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PubMed1999

Antiseptic-bonded central venous catheters and bacterial colonisation.

This study was undertaken to evaluate the impact of chlorhexidine/silver sulphadiazine-bonded catheters on the incidence of colonisation and catheter-related sepsis in critically ill patients. Threehundred and fifty-one catheters were inserted into 228 patients during the study period, 174chlorhexidine/silver sulphadiazine-bonded catheters and 177 standard catheters. Indications for catheter removal were: death, clinical redundancy and clinical evidence of local or systemic infection. All catheter tips were sent to the microbiology laboratory for semiquantitative analysis of bacterial colony count. Seventy-one (40.2%) of the standard catheters and 47 (27.2%) of the antiseptic-bonded catheters were found to be colonised on removal (p < 0.01). Eight cases (4.7%) of catheter-related sepsis were associated with standard catheters and three cases (1.7%) with antiseptic-bonded catheters, however, this reduction was not statistically significant. Our results indicate that the use of antiseptic-bonded catheters in critically ill patients significantly reduces the incidence of bacterial colonisation.

Adult↗
PubMed2001

A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood.

Epistaxis is common in children. Trials show antiseptic cream is as effective as cautery, but it is not known whether either is better than no treatment. We wished to know the efficacy of cream in children with recurrent epistaxis. The design was a single-blind, prospective, randomized controlled trial set in the Otolaryngology clinic in a children's hospital. The participants were 103 children referred by their general practitioner for recurrent epistaxis. Excluded were those with suspected tumours, bleeding disorders or allergies to constituents of the cream. Referral letters were randomized to treatment and no treatment groups. Treatment was antiseptic cream to the nose twice daily for 4 weeks, which was prescribed by the general practitioner before clinic attendance. All children were given an appointment for 8 weeks after randomization. The main outcome measures were the proportion of children in each group with no epistaxis in the 4 weeks preceding clinic review. Complete data were available for 88 (85%) of the children. Of the treatment group, 26/47 (55%) had no epistaxis in the 4 weeks before the clinic appointment. Of the controls, 12/41 (29%) had no epistaxis over the 4 weeks. This is a relative risk reduction of 47% for persistent bleeding (95% CI 9-69%) and an absolute risk reduction of 26% (95% CI 12-40%), giving a number needed to treat of 3.8 (95% CI 2.5-8.5). We conclude that antiseptic cream is an effective treatment for recurrent epistaxis in children.

Administration, Topical↗
PubMed2002

Allergic contact dermatitis from mercury antiseptics and derivatives: study protocol of tolerance to intramuscular injections of thimerosal.

BACKGROUND: Mercury derivatives are frequent contact allergens and their cross-reactivity is not constant. Thimerosal is an organic mercurial used as an antiseptic and as a preservative in most vaccines. OBJECTIVE: To evaluate cross-reactivity, exposure factors, and tolerance to vaccines containing thimerosal in patients sensitized to mercury derivatives. METHODS DESIGN: Observational study (cross-sectional); PATIENTS: 125 patients were recruited for the study, 72 women and girls and 53 boys and men, average age 18.7 years old, range 3 to 65, with positive patch tests to mercury derivatives and/or thimerosal; INTERVENTIONS: All patients were studied by means of enquiry, patch tests, intradermal tests, and intramuscular challenge with thimerosal. RESULTS: A sensitization to thimerosal was observed in 57 patients. Twenty-four of these 125 patients presented a positive intradermal reaction. Ammoniated mercury seems to be a good marker of mercury sensitization eliciting positive reaction in 78% of all patients and merbromin in 66%. In most cases, (100/125) cross-reactivity was found among mercury derivatives. The intramuscular injection of thimerosal induced a mild local reaction in only 5 patients (4% of the total, 9% of thimerosal positive reactions). Childhood vaccinations, merbromin used as an antiseptic, broken thermometers, and the use of drops were the main sources of exposure. CONCLUSIONS: The majority of the patients showed positive tests to both organic and inorganic mercury derivatives. Vaccination with thimerosal is relatively safe, even for individuals with delayed type hypersensitivity to this chemical, since more than 90% of allergic patients tolerated intramuscular challenge tests with thimerosal. A simplified protocol of patch tests to study mercury derivatives is proposed. It would be advisable to restrict the use of mercurial antiseptics and mercury thermometers.

