Comparison of the in-vitro efficacy of different mouthwash solutions targeting SARS-CoV-2 based on the European Standard EN 14476.

The outbreak of the SARS-CoV-2 pandemic is triggering a global health emergency alert. Until vaccination becomes available, a bundle of effective preventive measures is desperately needed. Recent research is indicating the relevance of aerosols in the spread of SARS-CoV-2. Thus, in this study commercially available antiseptic mouthwashes based on the active ingredients chlorhexidine digluconate and octenidine dihydrochloride (OCT) were investigated regarding their efficacy against SARS-CoV-2 using the European Standard 14476. Based on the requirement of EN 14476 in which reduction of at least four decimal logarithms (≥4 log10) of viral titre is requested to state efficacy, the OCT-based formulation was found to be effective within a contact time of only 15 s against SARS-CoV-2. Based on this in-vitro data the OCT mouthwash thus constitutes an interesting candidate for future clinical studies to prove its effectiveness in a potential prevention of SARS-CoV-2 transmission by aerosols.

Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature. PURPOSE: A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO. METHODS: PubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model. RESULTS: The RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.

[Care of the non-tunneled central venous catheter. Literature search on disinfectants, dressings and intervals between dressing changes]. / Die Versorgung des nicht-getunnelten Zentralvenenkatheters. Literaturrecherche zu Desinfektionsmittel, Verbandsmaterial und Zeitpunkt des Verbandwechsels.

Patient care in hospitals often involves insertion of a non-tunneled central venous catheter for administering drugs, intravenous solutions, or total parenteral nutrition. Every change of dressing must be carried out in an appropriate fashion in order to reduce the risk of bacterial infection. We reviewed the existent literature in order to make a listof recommended disinfectants, type of dressings and intervals between dressing changes of a central venous catheter. A comparison was drawn between the guidelines of the Centers for Disease Control and Prevention (CDC) and the Robert Koch-Institut (RKI) issued in 2002 with those more recently published. Our search showed that chlorhexidine gluconate (from 0.5 to 2 percent), povidone-iodine (from 5 to 10 percent) or alcohol (70 percent) are the recommended disinfecting agents. The recommended dressing is gauze or transparent steam-permeable polyurethane dressings. Intervals between dressing changes varied between once a day and once in seven days, depending on the nature of the dressing applied.

An in-use evaluation of an alcohol-based pre-surgical hand disinfectant.

OBJECTIVE: To determine whether alcohol hand disinfection is an effective alternative to traditional agents for the pre-surgical scrub. DESIGN: A prospective clinical trial of a 70% isopropanol pre-surgical hand disinfectant. SETTING: The operating room suites at two hospital sites in British Columbia. METHODS: Cases were selected to evaluate both short and longer procedures. The hand disinfectant was compared to agents in current use as surgical scrubs (4% chlorhexidine and 7.5% povidone-iodine). Surgical technique and glove use were not modified. Pre- and postoperative fingertip impression and "glove-juice" cultures were used to determine microbial burden, and hands were evaluated for skin integrity. RESULTS: There was no statistical difference between the microbial hand counts following use of the alcohol-based product or the current agents, for cases less than 2 hours' duration. Comparison of longer surgical cases revealed significantly better pre- and postoperative culture results with the alcohol hand rinse, but analysis of matched pairs showed no significant difference in microbial counts. The alcohol hand rinse was equivalent to the operative scrub in terms of skin integrity and user acceptability. CONCLUSION: An alcohol hand rinse was equivalently effective in reducing microbial hand counts as the traditional pre-surgical scrub, both immediately after hand disinfection and at the end of the surgical procedure.

In-vitro evaluation of povidone-iodine and chlorhexidine against methicillin-resistant Staphylococcus aureus.

The in-vitro activity of povidone-iodine (PVP-I) and chlorhexidine (CHX) against 33 clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) was evaluated by a quantitative suspension test method. Bactericidal potency was measured by the logarithmic reduction factors (LRFs) achieved with each strain, tested at dilutions 25-800 over exposure times 30-300 s using a challenge of approximately 10(7) colony forming units (cfu) ml-1. The mean LRFs achieved over all dilutions, times and strains were significantly higher for PVP-I than CHX. PVP-I exhibited a superior killing effect whether measured by rate of kill or final LRF achieved. This difference was highly significant as judged by analysis of variance (P less than 0.001). Full efficacy of an antiseptic has been defined as a safe LRF greater than five. Over the dilution range 25-200 this was achieved by CHX with only three of 33 strains. In contrast, PVP-I achieved full efficacy with all 33 strains.

