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PubMed2006

Meta-analysis of preoperative antiseptic bathing in the prevention of surgical site infection.

BACKGROUND: Preoperative bathing with an antiseptic solution is widely used to prevent surgical site infection, but trial results are conflicting. METHODS: Trials were identified by searches of Medline, Embase and the Cochrane controlled trials register. Studies were eligible if they compared an antiseptic solution used in preoperative bathing with a non-antiseptic washing agent or with no bathing and if they reported data on surgical site infection. RESULTS: Six trials with a total of 10 007 patients were included; all of them used 4 per cent chlorhexidine gluconate. Three trials with 7691 patients compared chlorhexidine with placebo. Bathing with chlorhexidine did not reduce surgical site infection rate; the relative risk (RR) was 0.91. Including only trials of high quality, the RR was 0.95. Three trials with 1443 patients compared bar soap with chlorhexidine; no differences in the surgical site infection rates were detected, and the RR was 1.02. Two trials of 1092 patients compared bathing with chlorhexidine with no washing. The surgical site wound infection rate in the two groups was similar, and the RR was 0.70. CONCLUSIONS: The evidence does not support preoperative bathing with chlorhexidine as a means of reducing surgical site wound infection.

Anti-Infective Agents, Local↗
PubMed1992

In vitro antibacterial activity of antiseptics against vaginal lactobacilli.

The results of investigations carried out to evaluate the inhibitory activity in vitro of seven vaginal antiseptic douche solutions against several strains of vaginal lactobacilli isolated from asymptomatic women are reported. Some of the products examined showed marked antibacterial activity even at high dilutions and for short exposure times. The post-antibiotic effect of two of these antiseptics on vaginal lactobacilli was also evaluated. The results of these investigations suggest that uncontrolled use of antiseptic products could cause changes in the normal vaginal flora.

Anti-Infective Agents, Local↗
PubMed2000

Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients.

OBJECTIVES: To document in intensive care unit (ICU) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections. DESIGN: Single-blind randomized comparative study. SETTING: A 16-bed adult intensive care unit in a university hospital. PATIENTS: Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation. INTERVENTIONS: After randomization, the treated group received dental plaque decontamination with 0.2% chlorhexidine gel, three times a day during the ICU stay. The control group received standard oral care. SPECIFIC MEASUREMENTS: Dental status was assessed by the Caries-Absent-Occluded index; the amount of dental plaque was assessed by a semi-quantitative plaque index. Bacterial sampling of dental plaque, nasal and tracheal aspirate, blood, and urine cultures were done on days 0, 5, 10, and every week. MAIN RESULTS: Sixty patients were included; 30 in the treated group and 30 in the control one (mean age: 51 +/- 16 years; mean Simplified Acute Physiological Score II: 35 +/- 14 points). On admission, no significant differences were found between both groups for all clinical and dental data. Compared with the control group, the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group (18 vs 33% days in the ICU and 10.7 vs 32.3% days of mechanical ventilation; P < 0.05). These results were consistent with a significant preventive effect of the antiseptic decontamination (Odds Ratio: 0.27; 95% CI: 0.09; 0.80) with a 53% relative risk reduction. There was a trend to a reduction of mortality, length of stay, and duration of mechanical ventilation. CONCLUSIONS: An antiseptic decontamination of dental plaque with a 0.2% chlorhexidine gel decreases dental bacterial colonization, and may reduce the incidence of nosocomial infections in ICU patients submitted to mechanical ventilation.

Adult↗
PubMed2004

[Polyhexamethylbiguanid (PHMB) as preoperative antiseptic for cataract surgery].

BACKGROUND: We examined the efficacy and tolerability of Lavasept (polyhexamethylenbiguanid or PHMB)-an iodine-free antiseptic-in comparison to polyvinylpyrolidon iodine and Ringer's solution, as an alternative preoperative antiseptic. PATIENTS AND METHODS: In a randomized controlled double-blind trial 3 drops of Lavasept, 1.25%, PVP-iodine or Ringer's solution were applied preoperatively in 29 patients. The number of colony forming units (cfu) grown from conjunctival smears and conjunctival hyperaemia, corneal epitheliopathy and ocular surface pain were assessed preoperatively, intraoperatively and 1 day postoperatively. RESULTS: Despite intraoperative application of PVP-iodine, 40% of patients receiving Ringers solution still presented with more than 5 colony forming units (cfu) at the end of the procedure, while all patients that had additional preoperative Lavasept or PVP-iodine achieved relative sterility with less than 5 cfu (p < 0.05). While the effect of Lavasept lasted until the next day, conjunctival microbial colonisation recurred in eyes treated with PVP-iodine. As expected conjunctival hyperaemia and corneal epitheliopathy increased significantly postoperatively but no differences were observed between the 3 solutions tested. CONCLUSION: The preoperative application of Lavasept reduces the conjunctival flora safely and effectively. The microbicidal efficacy is equal to PVP-iodine, but potentially longer lasting. No signs of local or systemic intolerability were observed. Lavasept may be used as a potential alternative preoperative antiseptic and is suitable for iodine-intolerant patients.

