Efficacy of quaternary ammonium salt-based disinfectant or chelated copper-zinc footbath solution in the treatment of digital dermatitis on one research dairy farm in Taiwan.

BACKGROUND: Footbaths can be used to manage digital dermatitis (DD), a common cause of lameness in dairy cattle. Copper sulfate and chelated copper-zinc (CZS) solutions in footbaths are potentially harmful to the environment. HYPOTHESIS/OBJECTIVES: To determine if a quaternary ammonium salt-based disinfectant (QASD) footbath is as effective as a chelated CZS solution in controlling DD in dairy cows. ANIMALS: Fifty-one lactating Holstein cows were randomly assigned to one of two treatment groups, with DD status based on the M-stage scoring system and locomotion score balanced between treatment groups. MATERIALS AND METHODS: The groups were treated with a 1% QASD or a 2.5% chelated CZS. Footbaths were performed once per week for 15 weeks. Logistic regression was used to analyse clinical improvement. All cows received appropriate medical treatment for DD and other hoof diseases. RESULTS: Clinical improvement rates were 67% in the QASD group and 38% in the CZS group (p = 0.03). Logistic regression analysis showed that the odds (95% confidence interval) for clinical improvement rate in the CZS group were 0.30 (0.095-0.948) times that of the QASD group (p = 0.04). The M0 score in the QASD and CZS groups increased significantly (p < 0.05) at the end of the 15 week study period. In the QASD group, the proportion of M2, M3 and M4 scores were significantly decreased (p < 0.05). CONCLUSION AND CLINICAL RELEVANCE: Over a 15 week period, QASD for footbathing was associated with a lower prevalence of active DD lesions than when using CZS.

Electrolysed oxidising water as a multi-purpose biocide in dental healthcare-A scoping review.

OBJECTIVES: The objective of this scoping review was to map evidence of electrolysed oxidising water (EOW) as a biocide for dental applications of relevance to older people and identify research gaps. BACKGROUND: EOW is an emerging, "green," and cost-effective biocide. There are no reviews on the landscape of EOW research as either an antiseptic or disinfectant in dental healthcare or its suitability for the oral healthcare of older people. MATERIALS AND METHODS: The review follows the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Database searches (Google Scholar, PubMed, Web of Science, Ovid, Scopus and Science Direct) were undertaken using MESH terms and Boolean operators with no date restrictions, to identify full-text, original reports published in English-language peer-reviewed journals. RESULTS: The search yielded 114 papers that met the inclusion/exclusion criteria. Dental applications of EOW include its use as an endodontic irrigant (39%); mouth rinse/surgical irrigant (21%); disinfectant for dental unit water lines (19%) and dental biomaterials (17%); and for antimicrobial efficacy, effects on oral tissues and on dental material properties. Most studies (83%) evaluated a single EOW formulation (acidic, moderately acidic or neutral) that was either generated at 'point-of-use' (POU; 72%), bottled ('ready-to-use', RTU; 24%) or from unspecified (3%) sources. Six reports evaluated storage-related parameters and 25 evaluated clinical applications; 89 were in vitro studies and one investigated the cost-effectiveness of POU EOW. CONCLUSIONS: Neutral-pH, EOW is effective as an antimicrobial agent without deleterious effects on oral tissues. However, research on the impact of storage conditions, anti-Candida biofilm efficacy and mechanism of action against yeasts, long-term effects on denture materials and cost-effectiveness is required to establish the suitability of EOW as a multipurpose biocide for dental healthcare, including infection-control requirements relating to older people.

Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models.

OBJECTIVE: Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions. METHOD: Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified. RESULTS: The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered. CONCLUSION: This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.

TB patients: Is sputum disinfection important?

BACKGROUND: Patients with pulmonary tuberculosis (TB) may produce large amount of infectious sputum which needs to be handled carefully both in health care and household settings. As mycobacteria may survive for long duration in sputum; proper collection, disinfection and disposal is necessary to avoid potential disease transmission. We aimed to assess the efficacy of bedside disinfectant treatment of sputum produced by TB patients using easily available disinfectants that can be used both in TB wards and household settings, to sterilize the infected sputum and compared it with sputum without disinfectant treatment. METHODS: It was a prospective case control study. Sputum of total 95 patients with sputum smear positive pulmonary tuberculosis was collected in sputum containers with lids. Patients on anti-tubercular treatment for more than 2 weeks were excluded. Each patient was given 3 sterile sputum containers to expectorate, Container A containing 5% Phenol solution, Container B containing 4.8% Chloroxylenol and Container C without any disinfectant, acting as a control. Thick sputum was liquified with Mucolytic agent N-acetyl cysteine (NAC). Aliquots of the sputum were sent for culture in Lowenstein-Jensen medium on day 0 (to confirm alive mycobacteria) and on day 1 i.e., after 24 hours (to evaluate effective sterilization). Drug resistance testing was done on all grown mycobacteria. RESULTS: If the samples on day 0 did not grow mycobacteria (indicating non-viable mycobacteria) or day 1 sample grew contaminants in any of the three containers, they were excluded from the analysis (15/95). In remaining 80 patients, bacilli were alive on day 0 and remained alive even after 24 hours (day 1) in control samples (without disinfectants). The sputum was effectively disinfected resulting in no growth after 24 hours (day 1) in 71/80 (88.75%) containing 5% Phenol and 72/80 (90%) with 4.8% Chloroxylenol. The efficacy of disinfection was 71/73 (97.2%) and 72/73 (98.6%) for drug sensitive mycobacteria respectively. The mycobacteria however remained alive with these disinfectants in all 7 samples of drug-resistant mycobacteria with an efficacy of 0%. CONCLUSION: We recommend use of simple disinfectants like 5% Phenol or 4.8% Chloroxylenol for safe disposal of sputum of pulmonary tuberculosis patients. It is necessary as sputum collected without disinfection remained infectious after 24 hours. Resistance of all drug resistant mycobacteria to disinfectants was a novel chance finding. This needs further confirmatory studies.

