washing, prior to treatment (pt). At 10 min pt, 7/10 swabs were positive from the TADD trailers; however, all swabs collected at 20 and 30 min pt were PRRSV negative by PCR, and trailer interiors were visibly dry. In contrast, 9/19, 6/10, and 6/10 swabs collected at 10, 20, and 30 min, respectively, from trailers treated with air only were positive and visibly wet. All swabs (10/10) collected from trailers treated with washing only were PRRSV positive by PCR and all swabs collected at 8 h of drying were PRRSV negative by PCR. All tests for the presence of infectious PRRSV were negative for trailers treated with TADD and overnight drying, while infectious PRRSV was detected in sentinel pigs and bioassay pigs in the other groups. Under the conditions of this study, the efficacy of the TADD system was equal to that of the overnight drying treatment, and it required a shorter period of time to complete its objective.

Animals↗
PubMed1992

Prevention of infection in burns: preliminary experience with selective decontamination of the digestive tract in patients with extensive injuries.

Evidence from studies of trauma patients suggests that selective decontamination of the digestive tract (SDD) might also be of value in preventing colonization and infection by enteric organisms in burn patients. In a retrospective study, 31 consecutive patients with burns of greater than 30% of total body surface area, admitted over a 2-year period, who were treated with an SDD regimen, were compared with a similar group of 33 consecutive patients admitted in the 2 years immediately preceding the introduction of SDD. Fewer SDD-treated patients developed wound colonization with Pseudomonas species (29% vs. 61%), or with Enterobacteriaceae (10% vs. 73%). Similar reductions in colonization with gram-negative organisms were found in urine and gastric aspirates. There were fewer respiratory infections in the SDD group (6.5% vs. 27.3%), and only one patient developed septicemia, compared with eight in the control group (3.2% vs. 24.2%). Fewer SDD-treated patients died (one death, compared with seven in the non-SDD group). These results suggest that SDD may be of value in the management of patients with severe burn injuries, but further studies are required to test the validity of this conclusion.

Adolescent↗
PubMed1991

Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit.

To evaluate the use of selective decontamination of the digestive tract (SDD) (polymyxin, amphotericin, tobramycin, and intravenous cefotaxime) in a mixed intensive care unit, we performed a stratified, randomized, prospective study. The 331 patients were recruited over an 18-month period, with 256 patients remaining more than 48 hours. Stratification by acute physiology and chronic health evaluation (APACHE II) preceded randomization to control (standard antibiotic therapy) or treatment (SDD) groups. Nosocomial infection was significantly reduced in the SDD group (16.7%; 21 of 126 patients) compared with the control group (30.8%; 40 of 130 patients; p = 0.008). No difference was found in overall mortality rate or length of stay between the two groups. Those patients with admission APACHE II scores 10 to 19 demonstrated the most significant reduction in nosocomial infection (23 of 70 control vs 13 of 76 SDD; p = 0.03) and mortality (15 of 70 control vs 8 of 76 SDD; p = 0.07). Emergence of multiresistant microorganisms was not a clinical problem, but a definite change occurred in the ecology of environmental and colonizing bacteria. With the exception of cefotaxime, a reduction was noted in systemic antibiotic usage in the SDD group. We conclude that SDD is useful in selected patients in a mixed intensive care unit.

Adolescent↗
PubMed2006

Bacterial decontamination of DUWL biofilm using Oxygenal 6.