Adolescent↗
PubMed1989

The use of antiseptics for handwashing by medical personnel.

Numerous studies have shown that the major reservoir of nosocomial infection in the hospital is the infected or colonised patient and the major mode of spread of organisms between patients is on the hands of medical personnel. A prolonged preoperative scrub with an antiseptic is one of the most time-honoured rituals of surgical asepsis. Hygienic handwashing in the hospital or clinic, to remove transient contaminants acquired from patients or the environment and prevent cross-infection to vulnerable patients, is similarly regarded as one of the most fundamental infection control measures, yet is done infrequently by personnel in most hospitals. Following a typical brief (7.10 second) handwashing with a nonmedicated soap, the number of organisms that can be transmitted from the person's hands may, paradoxically, actually increase. Use of chlorhexidine for handwashing or application of an evaporative alcohol-based lotion has been found to reduce shedding of bacteria-laden skin squames. Routine use of antiseptic-containing handwashing agents is clearly more effective than nonmedicated soaps for microbial removal, can enhance the value of the handwashings that are done and might further confer protection against contaminants acquired between handwashings. In a sequential comparative trial of three handwashing agents in a surgical intensive care unit--a nonmedicated soap, 10% povidone-iodine solution, and 4% aqueous chlorhexidine, each used exclusively for approximately six weeks--the incidence of nosocomial infection was 50% lower during the use of the antiseptic handwashing products than during the use of nonmedicated soap (P less than .001). Novel approaches are needed to improve the frequency of hygienic handwashing.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents, Local↗
PubMed2001

In vitro evaluation of the risk of developing bacterial resistance to antiseptics and antibiotics used in medical devices.

The risk of development of resistance in Staphylococcus epidermidis to the antibiotics and antiseptics impregnated in central venous catheters was evaluated. The culture was passaged 10-20 times through subinhibitory concentrations of different antimicrobials, singly and in combination, and the MIC of each antimicrobial before and after passage was compared. There was a 10- to 16-fold increase in the MIC of the combination of minocycline and rifampicin, while no significant increase in the MIC of minocycline alone was seen. The MIC of rifampicin was 25,000-fold higher against strains passaged through rifampicin alone (as compared with that for the original strain), while the increase was only 80-fold when it was combined with minocycline for passage. There was no substantial change in susceptibility to the antiseptic chlorhexidine when used alone or in combination with either silver sulphadiazine or triclosan (the MIC of triclosan alone increased eight-fold). In time-kill studies, synergy was observed between chlorhexidine and both triclosan and silver sulphadiazine. Zone of inhibition tests of catheters impregnated with minocycline and rifampicin showed that their activity against rifampicin-resistant strains was lower than that against the susceptible strain. On the other hand, the activity of the antiseptic (chlorhexidine and silver sulphadiazine) catheters against the rifampicin-resistant and -susceptible strains was similar. Although this study indicates that antibiotic catheters may be at a higher risk of being colonized by antibiotic-resistant bacteria, the implications of these results in clinical settings need to be determined.

Anti-Bacterial Agents↗
PubMed1997

Thyroid function in infants following cardiac surgery: comparative effects of iodinated and noniodinated topical antiseptics.

