Detrimental Effects of Chlorhexidine on Articular Cartilage Viability, Matrix, and Mechanics.

BACKGROUND: Chlorhexidine gluconate (CHG) solution is commonly used as an antiseptic irrigation for bacterial decontamination during orthopaedic surgery. Although the chondrotoxicity of CHG on articular cartilage has been reported, the full extent of CHG-related chondrotoxicity and its effects on the extracellular matrix and mechanical properties are unknown. PURPOSE: To investigate the in vitro effects of a single 1-minute CHG exposure on the viability, biochemical content, and mechanics of native articular cartilage explants. STUDY DESIGN: Controlled laboratory study. METHODS: Articular cartilage explants (6 per group) were harvested from femoral condyles of the porcine stifle and sectioned at tidemark. Explants were bathed in CHG solution (0.05% CHG in sterile water) at varying concentrations (0% control, 0.01% CHG, and 0.05% CHG) for 1 minute, followed by complete phosphate-buffered saline wash and culture in chondrogenic medium. At 7 days after CHG exposure, cell viability, matrix content (collagen and glycosaminoglycan [GAG]), and compressive mechanical properties (creep indentation testing) were assessed. RESULTS: One-minute CHG exposure was chondrotoxic to explants, with both 0.05% CHG (2.6% ± 4.1%) and 0.01% CHG (76.3% ± 8.6%) causing a decrease in chondrocyte viability compared with controls (97.5% ± 0.6%; P < .001 for both). CHG exposure at either concentration had no significant effect on collagen content, while 0.05% CHG exposure led to a significant decrease in mean GAG per wet weight compared with the control group (2.6% ± 1.7% vs 5.2% ± 1.9%; P = .029). There was a corresponding weakening of mechanical properties in explants treated with 0.05% CHG compared with controls, with decreases in mean aggregate modulus (177.8 ± 90.1 kPa vs 280.8 ± 19.8 kPa; P < .029) and shear modulus (102.6 ± 56.5 kPa vs 167.9 ± 16.2 kPa; P < .020). CONCLUSION: One-minute exposure to CHG for articular cartilage explants led to dose-dependent decreases in chondrocyte viability, GAG content, and compressive mechanical properties. This raises concern for the risk of mechanical failure of the cartilage tissue after CHG exposure. CLINICAL RELEVANCE: Clinicians should be judicious regarding the use of CHG irrigation at these concentrations in the presence of native articular cartilage.

Evaluation of Chitosan-Oleuropein Nanoparticles on the Durability of Dentin Bonding.

Purpose: To evaluate the effects of dentin pretreatment with chitosan-loaded oleuropein nanoparticles (CONPs) on the durability of resin-dentin bonding interfaces. Methods: Eighty freshly extracted non-carious human third molars were randomly divided into four groups (n = 20 each): a de-ionized water (DW) group, a chitosan (CS) group, a chlorhexidine (CHX) group and a CONP group. The dentin in the DW, CS, CHX, and CONP groups were pretreated with de-ionized water, 1.0 mg/L CS solution, 2% chlorhexidine solution, and CONP suspension (prepared with 100 mg/L oleuropein), respectively, followed by the universal adhesive and resin composites. The bonded teeth of each group were randomly divided into two subgroups: an immediate subgroup and an aged subgroup. The bonded teeth of each group were then cut into the bonded beams. We measured their microtensile bond strength (µTBS), observed the characteristics of bonding interface by atomic force microscope, calculated the percentage of silver particles in a selected area for interfacial nanoleakage analysis, and evaluated the endogenous gelatinase activity within the bonding interface for in-situ zymogram analysis. Data were analyzed with two-way ANOVA and LSD multiple comparison test (P < 0.05). Results: Regardless of after 24 h or after thermocycling, CONP exhibited better µTBS (P < 0.05) than the other three groups except that there was not a statistical significance (P > 0.05) in the CONP and CHX groups after 24 h. Besides, the CONP group presented significantly higher modulus of elasticity in the hybrid layers (P < 0.05), lower expression of nanoleakage (P < 0.05), and better inhibitory effect of matrix metalloproteinases than the other three groups before and after thermocycling. Conclusion: Altogether, the CONPs had the potential to act as a dentin primer, which could effectively improve the dentin-resin binding durability.