A comparison of four film-type dressings by their anti-microbial effect on the flora of the skin.

Two polyurethane dressings ('Tegaderm' and 'OpSite') were compared with their respective povidone iodine and chlorhexidine acetate-impregnated dressings ('Tegaderm Plus' and 'OpSite CH') for their effectiveness in reducing recolonization of skin after application of the dressings. After 7 days the average number of cfu on undamaged skin, covered with the four dressings, was significantly lower than the number of cfu on skin which had not been covered. The number of cfu on the skin covered with OpSite CH was significantly lower than with all other dressings tested. OpSite CH possesses most anti-microbial activity in relation to the flora of the skin.

Safety and efficacy of an improved antiseptic catheter impregnated intraluminally with chlorhexidine.

The safety and efficacy of a second-generation improved antiseptic catheter impregnated with silver sulfadiazine and increased levels of chlorhexidine on its outer surface and chlorhexidine alone on its luminal surfaces was compared in vitro and in vivo to standard antiseptic catheters impregnated with these antimicrobials on their outer surfaces only. In rat and pig intravenous models, the improved antiseptic catheter was significantly more effective in resisting both outer surface and luminal colonization compared with the standard antiseptic or control catheters. There was no evidence of tissue toxicity in any group.

[Comparison of four protocols for preoperative preparation in cattle]. / Comparaison de quatre protocoles de préparation préopératoire chez le bovin.

This study was designed to evaluate 4 preoperative skin preparations, that is, more specifically, to compare the efficacy of chlorhexidine gluconate (CG) and povidone-iodine (PI), as well as 2 hair removal techniques (clipper alone or clipper followed by razor) for preoperative skin preparation in cattle. The 4 protocols resulted in a significant decrease in the number of bacterial colony-forming units (cfu). Group 4 (clipping + shaving + CG) had a significantly lower number of preoperative cfu per gel plate compared with groups 1 (clipping + PI) and 3 (clipping + shaving + PI). Skin reaction frequency was significantly higher in groups 3 and 4 (47.8% for both protocols) than in groups 1 and 2 (clipping + PI or CG) (8.7% for both). Wound infection frequency was 4.3% (4/92) and no significant difference was observed between the 4 treatment groups. The 4 protocols tested were equivalent as to efficacy and satisfactorily decreased skin microflora. Clipping alone was shown to be preferable to clipping plus shaving as a method of hair removal in cattle, with fewer skin reactions and no more wound infections.

Efeito das soluções irrigadoras sobre os instrumentos Irrisafe e XP Endo utilizados na irrigação final dos canais radiculares / Effect of irrigation solutions on the Irrisafe and XP Endo used in final irrigation two root canals

Introdução: O objetivo deste estudo foi avaliar a resistência à corrosão das pontas de irrigação ultrassônica passiva Irrisafe® (Satelec/Acteon Group, Bordeaux, França) e dos instrumentos endodônticos XP Endo® (FKG Dentaire, La Chaux-de-Fonds, Switzerland), nas soluções irrigadoras hipoclorito de sódio (NaClO) 5,25%, ácido etilenodiaminotetracético (EDTA) 17% e clorexidina (CLX) 2%. O comportamento de ligas metálicas de aço inoxidável e NiTi nestas soluções também foi avaliado. Metodologia: Trinta novas pontas Irrisafe® e trinta novos instrumentos XP Endo® foram submetidos a ensaios de imersão dinâmica nas soluções irrigadoras NaClO 5,25%, EDTA 17% e CLX 2%. Cada instrumento foi submetido a dois ensaios na mesma solução com durações de 5 e 15 minutos. Antes e após cada ensaio, todos os instrumentos foram observados por microscopia eletrônica de varredura (MEV) para análise da superfície. Curvas redox das soluções de NaClO 5,25%, EDTA 17% e CLX 2% e curvas de polarização anódica de ligas metálicas de aço inoxidável e NiTi nestas soluções foram obtidas. Resultados: Não houve sinais de corrosão em nenhuma das pontas Irrisafe® e dos instrumentos XP Endo® ensaiados, independentemente do tempo de ensaio e da solução de teste utilizada. Os ensaios de polarização anódica de ambas as ligas metálicas na solução de NaClO 5,25% mostraram baixos valores de corrente até o potencial de +500 mVECS. As curvas de polarização anódica nas soluções de EDTA 17% e CLX 2% mostraram um trajeto semelhante ao da curva redox da solução em ambas as ligas metálicas. Conclusão: Concluiu-se que as pontas ultrassônicas Irrisafe® e os instrumentos endodônticos XP Endo® não sofrem corrosão nas soluções de NaClO 5,25%, EDTA 17% e CLX 2%. As ligas metálicas de aço inoxidável podem sofrer corrosão em solução de NaClO 5,25%, mas não sofrem corrosão em soluções de EDTA 17% e CLX 2%. A liga metálica de NiTi não sofre corrosão nas soluções NaClO 5,25%, EDTA 17% e CLX 2%. (AU)