Bacterial drug-resistance and viability phenotyping upon disinfectant exposure revealed by single-nucleotide resolved-allele specific isothermal RNA amplification.

Disinfectant abuse poses a risk of bacterial evolution against stresses, especially during the coronavirus disease 2019 (COVID-19) pandemic. However, bacterial phenotypes, such as drug resistance and viability, are hard to access quickly. Here, we reported an allele specific isothermal RNA amplification (termed AlleRNA) assay, using an isothermal RNA amplification technique, i.e., nucleic acid sequence-based amplification (NASBA), integrated the amplification refractory mutation system (ARMS), involving the use of sequence-specific primers to allow the amplification of the targets with complete complementary sequences. AlleRNA assay enables rapid and simultaneous detection of the single nucleotide polymorphism (SNP) (a detection limit, a LOD of 0.5 % SNP) and the viability (a LOD of 80 CFU) of the quinolone resistant Salmonella enterica. With the use of AlleRNA assay, we found that the quinolone resistant S. enterica exhibited higher survival ability during exposure toquaternary ammonium salt, 75 % ethanol and peracetic acid, which might be attributed to the upregulation of stress response-associated genescompared with the susceptible counterparts. Additionally, the AlleRNA assay indicated the potential risk in a high-frequency occurrence of viable but nonculturable (VBNC) quinolone resistant S. enterica induced by disinfectants due to the depression of ATP biosynthesis. The excessive usage of disinfectants during the COVID-19 pandemic should be carefully evaluated due to the latent threat to ecological and human health.

Effect of cavity disinfection protocols on microtensile bond strength of universal adhesive to dentin / Efecto de los protocolos de desinfección de cavidades en la fuerza de adhesión microtensil del adhesivo universal a la dentina

Abstract The purpose of this study was to compare the effect of different disinfection protocols of dentin on bond strength of an MDP-containing universal adhesive. Twelve extracted mandibular third molars were separated horizontally at the mid-coronal of crown to get smooth and sound dentin surfaces using low-speed diamond saw. The teeth were randomly fallen into four groups: chlorhexidine (CHX), ozone, Er,Cr:YSGG laser irradiation (LASER) and no treatment (control). After cavity disinfection application, a universal adhesive (G-Premio Bond) was applied to the surface of dentin according to self-etch mode as instructed by the manufacturer. After incremental built-up of composite resin (Charisma Smart), the specimens were immersed in distilled water at 37°C for 24h. Dentin/composite beams with 1 mm² cross sectional area were produced and micro-tensile bond strength (µTBS) was applied on these beams (n=20). Failure mods were determined under a stereomicroscope at ×40. The resin penetration of samples stained with Rhodamine B fluorochrome dye was examined with a confocal laser scanning microscope. Statistical analysis was performed with SPSS-22. Test results were analyzed using One-way Anova and Tukey HSD Post-Hoc tests (p0.5). All applications of cavity disinfection procedures decreased the µTBS of the resin-dentin interface.

Resumen El propósito de este estudio fue comparar el efecto de diferentes protocolos de desinfección de la dentina sobre la fuerza de unión de un adhesivo universal que contiene MDP. Doce terceros molares mandibulares extraídos se quebraron horizontalmente en la mitad de la corona para obtener superficies de dentina lisas y sólidas utilizando una sierra de diamante de baja velocidad. Los dientes se dividieron aleatoriamente en cuatro grupos: clorhexidina (CHX), ozono, irradiación con láser Er,Cr:YSGG (LASER) y ningún tratamiento (control). Después de la aplicación de la desinfección de la cavidad, se aplicó un adhesivo universal (G-Premio Bond) a la superficie de la dentina según el modo de autograbado indicado por el fabricante. Después de la obturación con resina compuesta (Charisma Smart), las muestras se sumergieron en agua destilada a 37°C durante 24h. Se produjeron porciones de dentina/resina con un área de sección transversal de 1 mm² y se aplicó una fuerza de adhesión microtensile (µTBS) (n=20). Los modos de falla se determinaron bajo un microscopio estereoscópico a ×40. La penetración de la resina de las muestras teñidas con colorante fluorocromo rodamina B se examinó con un microscopio de barrido láser confocal. El análisis estadístico se realizó con SPSS-22. Los resultados de las pruebas se analizaron utilizando las pruebas post-hoc Anova unidireccional y Tukey HSD (p0.5). Todas las aplicaciones de procedimientos de desinfección de cavidades redujeron el µTBS de la interfaz resina-dentina.