OBJECTIVES: Cardiopulmonary bypass has profound effects on thyroid hormone metabolism. These effects may be exacerbated in infants because they are able to absorb large quantities of iodine transcutaneously. The purpose of this study was to test the hypothesis that preoperative povidone-iodine contributes to postoperative thyroid depression in infants who undergo cardiac surgery. DESIGN: Prospective, randomized, controlled trial. SETTING: Children's Hospital and Medical Center, Seattle, WA. PATIENTS: Thirty-seven infants undergoing repair of congenital cardiac defects. INTERVENTIONS: Infants requiring cardiopulmonary bypass were divided into two groups: Group 1 received povidone-iodine; group 2 received chlorhexidine as a topical preoperative antiseptic. Group 3 did not require cardiopulmonary bypass for repair of cardiac defects and received povidone-iodine as a preoperative antiseptic. MEASUREMENTS AND MAIN RESULTS: Thyrotropin (TSH), total triiodothyronine (T3), and thyroxine (T4) were measured at four intervals: a) before preparation for surgery; b) immediately after surgery; c) at 2 days after surgery; and d) at 5 to 8 days after surgery. There was a significant decrease in TSH concentrations immediately after surgery in the two bypass groups. This change was significantly greater than in the change in TSH concentration in the thoracotomy group. Total T3 and T4 concentrations decreased by postoperative day 2 in both groups 1 and 2, and the changes were significant compared with group 3. Total T3 and T4 concentrations increased significantly in all groups after postoperative day 2, with no significant difference between the three groups. CONCLUSION: Cardiopulmonary bypass has a more significant effect on thyroid hormone metabolism than does the preoperative antiseptic.

Anti-Infective Agents, Local↗
PubMed2000

The safety of prolonging the use of central venous catheters: a prospective analysis of the effects of using antiseptic-bonded catheters with daily site care.

OBJECTIVE: To determine rates of catheter colonization and catheter-related bloodstream infection (CRBSI) when antiseptic-bonded central venous catheters (CVCs) and standardized daily site care are used with no predetermined interval for removal. DESIGN: Prospective observational study. SETTING: Two major trauma centers. PATIENTS: All trauma patients admitted to two major trauma centers that received a CVC from May 1996 through May 1998. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Catheters were semiquantitatively cultured to identify bacterial colonization and CRBSI. Monitored variables included total catheter days, anatomical site of catheter insertion, and area in hospital of catheter insertion. CVC tips and intracutaneous segments were semiquantitatively cultured. A total of 460 (92%) of 501 catheters placed in 324 trauma patients were evaluable, representing 95.5% of all catheter days during the study period. Rates of catheter colonization and CRBSI were 5% (5/1000 catheter days) and 1.5% (1.511000 catheter days), respectively. Subclavian catheters were in place longer than femoral or internal jugular catheters (p < .0001), but the colonization rate was significantly lower (p = .03; relative risk, 0.34; 95% confidence interval, 0.15-0.77). No differences in CRBSI rates among anatomical sites or between catheters used < or =14 days and those used >14 days were identified. CONCLUSION: Femoral and internal jugular antiseptic-bonded CVCs develop bacterial colonization earlier than subclavian CVCs. Subclavian antiseptic-bonded CVCs combined with standardized daily site care may be safely used >14 days in trauma patients.

Adolescent↗
PubMedDate not supplied

Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review.

This article reviews the results and conclusions from four pivotal and two comparative clinical trials. The six randomized, controlled, single-blinded, parallel-group clinical trials were conducted to determine which antiseptic is best for use as a patient preoperative skin preparation. The objective of these studies was to compare the immediate, persistent (residual), and cumulative antimicrobial efficacy and safety of 2% chlorhexidine gluconate (CHG) combined with 70% isopropyl alcohol (IPA) (ChloraPrep); another combination CHG and IPA antiseptic (CHG+IPA) and 2% aqueous CHG alone; 4% CHG (Hibiclens) alone; 70% isopropyl alcohol (IPA) alone; and an iodine-containing solution, 10% povidone-iodine (Betadine) alone as preoperative skin topical antiseptics for potential prevention of nosocomial infections.

2-Propanol↗
PubMed1994

A rational approach to the use of topical antiseptics.

The proper application of antiseptics to the open wound is controversial. With the goal of creating an optimal environment for wound repair, consideration of a topical antiseptic includes both its bactericidal activity and its potential cytotoxicity when applied to the healing wound in varying concentrations. This discussion reviews the events of wound healing, including the key cells that mediate this process, the significance of bacteria in the wound bed, and the impact of infection. Specific antiseptics, including povidone-iodine, hydrogen peroxide, acetic acid, and Dakin's solution are reviewed, emphasizing their bactericidal potential and their cytotoxic properties.