Adult↗
PubMed1986

Antiseptic toxicity in wounds healing by secondary intention.

The effects of two commonly used antiseptics for chronic ulcer care, chloramine T and chlorhexidine, on the biochemical and histological parameters of healing have been examined. The antiseptics were compared with saline when applied to 10 mm skin defects on Sprague-Dawley rats. Chloramine T significantly delayed the production of collagen and prolonged the acute inflammatory response compared with saline. Chlorhexidine did not differ from saline. We conclude that hypochlorite antiseptics may adversely affect healing by secondary intention and the antibacterial and desloughing action of agents should be carefully balanced against their toxic effect.

Animals↗
PubMed1991

Laboratory and in-vitro testing of skin antiseptics: a prediction for in-vivo activity?

Bacteria-laden skin squames, detached bacterial clumps and isolated bacteria floating in skin fluids are the major infective units in hand and skin transmission of microorganisms. These units have differing ability to colonize new surfaces and may have different susceptibility to antiseptics. MIC-MBC testing on isolated bacteria serves to confirm the expected susceptibility of particular isolates and is useful for surveillance of the evolution of antiseptic resistance; however, it is often unreliable in predicting the in-vivo effect. In-vitro tests aimed at duplicating natural conditions (including the effect of antiseptics on bacterial biofilms, or better, on the different infective units) are under evaluation. Meanwhile, tests involving natural skin surfaces, like the Story test, offer reproducible and useful data.

Anti-Infective Agents, Local↗
PubMed1991

Assay of antiseptic agents in cell culture: conditions affecting cytotoxicity.

In-vivo studies suggest that chlorine-releasing antiseptic agents inhibit wound healing. Studies which have used cell culture systems to evaluate cytotoxicity have generated conflicting results for the toxicity of free-chlorine agents relative to other antiseptics. Here we examine the following three factors which may influence the toxicity of individual agents within a cell culture assay: (1) cell number; (2) duration of exposure; and (3) the nature of the antiseptic diluent. Three agents (sodium hypochlorite, chlorhexidine and hydrogen peroxide) were tested on transformed human keratinocytes (SVK 14 cells). It was found that increasing cell number, and using serum or medium as a diluent, reduced the toxicity of all agents but had the greatest effect on sodium hypochlorite. In contrast, increasing the duration of exposure increased the toxicity of all agents but had the greatest effect on hydrogen peroxide. These observations may explain the high toxicity of hydrogen peroxide and relatively low toxicity of sodium hypochlorite which have been observed in vitro and are the reverse of in-vivo findings. Culture systems in which high cell numbers are coupled with an agent diluted in serum or medium, and a long exposure time, seem likely to decrease the toxicity of chlorine-releasing agents relative to hydrogen peroxide.

Cell Count↗
PubMed1992

Cytotoxicity evaluation of antiseptics and antibiotics on cultured human fibroblasts and keratinocytes.

Infection is the greatest problem in burn patients and topical antimicrobial agents must be chosen with great care, especially when cultured skin is grafted. We examined the cytotoxic effect of six antiseptics and six antibiotics commonly used on cultured human fibroblasts and keratinocytes. Cultured cells were exposed for 15 min to Hibitane (chlorhexidine), Biseptine (chlorhexidine+benzalkonium chloride+benzylic alcohol), Benzalkonium Chloride, Yellow Betadine (polyvidone-iodine+nonoxinol), Betadine Scrub (polyvidone-iodine+quaternary ammonium) and Green Betadine (polyvidone-iodine) and viability was determined using the MTT test. At therapeutic concentrations all the antiseptics are cytotoxic for fibroblasts and keratinocytes. Additionally the cells were exposed for 48 h to vancomycin, colistin, amikacin, imipeneme, pefloxaxin, piperacillin and cell viability was determined using the MTT test. The concentrations of antibiotics corresponding to the plasma peak obtained after therapeutic application were not cytotoxic to the tested cells. The CD50 was much higher than the MIC (from 125 to 875 times for keratinocytes and from 1400 to 5900 times for fibroblasts). These data suggest that commonly applied antiseptics must not be used before grafting cultured skin grafts. After grafting any infection can be controlled with topical applications of appropriate antibiotics.