Impact of the COVID-19 pandemic on TB services at ART programmes in low- and middle-income countries: a multi-cohort survey.

INTRODUCTION: COVID-19 stretched healthcare systems to their limits, particularly in settings with a pre-existing high burden of infectious diseases, including HIV and tuberculosis (TB). We studied the impact of COVID-19 on TB services at antiretroviral therapy (ART) clinics in low- and middle-income countries. METHODS: We surveyed ART clinics providing TB services in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in Africa and the Asia-Pacific until July 2021 (TB diagnoses until the end of 2021). We collected site-level data using standardized questionnaires. RESULTS: Of 46 participating ART clinics, 32 (70%) were in Africa and 14 (30%) in the Asia-Pacific; 52% provided tertiary care. Most clinics (85%) reported disrupted routine HIV care services during the pandemic, both in Africa (84%) and the Asia-Pacific (86%). The most frequently reported impacts were on staff (52%) and resource shortages (37%; protective clothing, face masks and disinfectants). Restrictions in TB health services were observed in 12 clinics (26%), mainly reduced access to TB diagnosis and postponed follow-up visits (6/12, 50% each), and restrictions in TB laboratory services (22%). Restrictions of TB services were addressed by dispensing TB drugs for longer periods than usual (7/12, 58%), providing telehealth services (3/12, 25%) and with changes in directly observed therapy (DOT) (e.g. virtual DOT, 3/12). The number of TB diagnoses at participating clinics decreased by 21% in 2020 compared to 2019; the decline was more pronounced in tertiary than primary/secondary clinics (24% vs. 12%) and in sites from the Asia-Pacific compared to Africa (46% vs. 14%). In 2021, TB diagnoses continued to decline in Africa (-8%) but not in the Asia-Pacific (+62%) compared to 2020. During the pandemic, new infection control measures were introduced or intensified at the clinics, including wearing face masks, hand sanitation and patient triage. CONCLUSIONS: The COVID-19 pandemic led to staff shortages, reduced access to TB care and delays in follow-up visits for people with TB across IeDEA sites in Africa and the Asia-Pacific. Increased efforts are needed to restore and secure ongoing access to essential TB services in these contexts.

Effect of Dentin-Disinfection Chemicals on Shear Bond Strength and Microhardness of Resin-Infiltrated Human Dentin in Different Adhesive Protocols.

Background and Objectives: Bacteria and its remnants beneath the restorations predispose the tooth to secondary caries and pulpal pathology. Hence, various chemical antibacterial agents are suggested to disinfect the prepared tooth structure before the definitive restorative procedure. This study aimed to investigate the effects of chemical disinfectant solutions on the micro-shear bond strength (µSBS) and microhardness of total-etch and self-etch resin-infiltrated human dentin. Materials and Methods: 100 caries-free intact permanent third molar teeth were vertically sectioned into the buccal and lingual half. All these specimens were mounted on acrylic resin and underlying dentin surfaces were exposed by grinding. Samples were randomly divided into five groups [n = 20] following total-etch and self-etch adhesive protocol. Teeth samples were divided according to surface treatment, as Group I (Control-CNT), Group II (2% chlorhexidine-CHX), Group III (5.25% sodium hypochlorite-NaOCl), Group IV (17% ethylenediaminetetraacetate acid­EDTA) and Group V (10% povidone iodine-PVI). A randomly selected 10 samples from each subgroup were used for µSBS and microhardness tests. After surface treatment and bonding procedure, nono-hybrid composite cylinders with a 3-mm diameter and 2-mm height were directly cured over the dentin substrate. The samples for µSBS were subjected to 5000 thermocycles and tested using a universal testing machine. Microhardness was assessed using a micro-indenter instrument, data were statistically analyzed using a one-way analysis of variance and Tukey HSD tests at p < 0.05. Results: Amongst the chemical disinfectant assessed, 2% CHX did not affect µSBS and produced a marginal reduction in dentin microhardness compared to the control group. The 5.25% NaOCl and 17% EDTA significantly compromised the microhardness of the dentin substrate. Meanwhile, 10% PVI surface treatment resulted in a substantial reduction in µSBS between composite and dentin. Conclusions: CHX with preservation of bonding to dentin and insignificant negative effect on dentin microhardness is a safe option for tooth disinfection.

Mosapride Citrate Combined with Divine Qu Disinfectant Oral Liquid for Children Function Dyspepsia and the Influence of Serum Factors.

In order to investigate the efficacy of mosapril citrate combined with ShenQu Xiaoshi oral liquid in the treatment of children with functional dyspepsia and the effect on serum cytokines, 136 children with functional dyspepsia admitted from May 2017 to September 2020 were divided into 2 groups randomly, 68 cases in each group. The western medicine group was treated with mosapril citrate tablets, and the combined group was treated with Shenqu xiaoshi oral liquid on the basis of the western medicine group. The efficacy of patients was evaluated 14 days after treatment, and the safety, symptom score, and serum cytokines of the two groups were compared. The results showed that, after 14 days of treatment, the scores of abdominal distension and abdominal pain (ADAP), lack of food (LOF), nausea and vomiting (NAV), irregular stool (IS), and mental fatigue (MF) in the combined group were all lower than those in the western group (P < 0.05). There was no statistical significance in the incidence of diarrhea, abnormal liver and kidney, and allergic rash between the two groups (p > 0.05). In conclusion, mosapride citrate tablets combined with Shenqu Xiaoshi oral liquid can achieve good therapeutic effects in children with functional dyspepsia, reduce symptom scores, improve serum cytokine levels, and have high drug safety, which is worthy of promotion and application.