Antibacterial and antifungal capacity of three commercially available mouthwashes with different concentrations of chlorhexidine / Efecto antibacteriano y antifúngico de tres enjuagues bucales comerciales con diferentes concentraciones de clorhexidina

Abstract Chlorhexidine was introduced almost seven decades ago and has a myriad of applications in dentistry. Few studies have evaluated the antimicrobial and antifungal capacity of different concentrations of chlorhexidine mouthwashes. Therefore, the aim of this study, was to evaluate in vitro, the antibacterial and antifungal capacity of three commercially available mouthwashes in Costa Rica, with different concentrations of chlorhexidine, 0.12%, 0.06%, and 0.03%. The experimental method selected was the Kirby-Bauer method to evaluate the antibacterial and antifungal effect of each compound by measuring the inhibitory effect on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, and Candida albicans strains, exposed to the antiseptic solutions. All samples showed some degree of antibacterial and antifungal effect. Even though we provide in vitro results, our findings are of relevance since all the species used in our experiment are microorganisms that may be present in dental plaque. Our results further support evidence that oral hygiene regimens may include mouthwashes with low doses of chlorhexidine and maintain reasonable antibacterial and antifungal efficacy.

Resumen La clorhexidina se introdujo hace casi siete décadas y tiene una gran variedad de aplicaciones en odontología. Pocos estudios han evaluado la capacidad antimicrobiana y antifúngica de diferentes concentraciones de enjuagues bucales con clorhexidina. Por lo tanto, el objetivo de este estudio fue evaluar in vitro, la capacidad antibacteriana y antifúngica de tres enjuagues bucales disponibles comercialmente en Costa Rica, con diferentes concentraciones de clorhexidina, 0.12%, 0.06% y 0.03%. El método experimental seleccionado fue el método Kirby-Bauer para evaluar el efecto antibacteriano y antifúngico de cada compuesto midiendo el efecto inhibidor sobre Staphylococcus aureus, Enterococcus faecalis, Escherichia coli y Candida albicans, expuestos a la solución antiséptica. Todas las muestras mostraron algún grado de efecto antibacteriano y antifúngico. Aunque proporcionamos resultados in vitro, nuestros hallazgos son de relevancia, ya que todas las especies utilizadas en nuestro experimento son microorganismos que pueden estar presentes en la placa dental. Nuestros resultados respaldan aún más la evidencia de que los regímenes de higiene bucal pueden incluir enjuagues bucales con dosis bajas de clorhexidina y mantener una eficacia antibacteriana y antifúngica razonable.

Cutaneous Microbiome Profiles Following Chlorhexidine Treatment in a 72-Hour Daily Follow-Up Paired Design: a Pilot Study.

Venous catheter-related bloodstream infections represent a significant problem in the United States. Our objective was to determine daily changes in skin microbiome profiles up to 72h postchlorhexidine treatment. Left and right forearm skin swab samples were obtained from 10 healthy volunteers over 72h at 24h intervals. Dorsal surface of left arm was treated with chlorohexidine gluconate (CHG) at initial time point (T = 0), while the right arm remained untreated (control). Swab samples were obtained shortly before (T = 0) and after CHG treatment (T = 24-48-72h). Bacterial DNA extraction, 16S rRNA gene V1-V3 sequencing and taxonomic annotation were performed using ZymoBIOMICS pipeline. PERMANOVA, linear discriminant and bacterial interaction network analyses were performed. A total of 13 total phyla, 273 genera, and 950 total species were detected across all time points, CHG-treated or CHG-untreated. Most abundant species included Cutibacterium acnes, Staphylococcus epidermidis, and Rothia Mucilaginosa. Low biomass-related inconsistent taxa detection was observed. PERMANOVA suggested a marginal difference between CHG-treated and CHG-untreated microbiome profiles (Genera: P(perm) = 0.0531; Species: P(perm) = 0.0450). Bacterial interaction network guided PERMANOVA analyses detected a microbiome change over time, suggesting a consistent CHG treatment-specific change. LEfSe identified Finegoldia magna, Bacillus pumilus, Bacillus thermoamylovorans as the only distinctive species. These species were more abundant and/or present post-CHG treatment in the CHG-treated group. These findings suggest that the skin microbiome was not significantly different 24, 48, or 72h after CHG treatment. Previous culture-based studies have found similar results after 24h. Future studies will be needed to determine the mechanisms of bacterial regrowth after CHG treatment. IMPORTANCE Annually, over 80,000 central line infections occur in the United States. Understanding the pathogenesis of these infections is crucial. Chlorhexidine is the most commonly used skin preparation before line placement. We hypothesized that the use of chlorhexidine and dressings will alter the normal arm skin microbiome over a period of 72h. We used 16S-rRNA gene next generation sequencing (NGS) to determine the forearm skin microbiome of volunteers. The left arm was swabbed with chlorhexidine and the right arm served as control. The skin microbiome returned to normal after 24h. Our NGS results confirm findings of two previous culture-based studies. Relative abundance of Bacillus spp. in the chlorhexidine-treated samples was increased, consistent with one previous study. Based on the results of this pilot study, we will need to measure viable bacteria during a 24h time course following chlorhexidine treatment to understand the source of skin microbiome replenishment.

