Types of antiseptics, presentations and rules of use. / Tipos de antisépticos, presentaciones y normas de uso.

Antiseptics are chemical substances that when applied topically onto intact skin, mucous membranes or wounds partially or completely reduces the population of living microorganisms in those tissues. Different types of antiseptics are available - those most commonly used in clinical practice being alcohols, iodinated compounds and chlorhexidine. When using an antiseptic, consideration is required of its spectrum of antimicrobial activity, latency, residual effects, possible interferences of the presence of organic material with the activity of the antiseptic, its side effects, compatibility with other antiseptics, and cost. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine).

Chylothorax is defined as an accumulation of chyle in the pleural space. This condition usually occurs after an operation, the congenital idiopathic form being rare (1/15000 births). Recovery is observed within four to six weeks of diagnosis in most cases. Treatment is either conservative or surgical. Four cases are reported of congenital chylothorax (three idiopathic, one accompanied by diffuse lymphangectasia) managed by chemical pleurodesis (intrapleural injection of povidone-iodine). Tolerance was satisfactory: unaltered thyroid function in the three cases explored; one case of transient generalised oedema. Treatment was deemed successful in three of the four cases. One child died from renal failure (unrelated to the chemical pleurodesis). Pleurodesis by povidone-iodine appears to be well tolerated and may represent a good alternative to mechanical abrasion or surgery for congenital idiopathic chylothorax. Its use for refractory chylothorax may also decrease the morbidity related to prolonged hospital stay.

[Effects of iodophor on the thyroid glands of female medical workers].

OBJECTIVE: To investigate the long-term effects of iodophor on thyroid function and autoimmunity in females. METHODS: 119 medical personnel who have been using iodophor as preoperative skin disinfectant more for than 2 years and 123 medical personnel who have not exposed to iodophor were studied. The urinary iodine, thyroid-stimulating hormone (TSH), free triiodothyronine (FT(3)), free thyroxine (FT(4)), thyroid peroxydase antibody (TPO-Ab) and TG-Ab in serum were measured and the thyroid were examined by B mode ultrasound apparatus. RESULTS: The median urinary iodine (MUI) was 300.4 micro g/L in the exposed group, not significantly higher than that in the non-exposed group (269.1 micro g/L, P > 0.05). The TSH levels of the exposed group and non-exposed group were 1.66 mU/L and 1.62 mU/L (P = 0.84). B mode ultrasound examination showed that the prevalence rate of thyroid disorders was 3.36% in the exposed group, not significantly different from that in the non-exposed group (2.44%). The thyroid autoantibody positive rate was not significantly different between these two groups too. The titer of autoantibody in the exposed group was 29.5 IU/L, significantly higher than that in the non-exposed group (22.4 IU/L, P = 0.048). The titer of TG-Ab in the exposed group was 21.85 IU/L, not significantly different from that in the non-exposed group (18.7 IU/L, P = 0.542). The mean titer of TPO-Ab in exposed group was 29.5 IU/L, significantly higher than that in non-exposed group (22.4 IU/L, P = 0.048). The total prevalence rate of all sorts of thyroid disorders in the exposed group was 11.76%, significantly higher than that in non-exposed group (4.07%, P = 0.026). The thyroid disorders discovered included clinical hyperthyroidism and subclinical hypothyroidism. CONCLUSION: Using iodophor as preoperative skin disinfectant may result in an increased incidence of thyroid disorders in female medical personnel. Medical personnel with iodophor exposure history should have their thyroid function and thyroid autoimmune status examined regularly.

The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations.

10 cases of contact dermatitis which began during the application of povidone-iodine preparations were examined with patch tests using 2 kinds of povidone-iodine preparations and their ingredients, i.e., povidone-iodine, polyoxyethylene nonylphenyl ether and glycerin, and also the components of povidone-iodine, i.e., iodine and polyvinylpyrrolidone. All 10 cases reacted positively to the povidone-iodine preparations and povidone-iodine, 3 out of the 10 to polyoxyethylene nonylphenyl ether, 1 out of the 9 tested to iodine, while no positive response was found to glycerin or polyvinyl-pyrrolidone. It was difficult to distinguish between allergic responses from irritation, as responses to patches of povidone-iodine and its preparations usually include irritation at high frequencies. Based on comparison of results with a control group, however, those showing + or stronger reactions to 2% povidone-iodine at days 3 to 5 were considered to be allergic. Thus, 4 out of the 10 cases were considered as sensitization to povidone-iodine. Another 3 cases were found to be polyoxyethylene nonylphenyl ether sensitized, and another 1 iodine sensitized, while the patch test reactions of the other 2 were considered to have been elicited by irritation.