Anti-Bacterial Agents↗
PubMed1992

High-level resistance to ethidium bromide and antiseptics in Staphylococcus aureus.

A gene encoding high-level resistance to ethidium bromide (EB) and antiseptics was isolated from a transferable plasmid, pTZ22, in Staphylococcus aureus. DNA sequencing revealed that the plasmid has two copies of the ebr gene that normally mediates low-level resistance to EB and antiseptics. The efflux rate for EB of strains with duplicated ebr genes was twice the rate of strains with a single ebr gene. It was concluded that the duplication of ebr is responsible for the high-level resistance to EB and antiseptics.

Amino Acid Sequence↗
PubMed2003

[Critical review of the literature concerning the comparative use of two antiseptic solutions before intravascular or epidural catheterization].

OBJECTIVES: To analyze the most pertinent data from the literature concerning the use of an antiseptic solution before the elaboration of invasive procedures such as blood cultures, insertion of peripheral or central intravenous catheters, and arterial or epidural catheters, and to identify, if any, the "ideal" antiseptic or, at least, the most efficient. DATA SOURCES: Review of the literature. Data collected from the Medline database concerning experimental, clinical and basic research studies published between 1966 and 2003 and a manual research of references of relevant papers. RESULTS: After a brief historic and pharmacological reminder, the results of experimental and clinical studies are presented. Concerning the clinical studies, they concerned almost exclusively iodine products and chlorhexidine. These comparative studies are classified according to the punction site and the antiseptic solution used. CONCLUSION: Even if the in vitro studies favor iodine products, chlorhexidine in alcoholic solution seems more efficient than povidone iodine in aqueous solution in the clinical setting. Several explanations are suggested to understand the in vitro/in vivo discordances. The place of povidone iodine in alcoholic solution, whose performances on the healthy skin are similar to those of alcoholic chlorhexidine, is being in evaluation.

Alcohols↗
PubMed2004

Comparison of two in vivo and two ex vivo tests to assess the antibacterial activity of several antiseptics.

An ex vivo test was adapted to mimic the in vivo conditions of testing antiseptic activity on human forearms and in the European Standard Hygienic Handwash Test (BSEN 1499). The study was to validate the ex vivo protocols using 4.8% (w/v) para-chloro-meta-xylenol (PCMX, neat Dettol), 0.5% (w/v) triclosan in 70% (v/v) isopropanol, and 2% (v/v) povidone-iodine against a high bacterial inoculum (>10(8) cfu/mL) of Escherichia coli NCTC 10538. Two ex vivo tests using human skin samples, including one introducing a mechanical rubbing effect, were compared with two corresponding in vivo tests (the forearm test and the BSEN handwashing test). All antiseptics assessed in vivo (forearm and handwash tests) produced reductions in bacterial counts that were significantly greater than those for the non-medicated soft soap control. When assessed ex vivo without rubbing, only PCMX and povidone-iodine achieved reductions significantly greater than soft soap. When assessed ex vivo with mechanical rubbing, only PCMX and triclosan achieved reductions significantly greater than soft soap. Overall, the antiseptics at the concentrations tested were more active when tested in vivo than ex vivo. The addition of a mechanical effect, either in vivo by the volunteers washing their hands or ex vivo by a drill rubbing two skin samples against each other, produced a significantly greater reduction in bacterial concentrations. The ex vivo tests were easily adapted to mimic in vivo protocols. The value of such tests, particularly the one that includes a rubbing effect, may be significant as they avoid the need for human volunteers.

Adolescent↗
PubMed1989

Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants.

The thyroid function of very-low-birthweight (VLBW; below 1500 g) infants admitted to neonatal intensive-care units was studied at two hospitals; one routinely used topical iodinated antiseptic agents and the other used chlorhexidine-containing antiseptics. Serial monitoring of urinary iodine excretion and serum thyrotropin and thyroxine levels was undertaken from birth for the first 4 weeks of life. Urinary iodine excretion rose dramatically in the 54 iodine-exposed infants and was up to fifty times greater than in the 29 non-exposed infants. Within 14 days, 25% (9 of 36) of the infants exposed to iodine had serum thyrotropin levels above 20 mIU/l, compared with none of the control group. The mean serum thyroxine level in these 9 infants (44.1 nmol/l) was significantly lower than that in exposed infants with normal thyrotropin levels (83.1 nmol/l) and in the non-exposed control group (83.0 nmol/l); thyroxine levels fell before serum thyrotropin rose. These disturbances in thyroid function correlated positively with urinary iodine excretion and hence iodine absorption. Thyroid function had returned to normal by the time of discharge from hospital. It is concluded that iodine absorption, from topical iodine-containing antiseptics, may cause hypothyroidism during a critical period of neurological development in the newborn infant. The routine use of iodine antisepsis in VLBW infants should be avoided because of this effect.