Introduction: The objective of this study was to evaluate the corrosion resistance of Irrisafe® (Satelec/Acteon Group, Bordeaux, França) passive ultrasonic irrigation tips and XP Endo® (FKG Dentaire, La Chaux-de-Fonds, Switzerland) endodontic instruments in 5,25% sodium hypochlorite (NaClO), 17% EDTA and 2% chlorhexidine (CLX) irrigating solutions. The behavior of stainless steel and NiTi alloys in these solutions was also evaluated. Methodology: Thirty new Irrisafe® tips and thirty new XP Endo® instruments were submitted to dynamic immersion tests in 5,25% NaClO, 17% EDTA and 2% CLX irrigating solutions. Each instrument was submitted to two tests using the same solution for 5 and 15 minutes. Before and after each test, the surface of all instruments was analyzed by scanning electron microscopy (SEM). Redox curves of 5,25% NaClO, 17% EDTA and 2% CLX solutions and anodic polarization curves of both metal alloys in these solutions were obtained. Results: Signs of corrosion were not observed in any of the Irrisafe® tips and XP Endo® instruments tested, regardless of test time and solution used. Anodic polarization tests of both metallic alloys in 5,25% NaClO solution showed low current values to +500 mVECS potential. Anodic polarization tests of both metallic alloys in 17% EDTA and 2% CLX showed a similar path to redox curve solutions for both metallic alloys. Conclusion: It was concluded that Irrisafe® tips and XP Endo® endodontic instruments were not corroded in 5,25% NaClO, 17% EDTA and 2% CLX irrigating solutions. The stainless steel alloy suffered corrosion in 5,25% NaClO solution, but not in 17% EDTA and 2% CLX . NiTi alloy did not suffer corrosion in 5.25% NaClO, 17% EDTA and 2% CLX irrigating solutions. (AU)

A scanning electron microscopic evaluation of different root canal irrigation regimens.

The purpose of this study was to assess the effectiveness of endodontic irrigants in removing the smear layer from instrumented root canal walls using Scanning Electron Microscopy (SEM). The endodontic irrigants used were: 1% sodium hypochlorite (NaOCl); 1% NaOCl mixed to 17% EDTAC; 2% chlorhexidine gel; and Ricinus communis gel. Photomicrographs of the middle and apical thirds were evaluated with the aid of the Fotoscore - v. 2.0 software. The results indicated that the mixture of sodium hypochlorite and EDTAC completely removed the smear layer from dentinal walls. The other endodontic irrigants were not as efficient in cleansing the root canals.

The oral clearance of chlorhexidine solutions and gels.

The oral clearance of 4 chlorhexidine (CH) preparations was investigated. Two 0.2% CH-solutions, Plak-Out liquid, a 10% alcoholic CH-solution and an aqueous ICI-Hibitane solution were compared with two chlorhexidine gels, Corsodyl gel (0.1%) and a test CH-gel (1.0%) prepared in this laboratory. Thirty subjects, 17 to 57 years of age and exhibiting a variety of oral hygiene conditions, participated in supervised rinsing with CH-solutions and toothbrushing with gels carried out at weekly intervals to eliminate carry-over effects. Mixed saliva samples were taken 7.5, 15, 30, 60 and 120 minutes following each administration and were analysed spectrophotometrically. The relative oral CH-retention values were for Plak-Out liquid 91%, aqueous Hibitane solution 69%, Corsodyl gel 46% and with the laboratory chlorhexidine gel 37%.