Association between consumption of antibiotics, infection control interventions and Clostridioides difficile infections: Analysis of six-year time-series data in a tertiary-care hospital in Greece.

BACKGROUND: To investigate the association between Clostridioides difficile infection (CDI), antibiotic use, and infection control interventions, during an antibiotic stewardship program (ASP) implemented in a tertiary-care hospital in Greece from 2013 to 2018. METHODS: Analysis was applied for the following monthly indices: 1. consumption of antibiotics; 2. use of hand hygiene disinfectant solutions; 3. percentage of isolations of patients either with multidrug-resistant (MDR) bacteria, or CDI, or admitted from another hospital; and 4. percentage of patients with CDI divided into two groups: community-acquired CDI (CACDI) and hospital-associated CDI (HACDI) (onset ≤72 h and >72 h after admission, respectively). RESULTS: During the study, a significant reduction in CACDI rate from 0.3%/admissions [95% CI 0.1-0.6] to 0.1%/admissions [95% CI 0.0-0.3] (p-value = 0.035) was observed in adults ICU, while CDI rates were stable in the rest of the hospital. Antibiotic consumption showed a significant reduction in total hospital, from 91.7 DDDs [95% CI 89.7-93.7] to 80.1 DDDs [95% CI 79.1-81.1] (p-value<0.001), except adults ICU. Non-advanced antibiotics correlated with decreased CDI rates in Adults Clinic Departments and ICU. Isolation of patients one and two months earlier correlated with decreased CACDI rates per 20% [95% CI 0.64-1.00, p-value = 0.046] and HACDI per 23% [95% CI 0.60-1.00, p-value = 0.050] in Adults Clinic Departments. Consumption of disinfectant solutions current month correlated with decreased rate for CACDI per 33% [95% CI 0.49-0.91, p-value = 0.011] and HACDI per 38% [95% CI 0.40-0.98, p-value = 0.040] in total Hospital Clinics. CONCLUSION: Rational antibiotic prescribing during ASP along with multipronged intervention strategy focusing on hand hygiene and patient isolation measures prevent and control CDI outbreaks in the hospital setting.

Photonic Hydrogels for Synergistic Visual Bacterial Detection and On-Site Photothermal Disinfection.

Rapid and sensitive diagnostics in the early stage of bacterial infection and immediate treatment play critical roles in the control of infectious diseases. However, it remains challenging to develop integrated systems with both rapid detection of bacterial infection and timely on-demand disinfection ability. Herein, we demonstrate a photonic hydrogel platform integrating visual diagnosis and on-site photothermal disinfection by incorporating Fe3O4@C nanoparticles into a poly(hydroxyethyl methacrylate)-co-polyacrylamide (PHEMA-co-PAAm) matrix. In vitro experiments demonstrate that such a hydrogel can respond to pH variation caused by bacterial metabolism and generate the corresponding color changes to realize naked-eye observation. Meanwhile, its excellent photothermal conversion ability enables it to effectively kill bacteria by destroying cell membranes under near-infrared irradiation. Moreover, the pigskin infection wound model also verifies the bacterial detection performance and disinfection ability of the hydrogel in vivo. Our strategy demonstrates a new approach for visual diagnosis and treatment of bacterial infections.

Bioseguridad en el laboratorio dental / Biosafety in the dental laboratory

Una enfermedad infecciosa es aquella producida por un agente infeccioso (bacterias, hongos, virus, etc.) que ingresa y se desarrolla en el organismo de un hospedero. Posteriormente, puede trasmitirse de un individuo a otro directamente por contacto entre ambos, o bien, indirectamente, por medio de un vec-tor biológico (de naturaleza animal o vegetal), o de un fómite (objeto inanimado). Las vías por las que un agente infeccioso puede ingresar a un hospedero son: inhalación (respiración de aerosoles), ingestión (salpicaduras de gotas), penetración de mucosas (na-sal, ocular y bucal) o lesiones en la piel o mucosas. Las fuentes de infección pueden ser los pacientes, el personal del consultorio o laboratorio, las superficies e instrumental contaminados y las prótesis o com-ponentes de éstas. Para evitar la propagación de los agentes microbianos se debe interrumpir el proceso de transmisión de los mismos. Todo profesional debe fortalecer y readecuar normas y protocolos de biose-guridad en la tarea diaria, para minimizar el riesgo de transmisión directa y cruzada entre el profesional, su equipo auxiliar, el laboratorista y los pacientes (AU)

An infectious disease is one caused by an infectious agent (bacteria, fungi, virus, etc.) that enters and develops in a host. Then it can be transmitted from one individual to another directly by contact between the two or, indirectly through a biological vector (an animal or plant nature), or a fomite (an inanimate object). The routes by which an infectious agent can enter a host are: inhalation (breathing of aerosols), ingestion (splash of droplets), penetration of mucous membranes (nasal, ocular and oral) and skin or mucous lesions. Sources of infection can be patients, office or laboratory personnel, contaminated surfaces and instruments and the prosthesis or component thereof. To prevent the spread of microbial agents, the process of their transmission must be interrupted. Every professional must strengthen and readjust biosafety standards and protocols in daily work to minimize the risk of direct and cross-transmission between the professional, his auxiliary team, the laboratory technician and the patients (AU)

A program to improve the quality of dental unit water in a medical center.