[Effect of chlorhexidine-loaded halloysite nanotube on human dentin bond strength].

PURPOSE: To evaluate the effect of chlorhexidine-loaded halloysite aluminosilicate clay nanotube (HNT) incorporation into a two-step etch-and-rinse (ONE-STEP) and a self-etch (XENO Ⅴ) adhesive on human dentin tensile shear strength (TSS). METHODS: Ten groups (n=12) were prepared according to the adhesive system and amount of CHX/HNT incorporated (5%, 10%, 15%) as follows: XE control(A1), XE experimental control (A2), 5% CHX/HNT-XE (A3), 10%CHX/HNT-XE (A4), 15% CHX/HNT-XE (A5), OS control (B1), OS experimental control (B2), 5% CHX/HNT-OS (B3), 10% CHX/HNT-OS (B4), 15% CHX/HNT-OS (B5). TSS testing was performed after 24 h. Scanning electron microscopy of the resin-dentin interface of selected specimens was carried out. One-way ANOVA was used to evaluate the TSS date in XE groups and OS groups. Two-way ANOVA was used to evaluate the effect of the adhesive system and the CHX/HNT content on dentin TSS with SPSS 19.0 software package. RESULTS: The TSS date of 5% CHX/HNT-XE was significantly higher than the other groups. The TSS date of 10% CHX/HNT-OS was significantly higher than the other groups (P<0.05). No significant difference was detected between adhesive systems and dentin TSS. significant difference was found between CHX/HNT content and dentin TSS. CONCLUSIONS: CHX/HNT addition into dentin adhesive increased bond strength to dentin.

Robbing Peter to Pay Paul: Chlorhexidine gluconate demonstrates short-term efficacy and long-term cytotoxicity.

Wound cleansing agents are routine in wound care and preoperative preparation. Antiseptic activity intends to prevent contaminating microbes from establishing an infection while also raising concerns of cytotoxicity and delayed wound healing. We evaluated the cytotoxicity of five clinically used wound cleaning agents (saline, povidone iodine, Dove® and Dial® soaps, and chlorhexidine gluconate [CHG]) using both an ex vivo and in vivo human skin xenograft mouse model, in contrast to classical in vitro models that lack the structural and compositional heterogeneity of human skin. We further established an ex vivo wound contamination model inoculated with ~100 cells of Pseudomonas aeruginosa or Staphylococcus aureus to evaluate antimicrobial efficacy. Scanning electron microscopy and confocal microscopy were used to evaluate phenotypic and spatial characteristics of bacterial cells in wound tissue. CHG significantly reduced metabolic activity of the skin explants, while all treatments except saline affected local cellular viability. CHG cytotoxicity persisted and progressed over 14 days, impairing wound healing in vivo. Within the contamination model, CHG treatment resulted in a significant reduction of P. aeruginosa wound surface counts at 24 h post-treatment. However, this effect was transient and serial application of CHG had no effect on both P. aeruginosa or S. aureus microbial growth. Microscopy revealed that viable cells of P. aeruginosa reside deep within wound tissue post-CHG application, likely serving as a reservoir to re-populate the tissue to a high bioburden. We reveal concerning cytotoxicity and limited antimicrobial activity of CHG in human skin using clinically relevant models, with the ability to resolve spatial localization and temporal dynamics of tissue viability and microbial growth.

Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore.