The aim of this study was bacteriological assessment of the dental unit waterlines (DUWL) biofilm - concentration and composition of the aerobe and facultative anaerobe bacterial microflora, and evaluation of the influence of a disinfecting product, Oxygenal 6, on the biofilm composition. Tubing fragments were taken from 25 units twice, before and after disinfection, and bacterial suspension of the biofilm was obtained from the samples. The bacterial flora was determined with the plate culture method. Bacteria were identified with biochemical microtests: API 20E, API 20NE (bioMerieux, France) and GP2 MicroPlate(TM) (BIOLOG, USA). Before disinfection, the following bacteria were identified: Gram-negative bacteria - Ralstonia pickettii, Pseudomonas vesicularis, Sphingomonas paucimobilis, Xanthomonas maltophilia; Gram-positive cocci - Micrococcus luteus, Micrococcus lylae, Staphylococcus cohnii, Staphylococcus lentus, Staphylococcus spp., Streptococcus spp.; Actinomycetes - Streptomyces albus. The prevailing bacteria were: Ralstonia pickettii (78.62%), found in all the units, and Sphingomonas paucimobilis (20.45%). After DUWL disinfection, Sphingomonas paucimobilis (88.79%) dominated in the biofilm, Staphylococcus spp. - 5.61% and Pseudomonas spp. - 3.74% were next most frequently occurring bacteria, and in more than a half of the biofilm samples 100% reduction of the bacterial microflora occurred. This study confirms effectiveness of Oxygenal 6 in bacterial decontamination of the DUWL biofilm.

Anti-Bacterial Agents↗
PubMed1991

[Laboratory studies of Salmonella decontamination in bone meal using propionic acid].

Laboratory investigations centered on determining the concentration and time of influence of propionic acid to decontaminate salmonella in bone meal as well as on the inhibitory effect of reanimation and recontamination. Tests have been conducted by means of contaminated bone meal charges either naturally or artificially stressed. Findings revealed, that freedom of salmonella could be achieved ranging between one hour and 21 days when adding 3% of propionic acid to the bone meal dependent on the stress of salmonella. Evidence could be proved to the inhibitory effect of reanimation of propionic acid at least one week after the entry of action. Protection of the bone meal treated with 3% of propionic acid against new contamination of salmonella has proved to be independent of the rate of recontamination. Freedom of salmonella lasting for two or three weeks could be stated after a holding time of one day.

Animal Feed↗
PubMed1991

[Prevention of septicemia caused by gastrointestinal tract organisms in patients with granulopenia. Comparison of three gastrointestinal tract decontamination treatments].

Three gastrointestinal tract decontamination regimens were tested in patients with granulopenia: vancomycin 250 mg, tobramycin 75 mg, and colistin 1 million international units (regimen A); vancomycin 125 mg, tobramycin 75 mg, and colistin 1 million IU (regimen B); and colistin 1 million IU (regimen C); nystatin was added to all three regimens. Effectiveness was evaluated by stool organism counts and blood cultures to detect bacterial translocation (passage of bacteria from the intestinal tract to the bloodstream). Regimen C proved insufficiently effective. Regimen A was found to be poorly tolerated by the digestive mucosa. Regimen B was the best treatment since the low dosage of vancomycin proved effective. Nystatin satisfactorily eliminated yeasts.

Agranulocytosis↗
PubMedDate not supplied

Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial.

Secondary pneumonia in patients requiring mechanical ventilation has a high morbidity and mortality. Diagnosis is difficult and treatment failure common; therefore, preventive measures are important. In a double-blind, placebo-controlled trial, we evaluated selective decontamination of the oropharynx with polymyxin B sulfate, neomycin sulfate, and vancomycin hydrochloride (PNV) in 52 patients requiring mechanical ventilation during a 3- to 34-day period (mean, 10 days). Either PNV or placebo was administered six times daily in the oropharynx. During the first 12 days of intubation, tracheobronchial colonization by gram-negative bacteria and Staphylococcus aureus, as well as pneumonia, occurred less frequently in the PNV than in the placebo group (16% vs 78%; P less than .0001). Hospital mortality was not different, but systemic antibiotics were prescribed less often in the PNV group and no resistant microorganism emerged. In these critically ill patients, topical oropharyngeal antibiotic application lowered the rate of ventilator-associated pneumonia by a factor of 5, probably by interrupting the stomach-to-trachea route of infection, and decreased the requirement for intravenous antibiotics.

Adult↗