ABSTRACT: The water quality of dental unit waterlines (DUWLs) is associated with patient safety. No program for DUWL water quality improvement has been formulated since the time they were established 20 years ago. This study provides an improvement program for the quality of dental unit water. The improvement program was implemented step by step: discharge of DUWLs for 5 minutes in the morning before clinical service to flush out the water left in the pipeline overnight; weekly disinfection of the handpiece connector with 75% alcohol and replacement of the old connector when the water quality of the same dental chair unit (DCU) was continuously found to be unqualified; monthly disinfection of the water supply system and pipeline; and establishment of DCU maintenance work standards and staff education and training. From 2016 to 2018, the water quality of 18 DCUs was tested by microorganism culture. The colonies >200 colony forming unit were categorized as unqualified. This program was divided into a pre-test phase, Phase 1, a maintenance phase, and Phase 2. A Chi-square test was used to calculate the difference of unqualified water quality numbers between each phase of the improvement program. In the pre-test phase, the water quality rate (high quality number/high-quality number + low-quality number) was 58.3%. In Phase 1, the quality rate before and after the intervention was 64.8% (35/54) and 92.2% (83/90) (P < .001), respectively. After Phase 1, the quality rate reached 100%. However, the quality rate dropped to 75% during the maintenance phase. Then, we proceeded into Phase 2 of the improvement program by further monthly disinfection to DUWLs. In Phase 2, the quality rate was 62/73 (84.9%) and improved to 142/144 (98.6%) after the intervention (P < .001). The quality rate reached 100% once again and was maintained at 100% thereafter. In conclusion, the 4 steps of the improvement program improved the water quality of the DUWL, which is important for patient safety.

Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: a meta-analysis and systematic review.

BACKGROUND: Although several meta-analyses reported the impact of chlorhexidine (CHX) use in patients undergoing various types of surgery, no meta-analysis summarized the overall effectiveness of CHX specifically for cardiac surgery. This meta-analysis aimed to examine the impact of CHX on infections after cardiac surgery compared with other cleansers or antiseptics. METHODS: PubMed, Embase, and the Cochrane Library were searched from inception up to October 2020 for potentially eligible studies: (1) population: patients who underwent cardiac surgery; (2) intervention or exposure: any type of CHX use in the treatment or exposed group; (3) outcome: number of patients with infections; (4) comparison: placebo or other antiseptic agents; (5) English. The primary outcome was surgical site infection (SSI). RESULTS: Fourteen studies were included, with 8235 and 6901 patients in the CHX and control groups. CHX was not protective against SSI (OR = 0.77, 95% CI: 0.57-1.04, P = 0.090). CHX was protective for superficial wound infection (OR = 0.42, 95% CI: 0.26-0.70, P = 0.001), but not with deep wound infection (P = 0.509). CHX was not protective against urinary tract of infection (P = 0.415) but was protective for bloodstream infection (OR = 0.36, 95% CI: 0.16-0.80, P = 0.012), nosocomial infections (OR = 0.55, 95% CI: 0.44-0.69, P < 0.001), and pneumonia (OR = 0.26, 95% CI: 0.11-0.61, P = 0.002). CONCLUSIONS: In patients undergoing cardiac surgery, CHX does not protect against SSI, deep wound infection, and urinary tract infections but might protect against superficial SSI, bloodstream infection, nosocomial infections, and pneumonia.

Combined Phialemonium curvatum and Acanthamoeba Keratitis: The Importance of Early Diagnosis and Specific Therapy.

PURPOSE: To report the clinical and confocal findings of a unique case of combined Phialemonium curvatum and Acanthamoeba keratitis and to highlight the role of the prompt diagnosis and specific medical treatment in preserving visual function. METHODS: A case report and literature review. RESULTS: A 54-year-old woman presented with a 3-day history of visual impairment, photophobia, and ocular pain in her right eye. Her best corrected visual acuity was 0.4 Logarithm of the Minimum Angle of Resolution scale, and the slit-lamp examination showed whitish corneal stromal infiltrate with satellite lesions. In vivo confocal microscopy evidenced Acanthamoeba cysts and fungal hyphae that resulted P. curvatum in the culture examination. The intensive medical treatment was started with topical 0.02% polyhexamethylene biguanide, voriconazole 1%, and moxifloxacin hydrochloride 0.5%. Progressive improvement of clinical and confocal pictures was registered with a complete recovery of visual function after 1 month. CONCLUSIONS: This is the first case report of combined P. curvatum and Acanthamoeba keratitis. The fast diagnosis with in vivo confocal microscopy allowed early and intensive specific treatment with recovery of corneal infection.

Rapid and Repetitive Inactivation of SARS-CoV-2 and Human Coronavirus on Self-Disinfecting Anionic Polymers.