PURPOSE: One of the key approaches to minimize the risk of COVID-19 transmission would be to reduce the titres of SARS-CoV-2 in the saliva of infected COVID-19 patients. This is particularly important in high-risk procedures like dental treatment. The present randomized control trial evaluated the efficacy of three commercial mouth-rinse viz. povidone-iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 patients compared with water. METHODS: A total of 36 SARS-CoV-2-positive patients were recruited, of which 16 patients were randomly assigned to four groups-PI group (n = 4), CHX group (n = 6), CPC group (n = 4) and water as control group (n = 2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis. RESULTS: Comparison of salivary Ct values of patients within each group of PI, CHX, CPC and water at 5 min, 3 h and 6 h time points did not show any significant differences. However, when the Ct value fold change of each of the mouth-rinse group patients were compared with the fold change of water group patients at the respective time points, a significant increase was observed in the CPC group patients at 5 min and 6 h and in the PI group patients at 6 h. CONCLUSION: The effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, as number of the samples analyzed, the use of CPC and PI formulated that commercial mouth-rinses may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19. ISRCTN (ISRCTN95933274), 09/09/20, retrospectively registered.

Comparative efficacy of honey 12.5% and chlorhexidine 0.2% mouthwashes on the oropharyngeal bacterial colonization in mechanically-ventilated patients: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of honey mouthwash 12.5% and chlorhexidine solution 0.2% to reduce the rate of oropharyngeal bacterial colonization in mechanically-ventilated patients. METHODS: This study was a randomized, single blind, phase Ⅲ controlled clinical trial. Sixty patients newly admitted to internal and trauma Intensive Care Units of the two educational hospitals of Sanandaj city affiliated with Kurdistan University of Medical Sciences were selected by convenience sampling and allocated to two groups of 30 patients using random blocks design. In each group, the mouthwash was applied twice a day for four consecutive days. Swab samples were taken from the mouth and throat of all patients three times a day (pre- intervention, two days, and four days after the intervention) and then the samples were transferred onto the blood agar and eosin methylene blue (EMB) culture plates and investigated for bacterial growth and colonization after 24-48 h. RESULTS: The findings showed that oropharyngeal colonization was not significantly different between the two groups, pre-intervention, two days, and four days after the intervention (P > 0.05). Rinsing with honey mouthwash 12.5% led to the inhibition of Staphylococcus aureus and Pseudomonas aeruginosa on the fourth day of the intervention in all samples. CONCLUSION: None of the studied solutions contributed to the reduction of oropharyngeal bacterial colonization. It seems that the growth inhibition of Staphylococcus aureus and Pseudomonas aeruginosa by the honey 12.5% mouthwash in mechanically-ventilated patients need further investigation.

The Contribution of Photodynamic Inactivation vs. Corsodyl Mouthwash to the Control of Streptococcus mutans Biofilms.

This work compared the inhibition effect of the commercially available mouthwash Corsodyl, containing 0.1% chlorhexidine digluconate, and photodynamic inactivation (PDI) employing methylene blue (MB) with irradiation from a red laser on 24-h biofilms formed by Streptococcus mutans strains on hydroxyapatite surfaces. The cytotoxicity of Corsodyl and MB was evaluated by Galleria mellonella surviving assay. The viability of biofilm cells after exposure to mouthwash and PDI was determined by counting colony-forming units. The inhibitory effect of antimicrobial agents was confirmed by confocal scanning laser microscopy. MB did not exhibit a cytotoxic effect on larval survival. Non-diluted Corsodyl slightly decreased the survival of larvae. Using our PDI parameters achieved better inhibition than with non-PDI, proving a significant effect on the eradication of S. mutans biofilms and therefore could be an appropriate supplement for the eradication of dental caries.

An intervention to improve patient understanding and use of preoperative chlorhexidine washes.

BACKGROUND: Despite a lack of consensus around which type of preoperative wash is most effect in preventing surgical site infection, their use in clinical practice remains common. Chlorhexidine gluconate (CHG) is widely used however a previous study indicated issues with patient understanding and use of CHG. In response an intervention was developed which aimed to improve patient understanding and compliance with CHG. METHODS: A patient information sheet and a standardised script to guide preadmission phone calls were developed to improve the delivery of information to patients at the study hospital. These interventions were implemented for four months with adult surgical inpatients. A cross-sectional survey was then conducted to assess the effectiveness of the intervention. RESULTS: A 75% (n = 226) response rate was attained. The majority of participants (86%, n = 189) used CHG prior to their surgical procedure and of these 71% (n = 129) used CHG the recommended two times. The quality of information received from the preadmissions nurses was rated more highly than information delivered by other hospital staff. Openended questions revealed key issues including lack of information, time and access issues, and inconsistencies in CHG use. CONCLUSION: The value of standardised calls and information sheets was evident in participants who reported receiving these measures. A moderate increase was seen from the original study in the number of participants who used CHG washes the recommended two times. However, issues remained with inconsistent information across the hospital. Clinicians need to draw on high quality, contemporary research to inform clinical practice.