Anti-Infective Agents, Local↗
PubMed2004

Severe contact dermatitis as a result of an antiseptic bath oil.

Siblings aged 7 and 5 years developed extensive truncal and flexural inflammation and desquamation unresponsive to standard eczema therapy. After delays in diagnosis, subsequent history revealed prior use of an antiseptic bath oil in a much stronger concentration than recommended. The case illustrates the severe irritant contact dermatitis that can arise following inadequate dilution of antiseptic bath oils, presumably as a result of skin contact with benzalkonium chloride and triclosan. Features that may direct attention to such irritant dermatitis are flexural predominance with superficial desquamation and rapid improvement after avoidance of exposure to the antiseptic solution.

Anti-Infective Agents, Local↗
PubMed1985

Efficacy of Listerine antiseptic in inhibiting the development of plaque and gingivitis.

A 9-month double-blind controlled clinical study was conducted on adult subjects using either Listerine antiseptic, its vehicle control, or a water control in order to determine the efficacy of the antiseptic mouthrinse in inhibiting the development of plaque and gingivitis. Following screening examinations for minimal entry levels of plaque and gingivitis, all subjects received a complete prophylaxis. Subjects then continued their usual oral hygiene habits for a 3-week normalization period and were examined for soft tissue abnormalities and baseline measurements of plaque, gingivitis, and tooth stain. 2 additional prophylaxes were then performed, followed by a second baseline gingival examination. Zero plaque was re-established by rubber cup polishing and twice daily rinsing was begun. Soft tissue, plaque, gingivitis, and extrinsic tooth stain were evaluated after 1, 3, 6 and 9 months of rinsing with the randomly assigned mouthrinses. Results demonstrated that Listerine antiseptic significantly reduced the development of plaque at 1, 3, 6 and 9 months and the development of gingivitis at 9 months, as compared to its vehicle control or water control.

Adolescent↗
PubMed1989

Effects of 6 months use of an antiseptic mouthrinse on supragingival dental plaque microflora.

This study was undertaken to determine whether long-term use (6-months) of an antiseptic mouthrinse (Listerine Antiseptic, Warner Lambert Co., Morris Plains, NJ, USA) led to an undesirable succession of oral pathogens or the emergence of resistant microbial forms. Supragingival plaque was collected from 83 subjects before treatment and after either 3 or 6 months use of either the active antiseptic or a 5% hydroalcohol control. Subjects rinsed with their assigned mouthrinse twice daily under supervision. The plaque samples were analyzed for microbial content by darkfield microscopy, culture on a series of nonselective and selective bacterial media, and by recognition of microbial forms by recognition of distinct colony on a nonselective medium. Statistical analysis of the results revealed no significant microbial shifts including no significant increases in presumptive oral pathogens, spirochetes, black-pigmented Bacteroides, Streptococcus mutans, or Candida albicans. Additionally, no detectable rise in either staphylococci or enteric bacteria, potential opportunistic pathogens, was observed.

Adolescent↗
PubMed2005

Efficacy of Listerine Antiseptic in reducing viral contamination of saliva.