While the ongoing COVID-19 pandemic affirms an urgent global need for effective vaccines as second and third infection waves are spreading worldwide and generating new mutant virus strains, it has also revealed the importance of mitigating the transmission of SARS-CoV-2 through the introduction of restrictive social practices. Here, it is demonstrated that an architecturally- and chemically-diverse family of nanostructured anionic polymers yield a rapid and continuous disinfecting alternative to inactivate coronaviruses and prevent their transmission from contact with contaminated surfaces. Operating on a dramatic pH-drop mechanism along the polymer/pathogen interface, polymers of this archetype inactivate the SARS-CoV-2 virus, as well as a human coronavirus surrogate (HCoV-229E), to the minimum detection limit within minutes. Application of these anionic polymers to frequently touched surfaces in medical, educational, and public-transportation facilities, or personal protection equipment, can provide rapid and repetitive protection without detrimental health or environmental complications.

Use of low-frequency contact ultrasonic debridement with and without polyhexamethylene biguanide in hard-to-heal leg ulcers: an RCT protocol.

OBJECTIVE: The purpose of this research is to investigate the effect of low-frequency contact ultrasonic debridement therapy (LFCUD) in hard-to-heal wounds with suspected biofilm, and compare the effect with or without a surfactant antimicrobial on bacterial colony counts and wound healing rates. METHOD: A single-blinded randomised controlled trial (RCT) will investigate the combination of LFCUD and the antiseptic polyhexamethylene biguanide with a surfactant betaine (referred to in this paper as PHMB) as a topical solution post-treatment and in a sustained dressing, compared with use of LFCUD alone. Potential participants from a community wound clinic (n=50) will be invited to take part in the 12-week trial. Wound swabs and tissue samples will be analysed for bacterial type and quantity, before and after treatments, using traditional culture techniques and advanced molecular methods. Wound healing, pain, quality of life and biofilm (via a specifically designed tool) will also be measured. DISCUSSION: Bacteria have the potential to cause a hard-to-heal wound, particularly when antibiotics are too frequently and unnecessarily prescribed, resulting in antibiotic-resistant microorganisms. Appropriate care is vital when caring for hard-to-heal wounds to avoid these scenarios. With no simple laboratory method available to identify or treat wound biofilm, clinicians rely on their expertise in wound management. This study aims to provide in vivo evidence on the effectiveness of PHMB, to prevent the reformation of biofilm when applied after LFCUD. The aim is to provide evidence-based and more cost-effective wound care.

Wound cleansing for treating venous leg ulcers.

BACKGROUND: Leg ulcers are open skin wounds that occur below the knee but above the foot. The majority of leg ulcers are venous in origin, occurring as a result of venous insufficiency, where the flow of blood through the veins is impaired; they commonly arise due to blood clots and varicose veins. Compression therapy, using bandages or stockings, is the primary treatment for venous leg ulcers. Wound cleansing can be used to remove surface contaminants, bacteria, dead tissue and excess wound fluid from the wound bed and surrounding skin, however, there is uncertainty regarding the effectiveness of cleansing and the best method or solution to use. OBJECTIVES: To assess the effects of wound cleansing, wound cleansing solutions and wound cleansing techniques for treating venous leg ulcers. SEARCH METHODS: In September 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or RCTs comparing different wound cleansing solutions, or different wound cleansing techniques. DATA COLLECTION AND ANALYSIS: We screened studies for their appropriateness for inclusion, assessed their risk of bias using the Cochrane 'Risk of bias' tool, and used GRADE methodology to determine the certainty of evidence. Two review authors undertook these tasks independently, using predetermined criteria. We contacted study authors for missing data where possible. MAIN RESULTS: We included four studies with a total of 254 participants. All studies included comparisons between different types of cleansing solutions, and three of these reported our primary outcomes of complete wound healing or change in ulcer size over time, or both. Two studies reported the secondary outcome, pain. One study (27 participants), which compared polyhexamethylene biguanide (PHMB) solution with saline solution for cleansing venous leg ulcers, did not report any of the review's primary or secondary outcomes. We did not identify any studies that compared cleansing with no cleansing, or that explored comparisons between different cleansing techniques. One study (61 participants) compared aqueous oxygen peroxide with sterile water. We are uncertain whether aqueous oxygen peroxide makes any difference to the number of wounds completely healed after 12 months of follow-up (risk ratio (RR) 1.88, 95% confidence interval (CI) 1.10 to 3.20). Similarly, we are uncertain whether aqueous oxygen peroxide makes any difference to change in ulcer size after eight weeks of follow-up (mean difference (MD) -1.38 cm2, 95% CI -4.35 to 1.59 cm2). Finally, we are uncertain whether aqueous oxygen peroxide makes any difference to pain reduction, assessed after eight weeks of follow-up using a 0 to 100 pain rating, (MD 3.80, 95% CI -10.83 to 18.43). The evidence for these outcomes is of very low certainty (we downgraded for study limitations and imprecision; for the pain outcome we also downgraded for indirectness). Another study (40 participants) compared propyl betaine and polihexanide with a saline solution. The authors did not present the raw data in the study report so we were unable to conduct independent statistical analysis of the data. We are uncertain whether propyl betaine and polihexanide make any difference to the number of wounds completely healed, change in ulcer size over time, or wound pain reduction. The evidence is of very low certainty (we downgraded for study limitations and imprecision). The final study (126 participants) compared octenidine dihydrochloride/phenoxyethanol (OHP) with Ringer's solution. We are uncertain whether OHP makes any difference to the number of wounds healed (RR 0.96, 95% CI 0.53 to 1.72) or to the change in ulcer size over time (we were unable to conduct independent statistical analysis of available data). The evidence is of very low certainty (we downgraded for study limitations and imprecision). None of the studies reported patient preference, ease of use of the method of cleansing, cost or health-related quality of life. In one study comparing propyl betaine and polihexanide with saline solution the authors do not report any adverse events occurring. We are uncertain whether OHP makes any difference to the number of adverse events compared with Ringer's solution (RR 0.58, 95% CI 0.29 to 1.14). The evidence is of very low certainty (we downgraded for study limitations and imprecision). AUTHORS' CONCLUSIONS: There is currently a lack of RCT evidence to guide decision making about the effectiveness of wound cleansing compared with no cleansing and the optimal approaches to cleansing of venous leg ulcers. From the four studies identified, there is insufficient evidence to demonstrate whether the use of PHMB solution compared with saline solution; aqueous oxygen peroxide compared with sterile water; propyl betaine and polihexanide compared with a saline solution; or OHP compared with Ringer's solution makes any difference in the treatment of venous leg ulcers. Evidence from three of the studies is of very low certainty, due to study limitations and imprecision. One study did not present data for the primary or secondary outcomes. Further well-designed studies that address important clinical, quality of life and economic outcomes may be important, based on the clinical and patient priority of this uncertainty.