Evaluation of surgical scrub methods for large animal surgeons.

OBJECTIVE: The objective of this study was to determine the effectiveness of a 5-minute surgical scrub using either a one-brush or a two-brush technique in clean and dirty surgical procedures, and to compare the efficacy of povidone iodine with chlorhexidine as surgical scrub solutions. STUDY DESIGN: Prospective clinical trial. METHODS: Nine veterinarians scrubbed their hands on eight separate occasions using either povidone iodine or chlorhexidine gluconate. A 5-minute scrub and either a one-brush or two-brush technique used in both clean and dirty operations were evaluated by taking glove juice samples before scrubbing, immediately after scrubbing, and 30, 60, 90, and 120 minutes after scrubbing. Glove juice samples were cultured and the colonies were counted. Percent reductions of bacterial forming units were calculated for all eight scrub procedures. RESULTS: All scrub procedures provided an adequate percent reduction in colony forming units (CFU) during the 2-hour sampling period. The number of CFU immediately after scrubbing were significantly lower than prescrub. At 120 minutes, there were significantly fewer CFUs than presecrub, but there were more than immediately after scrubbing. No significant difference in reduction in CFUs were detected between one-brush and two-brush techniques. Both chlorhexidine and povidone iodine scrub solutions adequately reduced bacterial colony counts for 120 minutes after scrubbing regardless of the amount of contamination before skin preparation. CONCLUSIONS: Bacterial counts after a hand scrub procedure using a one-brush technique were not significantly different than after a procedure that used a two-brush technique. Povidone iodine and chlorhexidine are equally effectively in decreasing bacterial numbers on the skin, given a variety of contamination levels present before the scrub procedure. CLINICAL RELEVANCE: Surgeons may use either chlorhexidine or povidone iodine for antiseptic preparation of their hands before surgery. A two-brush technique is not necessary.

Comparative evaluation of two surgical scrub preparations in cattle.

One hundred seventeen cattle that had undergone surgery were assigned randomly to two preoperative skin preparation protocols. Group 1 (60 animals) skin preparation was with povidoneiodine soap and isopropyl alcohol, whereas group 2 (57 animals) had skin preparation with chlorhexidine gluconate and isopropyl alcohol. Quantitative microbial culture plates were used to estimate the number of colony forming units (CFUs) before skin preparation (prescrub), after skin preparation (postscrub), after surgery (postoperative), and in room air (environment). A significant decrease in CFU occurred postscrub for both skin preparations (P < .05). Chlorhexidine and alcohol preparation resulted in significantly fewer CFUs (LSMean +/- SE = 2.79 CFU +/- 1.74) and a greater percentage reduction in CFUs (98.64% +/- 2.01) postscrub than providone and alcohol (LSMean +/- SE = 10.27 CFUs +/- 1.51, 93.29% +/- 1.85); (P < .005). Group 2 had a significantly higher frequency of negative cultures postscrub (49.1%) compared with group 1 (18.3%) (P < .001). The number of postoperative CFUs were not significantly different between the two treatment groups. Wound infection frequency for clean surgical procedures was not significantly different between the two skin preparation protocols (group 1 = 9.8%, group 2 = 10.7%), however, infection frequency was significantly higher for surgical procedures with a ventral abdominal approach (5 of 14, 35.7%,) compared with a flank approach (1 of 41, 2.4%) or other approaches (orthopedic procedures) (1 of 16, 6.3%) (P < .05). Both skin preparation protocols were effective and safe in decreasing the skin microflora population of cattle before surgery and although preparation with chlorhexidine gluconate and alcohol resulted in less CFUs immediately postscrub, the frequency of surgical wound infection was similar for both protocols.