AIM: The anti-viral efficacy of oral antimicrobial rinses has not been adequately studied in terms of potential clinical significance. As a follow-up to an in vitro study on the effect of oral antiseptics on Herpes simplex virus, Type 1, this study was undertaken to evaluate the in vivo effect of an essential oil containing oral antiseptic on the reduction of viral titer in saliva during active viral infection. METHOD: Patients were recruited and evaluated in a single visit protocol at the onset of a perioral outbreak, consistent historically and clinically with recurrent Herpes labialis. Direct immunofluorescence of cytological smears of the lesions/oral fluids was used to confirm Herpes simplex virus types I or II. Patients were randomly assigned to one of two treatment groups: (1) active ingredient and (2) sterile water control. The viral lesion was evaluated as to clinical stage according to standard protocol. Salivary fluid samples were taken: (1) at baseline; (2) immediately following a 30 s rinse; (3) 30 min. after the 30 s rinse; and (4) on the repeat trial, also at 60 min. after the 30 s rinse. All samples were evaluated for viral titer and results compared. RESULTS: In Trial 1, the sample population consisted of 19 males and 21 females with an average age of 29.2 and in Trial 2, 21 males, 19 females with an average age of 28. In both Trials 1 and 2, recoverable infectious virions were reduced to zero after a 30 s experimental rinse; whereas, the control rinse resulted in a non-significant (p>0.05) reduction. The experimental group also demonstrated a continued significant (p<0.05) reduction 30 min. post rinse when compared with baseline while the control group returned to baseline levels. In Trial 2, the 60 min. post rinse follow-up demonstrated a 1-2 log residual reduction from baseline in the experimental group; however, this was not significant. CONCLUSIONS: There is clinical efficacy in utilizing an oral rinse with the antimicrobial agent Listerine Antiseptic in reducing the presence of viral contamination in oral fluids for at least 30 min. after oral rinse. The risk of viral cross contamination generated from these oral fluids in person to person contact or during dental treatment may be reduced.

Adult↗
PubMed2006

In vitro antiseptic properties of an ammonium compound combined with denture base acrylic resin.

BACKGROUND: Denture base acrylic resin is easily colonised by oral endogenous bacteria and Candida spp., and eventually by extra-oral species such as Staphylococcus spp., Pseudomonadaceae or members of Enterobacteriaceae. This microbial reservoir can be responsive for denture related stomatitis and aspiration pneumonia, a life-threatening infection especially in geriatric patients. However, the oral and denture hygiene of dependent elderly individuals is extremely poor. OBJECTIVE: This in vitro study aimed to determine the per cent of a quaternary ammonium compound heat-polymerised in acrylic resin necessary to obtain denture base displaying antiseptic properties. DESIGN: Acrylic resin discs containing 2-50% ammonium polymer (Poly 202063A; 0% control) were soaked in artificial saliva for 4 weeks. Resin discs were incubated for 24 hours with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa [37 degrees C, brain-heart infusion (BHI) broth and phosphate-buffered saline (PBS) buffer] and Candida albicans (30 degrees C, Schaedler broth), in 15 ml (168 discs) and 600 microl (168 discs) of inoculum. Microbial growth was verified at t 0 hours and t 24 hours. Data were recorded as the mean of three colony forming unit (CFU) numerations. The borderline of antimicrobial effect was determined at 0.1% viable cells. RESULTS: In 600 microl of PBS inoculum, resin specimens had a bactericidal effect (E. coli and S. aureus: 2%; P. aeruginosa: 10%) and a fungicidal effect (C. albicans: 50%). Long-term stability and toxicity in vivo studies are now required. CONCLUSION: A 2% quaternary ammonium compound polymerised with a denture acrylic resin displayed antiseptic properties after a 4-week soaking period in artificial saliva. Such antiseptic denture base could help geriatric patients to improve their oral health.

Acrylic Resins↗
PubMed1995

Effect of testing method on apparent activities of antiviral disinfectants and antiseptics.

This study was designed to evaluate the independent effects of various test methods on the activities of antiviral chemical germicides. The activities of germicides against MS2 and phi 6 bacteriophages in a new porcine tissue carrier model were compared to those obtained by four other methods (suspension, glass carrier, tile carrier, and fingerpad tissue carrier tests). After a 1-min contact followed by neutralization (and elution off the carriers), the residual virus in the treated samples was quantified and the amount was compared with that in the saline controls. Antiviral activity was highly dependent on the test method for both viruses and was always greatest in suspension tests and lowest in tissue carrier tests. Results obtained for hydrophilic MS2 with the porcine tissue carrier were comparable to those from fingerpads, but lipophilic phi 6 was subject to spontaneous inactivation on human skin and proved unsuitable for fingerpad testing. These data indicate that the activities of germicides in tests with nonbiological substrates may overestimate antiviral antiseptic activity on skin surfaces. Products intended for use as antiviral antiseptics or hand-washing agents should be evaluated in a tissue carrier system. The porcine tissue carrier model provides a safe, inexpensive, accurate, and reproducible method for testing the activities of antiseptics.