ANTECEDENTES: Las úlceras de la pierna son heridas cutáneas abiertas que se producen por debajo de la rodilla, pero por encima del pie. La mayoría de las úlceras de la pierna son de origen venoso, y se producen como resultado de la insuficiencia venosa, en la que el flujo de sangre a través de las venas se ve afectado; suelen surgir debido a coágulos de sangre y venas varicosas. El tratamiento de compresión (vendas o medias) es el tratamiento principal para las úlceras venosas de la pierna. La limpieza de la herida se puede utilizar para eliminar los contaminantes superficiales, las bacterias, el tejido muerto y el exceso de líquido de la base de la úlcera y de la piel circundante; sin embargo, no se sabe con certeza cuál es la efectividad de la limpieza ni cuál es el mejor método o solución a utilizar. OBJETIVOS: Evaluar los efectos de la limpieza de heridas, las soluciones de limpieza de heridas y las técnicas de limpieza de heridas para el tratamiento de las úlceras venosas de la pierna. MÉTODOS DE BÚSQUEDA: En septiembre de 2019 se hicieron búsquedas en el Registro especializado del Grupo Cochrane de Heridas (Cochrane Wounds Group), en el Registro Cochrane central de ensayos controlados (CENTRAL); Ovid MEDLINE (incluido In­Process & Other Non­Indexed Citations); Ovid Embase y EBSCO CINAHL Plus. También se buscaron estudios en curso y no publicados en los registros de ensayos clínicos, y se examinaron las listas de referencias de los estudios incluidos pertinentes, así como de las revisiones, los metanálisis y los informes de tecnología sanitaria para identificar estudios adicionales. No hubo restricciones en cuanto al idioma, la fecha de publicación ni el contexto de los estudios. CRITERIOS DE SELECCIÓN: Se consideraron los ensayos controlados aleatorizados (ECA) que compararon la limpieza de heridas con ninguna limpieza de heridas, o ECA que compararon diferentes soluciones de limpieza de heridas o diferentes técnicas de limpieza de heridas. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Se examinaron los estudios para determinar si eran adecuados para inclusión, el riesgo de sesgo se evaluó mediante la herramienta Cochrane "Risk of bias" y se utilizó el método GRADE para determinar la certeza de la evidencia. Dos autores de la revisión realizaron estas tareas de forma independiente, utilizando criterios predeterminados. Cuando fue posible, se estableció contacto con los autores de los estudios para obtener los datos faltantes. RESULTADOS PRINCIPALES: Se incluyeron cuatro estudios con un total de 254 participantes. Todos los estudios incluyeron comparaciones entre diferentes tipos de soluciones de limpieza, y tres de ellos informaron sobre los desenlaces principales de esta revisión, cicatrización completa de la herida o cambio en el tamaño de la úlcera con el tiempo, o ambos. Dos estudios informaron sobre el desenlace secundario de dolor. Un estudio (27 participantes), que comparó la solución de polihexametileno biguanida (PHMB) con el suero fisiológico para la limpieza de las úlceras venosas de la pierna, no informó sobre ninguno de los desenlaces principales ni secundarios de la revisión. No se identificaron estudios que compararan la limpieza con ninguna limpieza, o que explorara comparaciones entre diferentes técnicas de limpieza. Un estudio (61 participantes) comparó el peróxido de oxígeno acuoso con el agua estéril. No hay certeza de que el peróxido de oxígeno acuoso suponga alguna diferencia en el número de heridas completamente cicatrizadas tras 12 meses de seguimiento (razón de riesgos [RR] 1,88; intervalo de confianza [IC] del 95%: 1,10 a 3,20). Del mismo modo, no hay certeza de que el peróxido de oxígeno acuoso suponga alguna diferencia en el cambio del tamaño de la úlcera tras ocho semanas de seguimiento (diferencia de medias [DM] ­1,38 cm2; IC del 95%: ­4,35 a 1,59 cm2). Por último, no hay certeza de que el peróxido de oxígeno acuoso suponga alguna diferencia en la reducción del dolor, evaluada tras ocho semanas de seguimiento mediante una calificación del dolor de 0 a 100 (DM 3,80; IC del 95%: ­10,83 a 18,43). La evidencia para estos desenlaces es de certeza muy baja (se disminuyó la calificación por las limitaciones del estudio y la imprecisión; para el desenlace dolor también se disminuyó la calificación por medidas indirectas). Otro estudio (40 participantes) comparó la propil betaína y la polihexanida con una solución salina. Los autores no presentaron los datos brutos en el informe del estudio, por lo que no fue posible realizar un análisis estadístico independiente de los datos. No se sabe si la propil betaína y la polihexanida suponen alguna diferencia en el número de heridas completamente cicatrizadas, en el cambio del tamaño de la úlcera con el tiempo o en la reducción del dolor de la herida. La evidencia es de certeza muy baja (se disminuyó por las limitaciones del estudio y la imprecisión). El último estudio (126 participantes) comparó el dihidrocloruro de octenidina/fenoxietanol (OHP) con la solución de Ringer. No hay certeza de que el OHP suponga alguna diferencia en el número de heridas cicatrizadas (RR 0,96; IC del 95%: 0,53 a 1,72) ni en el cambio del tamaño de la úlcera con el tiempo (no fue posible realizar un análisis estadístico independiente de los datos disponibles). La evidencia es de certeza muy baja (se disminuyó por las limitaciones del estudio y la imprecisión). Ninguno de los estudios informó sobre la preferencia de los pacientes, la facilidad de uso del método de limpieza, el coste o la calidad de vida relacionada con la salud. En un estudio en el que se compara la propil betaína y la polihexanida con la solución salina, los autores no informaron la aparición de eventos adversos. No hay certeza de que el OHP suponga alguna diferencia en el número de eventos adversos en comparación con la solución de Ringer (RR 0,58; IC del 95%: 0,29 a 1,14). La evidencia es de certeza muy baja (se disminuyó por las limitaciones del estudio y la imprecisión). CONCLUSIONES DE LOS AUTORES: En la actualidad se carece de evidencia de ECA para guiar la toma de decisiones sobre la efectividad de la limpieza de heridas en comparación con ninguna limpieza y los enfoques óptimos para la limpieza de las úlceras venosas de la pierna. A partir de los cuatro estudios identificados, no hay evidencia suficiente para demostrar si el uso de la solución PHMB en comparación con el suero fisiológico; el peróxido de oxígeno acuoso en comparación con el agua estéril; la betaína propil y la polihexanida en comparación con un suero fisiológico; o el OHP en comparación con la solución de Ringer supone alguna diferencia en el tratamiento de las úlceras venosas de la pierna. La evidencia de tres de los estudios es de certeza muy baja, debido a las limitaciones de los estudios y a la imprecisión. Un estudio no presentó datos para los desenlaces principales ni secundarios. Podría ser importante realizar más estudios bien diseñados que aborden desenlaces clínicos, de calidad de vida y económicos importantes, sobre la base de la prioridad clínica y para el paciente de esta falta de certeza.