Administration, Topical↗
PubMed2003

A standardized test to assess the impact of different organic challenges on the antimicrobial activity of antiseptics.

This paper presents a suggestion for determining the antimicrobial efficacy of antiseptics in a phase 2/step 1 assay. Emphasis is placed on specific organic challenges to evaluate the efficacy of antiseptics used to rinse the oral cavity, mucous membranes, or wounds for either prophylactic or therapeutic reasons. Basic data are given concerning ready-to-use products based on Poly(1-vinyl-2-pyrrolidone-)iodine-complex (PVP-iodine), chlorhexidine, octenidine, or cetylpyridinium chloride. Hydrogen peroxide (3.0%) was included to assess a product with known limited efficacy only. Using Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Enterococcus faecium, and Candida albicans, a 10(5)-fold reduction can be achieved in 10 min without interfering substances. In the presence of 10% albumin, 10% sheep blood, or 1% mucin, a 10(3)-fold reduction is yielded using products based on PVP-iodine, octenidine, or chlorhexidine. The combination of 4.5% albumin, 4.5% sheep blood, and 1% mucin was the most difficult organic challenge and only the products based on PVP-iodine, octenidine, or chlorhexidine remained active. The cetylpyridinium-based product and hydrogen peroxide were less effective. Based on these data, a proposal for a phase 2/step 1 assay for antiseptics is presented to promote the standardization efforts.

Albumins↗
PubMed2003

Determination of hydrogen peroxide concentration in antiseptic solutions using portable near-infrared system.

Hydrogen peroxide (H2O2) concentrations in antiseptic solutions (normally 3% H2O2) has been determined non-destructively using a portable near-infrared (NIR) analyzer. The spectral variation due to -OH band around 1400 nm in the second derivative spectra has been found as H2O2 concentration changes. Both multiple linear regression (MLR) and partial least squares (PLS) were employed to generate calibration models over the 1100-1720 nm range. The PLS calibration model showed the better calibration performance with a standard error of prediction (SEP) of 0.16%. In order to validate the developed PLS calibration model, H2O2 concentrations in commercial antiseptic solutions were predicted and compared with values from a conventional redox titration method. The results showed that NIR predictions had good correlation with conventional analysis values. The rapid and non-destructive determination of H2O2 in the antiseptic solution was successfully performed using portable NIR analyzer without any hazardous chemical solvents.

Anti-Infective Agents, Local↗
PubMed1999

[Antiseptic treatment of the umbilical cord in newborns: survey and recommendations].

AIM: To determine whether umbilical cord care of the neonate is in accordance with the guidelines of antiseptic treatment at this age of life. MATERIAL AND METHODS: A survey was conducted during the 3rd trimester of 1996 in 57 maternity units and departments of neonatalogy in the region of Provence-Alpes-Côte d'Azur (south of France). A questionnaire was sent to the head of each unit asking the modalities of disinfection of the umbilical cord. RESULTS: Fifty units answered the questionnaire. Six different groups of antiseptic products were used, corresponding to 17 distinct commercial preparations. The simultaneous association of several products (two or three) was done in 70% of cases. Eosin was the most frequently used (60%), in association with 25 units. Alcohol was used in 28 centers (56%). It was associated 22 times. Chlorhexidine was used in 16 units (32%), twice alone, and with another topic 14 times. The commercial association chlorhexidine-benzalkonium chloride (Biseptine) was reported seven times (six times in association with another topical treatment). Ektogan (a powder of Zn and Mg peroxide and Zn oxide) was used in ten centers, always in association. Hexamidine was used in four units, once in association. Silver nitrate, Milian solution, iodinated alcohol, and povidone iodine were respectively used once. CONCLUSION: This survey shows that a great variety of umbilical cord care modalities is used in this region, and that the recommendations for antiseptic treatment in young babies, are not always respected. According to these, eosin, ethanol, Ektogan and iodine should not be used for this purpose. Although chlorhexidine has been proven to be the most suitable disinfectant, it comes only in third place, used in association in 95% of the cases. Several studies in neonates have shown that it is well tolerated and efficient even if it delays cord separation. This study should lead to interdisciplinary consensual guidelines for umbilical cord care.