Comparison of two pre-surgical skin preparation techniques.

A one-step iodophor skin preparation solution was compared to chlorhexidine gluconate application as a pre-operative skin preparation method in 100 animals undergoing elective ovariohysterectomy. Pre-operative and intra-operative skin cultures demonstrated no difference in antiseptic efficacy. No animal in the study demonstrated signs of systemic infection, and no adverse local effects from either antiseptic were seen. The iodophor solution evaluated (DuraPrep) is a safe and effective pre-operative skin preparation agent in small animal patients undergoing clean surgical procedures.

The influence of long-term treatment with povidone-iodine on thyroid function.

Povidone-iodine (PVP-I) is generally very safe, but cases of thyroid dysfunction induced by PVP-I have been reported. The effect of long-term treatment with PVP-I on thyroid function was to be assessed. In 40 inpatients of the department of neurology, the status of the use of PVP-I preparations and their effects on serum inorganic iodine levels and thyroid functions were investigated. In 27 patients treated with PVP-I for a long term, inorganic iodine levels were significantly increased as compared to those in 13 patients without PVP-I treatment. Out of 27 patients treated with PVP-I in the long term, subclinical hypothroidism was seen in 3 patients, mild hyperthroidism was seen in 1 patient, and subclinical hyperthyroidism was suspected in 7 patients. Patients treated with PVP-I for a long time should be observed carefully for any manifestation of thyroid dysfunction.

Cytotoxicity and sensitization of povidone-iodine and other frequently used anti-infective agents.

Povidone-iodine is an antiseptic widely used in dermatology. In vitro experiments showed a certain cytotoxicity, yet it is not easy to transfer these toxicological data to in vivo circumstances. In vivo investigations in animals and in humans could exclude cytotoxic effects of povidone-iodine, measured by the wound healing process. Only when administered in combination with detergents was an obvious cytotoxicity seen in wounds but not on the intact skin. In comparison to the frequently used antibiotic neomycin, the sensitization rate of povidone-iodine is very low.

Effects of laboratory disinfecting agents on color stability of denture acrylic resins.

This study determined the effects of chemical disinfecting agents on denture acrylic resins. Tested resins included the products CH Lucitone, Triad VLC, and Truliner. The disinfecting agents were sodium hypochlorite, Exspor, Cidex, and Wescodyne-D. Acrylic resin samples were placed in the various disinfecting agents and then evaluated for color changes at time intervals ranging from 15 minutes to 72 hours. No observable color change of any acrylic resin was seen before 2 hours. Both 1% sodium hypochlorite and 2% Cidex disinfectants produced the least discoloration of the acrylic resins, and Wescodyne-D disinfectant produced the most acrylic resin discoloration. Truliner resin discolored more than Triad VLC resin, and both underwent more color change than CH Lucitone resin. If manufacturers' recommended disinfecting times are followed, clinical and laboratory disinfection of acrylic resin dentures should cause no observable color change.

Dimensional stability of impression materials immersed in an iodophor disinfectant.

The potential for disease transmission has increased the importance of infection control in the dental laboratory. Impressions must be disinfected without altering their accuracy. The purpose of this study was to determine the dimensional stability of three impression materials: irreversible hydrocolloid, reversible hydrocolloid, and poly(vinyl siloxane). Thirty-six impressions were made with each material and divided into control, 10-minute, and 30-minute immersion groups using an iodophor as the disinfectant. A microscope was used to measure dimensional changes in the stone casts made from each group of impressions, and the percent change was analyzed using a two-way ANOVA. All dimensional changes after iodophor disinfection were small and within established limits.

Milk iodine as influenced by an iodophor teat dip.

We quantitated the increase of iodine in milk from iodophor teat dips and determined the mode by which that iodine entered the milk. In one trial with teat dipping for 1 wk, iodine in milk increased 8.8 microgram/100 ml. In another trial, only right udder halves were dipped with the iodophor. Samples of milk from the left udder half increased in iodine corresponding to the right udder half only slightly less. Tincture of iodine was applied to the skin between the vulva and the point of udder attachment of cows. Samples of milk from the group with tincture increased markedly in iodine content over the control group. Iodophor teat dips increased the iodine in milk by 8 to 10 microgram/100 ml. The primary mode of increased iodine appears to be absorption through the skin and entry into the milk by the milk synthesis process rather than by contamination from the teat's surface.