A scanning electron microscopic evaluation of different root canal irrigation regimens / Avaliação por microscopia eletrônica de varredura de diferentes regimes irrigantes no canal radicular

The purpose of this study was to assess the effectiveness of endodontic irrigants in removing the smear layer from instrumented root canal walls using Scanning Electron Microscopy (SEM). The endodontic irrigants used were: 1 percent sodium hypochlorite (NaOCl); 1 percent NaOCl mixed to 17 percent EDTAC; 2 percent chlorhexidine gel; and Ricinus communis gel. Photomicrographs of the middle and apical thirds were evaluated with the aid of the Fotoscore - v. 2.0 software. The results indicated that the mixture of sodium hypochlorite and EDTAC completely removed the smear layer from dentinal walls. The other endodontic irrigants were not as efficient in cleansing the root canals.

A proposta deste estudo foi avaliar, por meio de microscopia eletrônica de varredura (MEV), a efetividade dos irrigantes endodônticos na remoção da "smear layer" das paredes dos canais radiculares instrumentados. Os irrigantes endodônticos utilizados foram: solução de hipoclorito de sódio a 1 por cento; solução de hipoclorito de sódio a 1 por cento misturado ao EDTAC a 17 por cento, gel de clorexidina a 2 por cento e gel de Ricinus communis. Fotomicrografias dos terços médio e apical foram avaliadas com o auxílio do software Fotoscore - versão 2.0. Os resultados indicaram que a mistura da solução de hipoclorito de sódio e EDTAC removeu eficientemente a "smear layer" das paredes dentinárias. Os demais irrigantes endodônticos não foram tão eficientes na limpeza dos canais.

Eficácia da clorexidina em infecções endodônticas: revisão sistemática / Efficacy of chlorhexidine in endodontic infections: systematic review

Avaliou-se em estudos longitudinais a eficácia da clorexidina em infecções endodônticas detectadas por cultura ou reação em cadeia da polimerase (PCR), por meio de revisão sistemática. As estratégias de busca incluíram buscas eletrônicas (Medline, Embase, Central) e manuais, utilizando-se várias palavras-chave: chlorhexidineand (endodontic* OR endodontic* infection* OR root canal infection*). A busca apresentou 196 artigos, sendo que dos 48 estudos in vivo, sete satisfizeram os critérios de inclusão. A combinação de resultados com vistas à estruturação de uma meta-análise não foi possível em função da heterogeneidade dos estudos. O emprego da clorexidina como irrigante durante o preparo de canais radiculares infectados mostrou reduzir a microbiota endodôntica remanescente.

Avaliação clínica do efeito de Noplak(R) Max sobre gengivite e placa dental bacteriana / Clinical evaluation of the effect of Noplac(R) Max on gingivitis and dental plaque

O objetivo deste estudo foi analisar clinicamente o efeito de um enxaguatório bucal contento clorexidina (0,12%) - Noplak® Max - sobre a gengivite e placa dental bacteriana. Quarenta e cinco indivíduos apresentando gengivite moderada ou severa receberam instrução de higiene oral e foram aleatoriamente alocados em três grupos de acordo com o enxaguatório utilizado como adjunto à escovação: I) Noplac® Max; II) solução de clorexidina a 0,12%; III) placebo. Em geral, os três grupos apresentaram melhora nos parâmetros analisados, placa visível e sangramento gengival. Os pacientes do grupo II (solução de clorexidina 0,12%) apresentaram pigmentação extrínseca intensa ao final do estudo, fato este que não foi clinicamente observado nos Grupos I e III. Foi concluído que Noplak® Max é eficaz como adjunto no tratamento da gengivite, combatendo a placa bacteriana e reduzindo o sangramento gengival

Avaliação do efeito imediato e residual do sabão anti-séptico, do PVP-I degermante, do PVP-I tópico e da clorexidina na degermação das mãos / Evaluation of immediate and residual effect of liquid soap, degerming povidine-iodine, topic povodine-iodine and chlorhexidine on handwashing

O objetivo deste trabalho foi avaliar o efeito imediato e residual da água e do sabão bactericida, do PVP-I degermante, do PVP-I tópico e da clorexidina na degermação das mãos de graduandos da Faesa-Vitória, em procedimentos críticos. A coleta microbiológica foi realizada antes da degermação, após a degermação e uma hora após o uso de luvas. Foi possível concluir que: houve diferença significante entre o grupo água e sabão e os demais; a lavagem das mãos com água e sabão não inibiu o crescimento de Staphylococcus sp imediatamente; o PVP-I degermante e o PVP-I tópico e a clorexidina impediram o crescimento de qualquer micro-organismo no ato de seu uso e 1 hora depois