Anti-Infective Agents, Local↗
PubMed2000

Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels.

BACKGROUND: Clinical studies in which antimicrobial mouthrinses were shown to have significant antiplaque activity most frequently have used gingivitis as the clinically relevant endpoint. However, there is evidence to suggest that mouthrinses containing active agents effective against Streptococcus mutans, such as chlorhexidine, may also have a role in inhibiting dental caries. This clinical study was conducted to determine the effect of 2x-daily rinsing with an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic) on levels of recoverable S. mutans and total streptococci in supragingival interproximal plaque and in saliva. Additionally, a follow-up in vitro study is reported which determined whether a differential susceptibility to the antiseptic mouthrinse exists among different strains of streptococci. METHOD: Following baseline saliva and plaque sampling for quantification of recoverable S. mutans and total streptococci, 29 qualifying subjects were randomly assigned either the essential oil mouthrinse or a sterile water control. They rinsed with 20 ml for 30s 2 x daily for 11 days and once on the 12th day, in addition to their usual oral hygiene procedures. On day 12, saliva and plaque samples were again collected and microbiological quantification performed. The procedures were repeated with the alternate rinse after a 1-week washout period. RESULTS: The essential oil mouthrinse produced respective reductions of 69.9% and 75.4% in total recoverable streptococci and in S. mutans in plaque, and corresponding reductions of 50.8% and 39.2% in saliva. The in vitro study revealed that streptococci from the mutans group were more susceptible to the bactericidal activity of the essential oil mouthrinse than streptococci from the mitis group. CONCLUSIONS: As antimicrobial mouthrinses are most frequently recommended to patients whose mechanical oral hygiene procedures are not adequate for the control of supragingival plaque and gingivitis, this study provides an additional rationale for the inclusion of the essential-oil mouthrinse as an adjunct to daily oral hygiene procedures.

Adult↗
PubMed2003

Comparison of antiadhesive and antibacterial effects of antiseptics on Streptococcus sanguinis.

Three antiseptic (chlorhexidine, Olaflur, Octenisept) and one putative antiadhesive (chitosan) agent were investigated for their effect on viable planktonic and attached Streptococcus sanguinis cells. The bacterial pretreatment with each chemotherapeutic was performed in two steps: (i) After the exposure of planktonic streptococci to the antiseptics, the cells were suspended in human sterile saliva and allowed to attach to human enamel for 60 min; (ii) After 60 min in the flow chamber system, initially attached streptococci were treated with these agents. The microbial viability was monitored by the percentage of vital streptococci determined by fluorescence microscopy and cell reproduction. In comparison with the negative control NaCl, the non-bactericidal chitosan derivative showed distinctive antiadhesive properties. For both treatment procedures, the efficacy of the antiseptics in reducing the viability of planktonic and attached streptococci was Octenisept > Olaflur > chlorhexidine > saline > chitosan. Further studies appear warranted to develop new antiplaque/antibiofilm strategies involving highly efficient bactericidals with antiadhesive formulations.

Anti-Infective Agents, Local↗
PubMed1981

Antiseptic and antibiotic resistance in gram-negative bacteria causing urinary tract infection in spinal cord injured patients.

Fifty-seven isolates of Gram-negative bacterial species from urinary tract infections in spinal cord injured patients were tested for their sensitivity to chlorhexidine, cetrimide, glutaraldehyde, phenyl mercuric nitrate (PMN), a phenolic disinfectant (Hycolin) and a proprietary antiseptic containing a mixture of picloxydine, octylphenoxypolyethoxyethanol and benzalkonium chloride (Resiguard). None of the isolates were resistant to glutaraldehyde, Hycolin or PMN but a substantial percentage were resistant to chlorhexidine (44 per cent), cetrimide (26 per cent) and Resiguard (42 per cent). The resistant organisms were members of the genera Proteus, Providencia and Pseudomonas and they were also generally resistant to five, six or seven antibiotics. Significant correlations were observed between multiplicity of antibiotic resistance and the minimum inhibitory concentrations of the three cationic antiseptics. It is suggested that an antiseptic policy for the bladder management of spinal cord injured patients that relies on the extensive use of cationic agents might lead to the selection of a flora of notoriously drug-resistant species.

Anti-Bacterial Agents↗