Ex vivo and in vivo evaluation of residual chlorhexidine gluconate on skin following repetitive exposure to saline and wiping with 2% chlorhexidine gluconate/70% isopropyl alcohol pre-operative skin preparations.

BACKGROUND: Skin antisepsis is performed before surgery to minimize the risk of surgical site infections. Chlorhexidine gluconate (CHG) is routinely used in this application, but it may be removed during surgery when prepped areas are exposed to fluid and repeated blotting. AIM: This work evaluated the effect of adding a film-forming acrylate copolymer to a CHG-containing skin preparation on minimizing CHG loss during a simulated surgical irrigation and wiping procedure. The results were compared with those obtained with a commercially available water-soluble CHG preparation. METHODS: Two studies using excised porcine skin and one study on human volunteers were performed. In each study, the CHG preparations were applied and the treated sites were challenged with repetitive saline soaks and gauze dabbing to simulate surgical conditions. Challenged and unchallenged sites were analysed either for CHG content by high-performance liquid chromatography, or for bacterial log recovery after seeding an indicator organism (reflecting remaining CHG activity). FINDINGS: After irrigation and wiping, skin treated with the film-forming CHG preparation had more CHG remaining both on excised pig skin and in the human model. In the pig model, there was a lower recovery of inoculated bacteria with the CHG preparation containing the film-forming copolymer. No skin irritation or adverse events were reported in the human study. CONCLUSIONS: The addition of a film-forming copolymer has the potential to improve the retention of CHG on skin throughout a surgical procedure compared to a water-soluble preparation. This improved retention may lead to better antimicrobial activity.

Oropharyngeal Bacterial Colonization after Chlorhexidine Mouthwash in Mechanically Ventilated Critically Ill Patients.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Oropharyngeal care with chlorhexidine to prevent ventilator-associated pneumonia is currently questioned, and exhaustive microbiologic data assessing its efficacy are lacking. The authors therefore aimed to study the effect of chlorhexidine mouthwash on oropharyngeal bacterial growth, to determine chlorhexidine susceptibility of these bacteria, and to measure chlorhexidine salivary concentration after an oropharyngeal care. METHODS: This observational, prospective, single-center study enrolled 30 critically ill patients under mechanical ventilation for over 48 h. Oropharyngeal contamination was assessed by swabbing the gingivobuccal sulcus immediately before applying 0.12% chlorhexidine with soaked swabs, and subsequently at 15, 60, 120, 240, and 360 min after. Bacterial growth and identification were performed, and chlorhexidine minimal inhibitory concentration of recovered pathogens was determined. Saliva was collected in 10 patients, at every timepoint, with an additional timepoint after 30 min, to measure chlorhexidine concentration. RESULTS: Two hundred fifty bacterial samples were analyzed and identified 48 pathogens including Streptococci (27.1%) and Enterobacteriaceae (20.8%). Oropharyngeal contamination before chlorhexidine mouthwash ranged from 10 to 10 colony-forming units (CFU)/ml in the 30 patients (median contamination level: 2.5·10 CFU/ml), and remained between 8·10 (lowest) and 3·10 CFU/ml (highest count) after chlorhexidine exposure. These bacterial counts did not decrease overtime after chlorhexidine mouthwash (each minute increase in time resulted in a multiplication of bacterial count by a coefficient of 1.001, P = 0.83). Viridans group streptococci isolates had the lowest chlorhexidine minimal inhibitory concentration (4 [4 to 8] mg/l); Enterobacteriaceae isolates had the highest ones (32 [16 to 32] mg/l). Chlorhexidine salivary concentration rapidly decreased, reaching 7.6 [1.8 to 31] mg/l as early as 60 min after mouthwash. CONCLUSIONS: Chlorhexidine oropharyngeal care does not seem to reduce bacterial oropharyngeal colonization in critically ill ventilated patients. Variable chlorhexidine minimal inhibitory concentrations along with low chlorhexidine salivary concentrations after mouthwash could explain this ineffectiveness, and thus question the use of chlorhexidine for ventilator-associated pneumonia prevention.