Animals↗
PubMed1973

Effectiveness of septisol antiseptic foam as a surgical scrub agent.

Septisol antiseptic foam (0.23% hexachlorophene in a 46% ethyl alcohol base) is a new surgical scrub agent for both primary and re-entry use that is designed to minimize the harsh effects to the skin of the conventional scrub while retaining effective antibacterial properties. A preliminary surgical scrub study of 1-week duration yielded an immediate reduction in resident flora of 92% from an average single scrub coupled with a residual bacteriostatic effect from repeated use that gave a plateau at 57% of the pretest resident population level. A separate study demonstrated complete elimination of both gram-positive and gram-negative transients from the skin with a single application of the product. In an 8-week surgical scrub study, equal effectiveness was shown between Septisol antiseptic foam and a standard 3% hexachlorophene detergent. However, Septisol antiseptic foam offers considerable advantage in minimizing the harsh effects to the skin of the conventional surgical scrub and results in a substantially lower hemic level of hexachlorophene in the user than that obtained with 3% hexachlorophene detergent. Sampling was conducted by the fingerprint impression plate technique of Gale.

Anti-Bacterial Agents↗
PubMed1999

Antiseptics and disinfectants: activity, action, and resistance.

Antiseptics and disinfectants are extensively used in hospitals and other health care settings for a variety of topical and hard-surface applications. A wide variety of active chemical agents (biocides) are found in these products, many of which have been used for hundreds of years, including alcohols, phenols, iodine, and chlorine. Most of these active agents demonstrate broad-spectrum antimicrobial activity; however, little is known about the mode of action of these agents in comparison to antibiotics. This review considers what is known about the mode of action and spectrum of activity of antiseptics and disinfectants. The widespread use of these products has prompted some speculation on the development of microbial resistance, in particular whether antibiotic resistance is induced by antiseptics or disinfectants. Known mechanisms of microbial resistance (both intrinsic and acquired) to biocides are reviewed, with emphasis on the clinical implications of these reports.

Anti-Infective Agents, Local↗
PubMed2006

Antimicrobial agent of susceptibilities and antiseptic resistance gene distribution among methicillin-resistant Staphylococcus aureus isolates from patients with impetigo and staphylococcal scalded skin syndrome.

The susceptibilities to antimicrobial agents of and distributions of antiseptic resistance genes in methicillin-resistant Staphylococcus aureus (MRSA) strains isolated between 1999 and 2004 in Japan were examined. The data of MRSA strains that are causative agents of impetigo and staphylococcal scalded skin syndrome (SSSS) were compared with those of MRSA strains isolated from patients with other diseases. The susceptibilities to antiseptic agents in MRSA isolates from patients with impetigo and SSSS were higher than those in MRSA isolates from patients with other diseases. The distribution of the qacA/B genes in MRSA strains isolated from patients with impetigo and SSSS (1.3%, 1/76) was remarkably lower than that in MRSA strains isolated from patients with other diseases (45.9%, 95/207). Epidemiologic typings of staphylococcal cassette chromosome mec (SCCmec) and pulsed-field gel electrophoresis (PFGE) showed that MRSA strains isolated from patients with impetigo and SSSS had type IV SCCmec (75/76), except for one strain, and 64.5% (49/76) of the strains had different PFGE types. In addition, the patterns of restriction digestion of all tested qacA/B plasmid in MRSA isolates having different PFGE types were identical. The results showed that a specific MRSA clone carrying qacA/B was not prevalent, but qacA/B was spread among health care-associated MRSA strains. Therefore, it was concluded that the lower distribution rate of qacA/B resulted in higher susceptibilities to cationic antiseptic agents in MRSA isolated from patients with impetigo and SSSS.

Anti-Bacterial Agents↗