Using a Data-Driven Improvement Methodology to Decrease Surgical Site Infections in a Community Neurosurgery Practice: Optimizing Preoperative Screening and Perioperative Antibiotics.

OBJECTIVE: We used a data-driven methodology to decrease the departmental surgical site infection rate to a goal of 1%. METHODS: A prospective interventional study with historical controls comparing preimplementation/intervention (unknown methicillin-sensitive Staphylococcus aureus [MSSA]/methicillin-resistant Staphylococcus aureus [MRSA] status and standard weight and drug allergy-based preoperative antibiotics) with postimplementation/intervention (optimized preoperative chlorhexidine showers, MSSA/MRSA screening, MSSA/MRSA decolonization, and optimized preoperative antibiotic order set implementation). The American College of Surgeons National Surgical Quality Improvement Program was used for case surveillance. The primary outcome was the presence of a surgical site infection with a secondary outcome of cost(s) of implementation. RESULTS: A total of 317 National Surgical Quality Improvement Program abstracted neurosurgical cases were analyzed, 163 cases before implementation and 154 cases after implementation. There were no significant differences between the preimplementation and postimplementation cohorts regarding patient demographics and baseline comorbidities, with the exceptions of inpatient and functional status (P < 0.001). The most common procedures were lumbar decompression (31%), lumbar discectomy (27%), and anterior cervical discectomy and fusion (10.4%). After implementation, 30 patients were MSSA positive (20%) and 4 MRSA positive (2.6%). Thirty patients received preoperative intranasal mupirocin decolonization (88%), and 4 patients received adjusted preoperative antibiotics (12%). After protocol implementation, the surgical site infection rate decreased from 6.7% (odds ratio, 2.82) to 0.96% (odds ratio, 0.91). The cost of implementation was $27,179, or $58 per patient. CONCLUSIONS: The findings highlight the importance of systematically investigating areas of gap in existing clinical practice and quality improvement projects to increase patient safety and enhance the value of care delivered to neurosurgical patients.