Making a choice of catheterisation gel and the role of chlorhexidine.

It is estimated that over 90 000 people in the UK community live with an indwelling catheter ( Wilson, 2016 ). It is essential that a lubricating gel is used during catheterisation, as this helps to reduce the risk of pain, trauma and infection ( Loveday et al, 2014 ; National Institute for Health and Care Excellence, 2012 ). Chlorhexidine is an antiseptic contained in many catheterisation gels. Evidence demonstrates that increasing numbers of patients are experiencing hypersensitivity reactions to this ingredient ( Australian and New Zealand College of Anaesthetists, 2014 ). This article considers the range of catheterisation gel choices available to clinicians and the importance of selecting the correct gel for each patient. It addresses the benefits of using OptiLube Active CHG Free (with lidocaine 2%) - the only catheterisation gel currently available in the UK that contains the benefits of local anaesthetic without chlorhexidine - and recommends that this should be the gel of choice for non-specialist staff conducting catheterisations without individual patient assessments.

Measurements of chlorhexidine, p-chloroaniline, and p-chloronitrobenzene in saliva after mouth wash before and after operation with 0.2% chlorhexidine digluconate in maxillofacial surgery: a randomised controlled trial.

Chlorhexidine gluconate is used to prevent the accumulation of dental plaque and gingivitis, infection of the surgical site, and ventilator-associated pneumonia in maxillofacial surgery, but it is not clear whether the metabolites of chlorhexidine are detectable in the patient's saliva at clinically relevant concentrations. Forty-three patients who had orofacial operations were randomised to use a 0.2% chlorhexidine gluconate (n=23), or an octenidine-based, chlorhexidine-free (n=20), mouthwash once preoperatively and three times daily for five postoperative days. After the first, 8.7 (23.3) mg/L chlorhexidine (0.7%-2.5% of the total amount used) was measured in saliva. The concentration increased to 15.2 (6.2) mg/L after the second rinse (first postoperative day), and peaked at 29.4 (11.2) mg/L on the fourth postoperative day. It remained detectable for up to 12hours after the last one, but was not detectable in serum or urine at any time. The potentially carcinogenic metabolite p-chloroaniline was detectable in saliva at higher concentrations in the chlorhexidine group (0.55mg/L) than the octenidine group (0.21mg/L), and p-chloronitrobenzene was detected in both groups in only minimal concentrations (0.001-0.21mg/L). Chlorhexidine gluconate mouthwashes do increase the concentration of p-chloroaniline, but a single use seems to be safe. Whether prolonged exposure over many years may have carcinogenic potential is still not clear. Based on the hitherto unknown kinetics of p-chloroaniline in saliva, the recent recommendation of the Federal Drug Administration (FDA) in the USA to limit the use of a chlorhexidine gluconate mouthwash to a maximum of six months seems to be justified.

Chlorhexidine Only Works If Applied Correctly: Use of a Simple Colorimetric Assay to Provide Monitoring and Feedback on Effectiveness of Chlorhexidine Application.

We used a colorimetric assay to determine the presence of chlorhexidine on skin, and we identified deficiencies in preoperative bathing and daily bathing in the intensive care unit. Both types of bathing improved with an intervention that included feedback to nursing staff. The assay provides a simple and rapid method of monitoring the performance of chlorhexidine bathing.

Studies on adsorption, reaction mechanisms and kinetics for photocatalytic degradation of CHD, a pharmaceutical waste.

The photocatalytic degradation of chlorhexidine digluconate (CHD), a disinfectant and topical antiseptic and adsorption of CHD catalyst surface in dark condition has been studied. Moreover, the value of kinetic parameters has been measured and the effect of adsorption on photocatalysis has been investigated here. Substantial removal was observed during the photocatalysis process, whereas 40% removal was possible through the adsorption route on TiO2 surface. The parametric variation has shown that alkaline pH, ambient temperature, low initial substrate concentration, high TiO2 loading were favourable, though at a certain concentration of TiO2 loading, photocatalytic degradation efficiency was found to be maximum. The adsorption study has shown good confirmation with Langmuir isotherm and during the reaction at initial stage, it followed pseudo-first-order reaction, after that Langmuir Hinshelwood model was found to be appropriate in describing the system. The present study also confirmed that there is a significant effect of adsorption on photocatalytic degradation. The possible mechanism for adsorption and photocatalysis has been shown here and process controlling step has been identified. The influences of pH and temperature have been explained with the help of surface charge distribution of reacting particles and thermodynamic point of view respectively.

Residues of different gel formulations on dentinal walls: A SEM/EDS analysis.

The aim of this study was to evaluate the presence of residues of sodium hypochlorite gel, chlorhexidine gel, and EDTA gel on dentinal walls after canal preparation through chemical SEM- elemental chemical microanalysis (EDS) analysis. Forty-eight single-rooted teeth were selected. They had their crowns sectioned and were instrumented with a reciprocating system. The canals were irrigated with 5 mL of saline solution during root canal preparation. After instrumentation, the root canals were irrigated with 3 mL 17% EDTA followed by 1 min of ultrasonic passive activation (3× 20 sec) to remove the smear layer, and then irrigated with 3 mL of saline solution. The specimens were randomized into three groups (n = 12) according to the chemical substance that filled the root canal for 30 min: GI: 5.5% sodium hypochlorite gel; GII: 2% chlorhexidine gel; GIII: 24% EDTA gel; Negative control group: no substance was used. Then, the root canals were irrigated with 6 mL of saline solution followed by 1 min of ultrasonic passive activation (3× 20 sec). After ultrasonic activation, the canals were irrigated with 2 mL saline. The roots were sectioned, and the percentage of each chemical element present in the samples was analyzed through chemical SEM-EDS microanalysis. All experimental groups showed a significantly higher percentage of chemical elements (Na and/or Cl) than the control group (P < 0.03). This in vitro study has shown that, regardless of chemical solutions used even after the final irrigation protocol, chemical residues of different substances remained attached to the root canal walls.

Chlorhexidine in cosmetic products - a market survey.

BACKGROUND: Chlorhexidine may cause type I and type IV allergy. Some chlorhexidine-allergic individuals have been exposed in the healthcare setting as patients or healthcare workers, but for others the source of sensitization is unknown. Chlorhexidine may be used as a preservative or an antimicrobial agent in cosmetic products at a concentration up to 0.3%, as set by the European Cosmetics Directive (now Regulations). OBJECTIVES: To identify cosmetic product types containing chlorhexidine, and to measure the concentration of chlorhexidine in selected products. METHODS: Between February 2013 and April 2013, we checked for chlorhexidine in cosmetic products in 14 supermarkets, one hairdressing salon and one beauty and retail store in Copenhagen, Denmark by reading the ingredient labels. The chlorhexidine concentration was measured in 10 selected products by high-performance liquid chromatography (HPLC) with an ultraviolet (UV) detector. RESULTS: Chlorhexidine was found in 80 of 2251 checked products (3.6%) in the following categories: hair products (57/760), creams (9/324), face washes (4/24), wet wipes (4/63), skin tonics (3/22), make-up removers (2/25), and mouth washes (1/17). Chlorhexidine concentrations were 0.01-0.15%. CONCLUSIONS: We found chlorhexidine in various cosmetic product types, predominantly aimed at females, and in hair products. The measured chlorhexidine concentrations were all within the permitted limit. The relevance for allergic sensitization should be further explored.

[Determination of five kinds of restricted preservatives in cosmetics by HPLC].

OBJECTIVE: In order to detect and monitor preservative component in cosmetic, the method for determination of five kinds of restricted substances benzoic acid, chloroxylenol, o-phenyl phenol and p-chloro-m-cresol chlorhexidine in cosmetics by HPLC was carried out. METHODS: 10 kinds of commercial cosmetics as test samples, using methanol as the extracting solution, saturated sodium chloride solution as precipitant, and Agilent Eclipse XDB-C18 (250 mm x 4.6 mm, 5 microm) as analytical column methanol -0.1 nol/L sodium dihydrogen phosphate solution (pH 3.0) was as mobile phase eluting at a flow rate 1.0 ml/min, the detective wavelength was 285 nm. RESULTS: The method for determination of chlorhexidine and other four kinds of restricted substances had good linear relationship, the linear correlation coefficients were greater than 0.9990, the limit of detection ( LOD) of 0.8 - 2.2 ng, the average recoveries were between 95.0% -104.0%. CONCLUSION: The method is accurate and reliable, and it is a useful supplement for "Hygienic Standard for Cosmetics".