[Optimalization of biocompatible artificial tears containing povidone-iodine according to pharmaceutical technological and microbiological aspects]. / PVP-J tartalmú biokompatibilis mukönnyek gyógyszertechnológiai es mikrobiológiai optimalizálása.

Microbiological preservatives play a great role in the preparation of artificial tears because they protect the eyes from further microorganisms and the preparation from contamination. In this contribution we are summarizing our experimental results given by pharmaceutical and microbiological optimalization of artificial tears. The incidental adaptability of povidone-iodine (PVP-I) as a preservative in artificial tears was examined compared to usually used materials. Some artificial tears (Oculogutta carbomerae and Oculogutta viscosa) were prepared according to the Formulae Normales Edition VII., others were isotonisated and buffered containing 3.0% and 3.5% povidonum as active substance. The analysed samples as a preservative instead of generally used agents contained 0.10%, 0.05% and 0.01% PVP-I. Reference preparations were dispensed using microbiological preservatives (Cetrimidum, Thiomersalum solutum 0.1%, Benzalconium chloratum solutum 10%). Pharmaceutical (pH, viscosity, freezing-point depression, refraction, surface-tension) and microbiological (breeding on aerobe and anaerobe bacteriological culture medium) trials were made to determine the qualitative property and adaptability of analysed preparations in which we also studied the stability and the microbiological changes after opening them. According to our experimental results we can establish that the PVP-I is suitable as microbiological preservative in the examined preparations.

Increase in catheter insertion-site infections associated to the introduction of a substandard competitive antiseptic.

The introduction of low-cost competitive antiseptic products may offer savings, but, unfortunately, their quality control is poor in many developing countries. The use of a new brand of idopovidone solution, used routinely for catheter insertion-site cleaning, was associated with a 55% increase in catheter insertion-site infection per 100 active catheters, returning to usual after the product was recalled. The new brand of iodopovidone solution had less free iodine (.76%) and lower pH (2.7) than required by local standards (pH 3-6.5). Use of substandard antiseptics in developing countries, because of poor quality control, is a risk for patients and results in increased health services expenses and burden of work.

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

[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.

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.

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.

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.

[Efficacy of 2 antiseptics intended for the disinfection of normal skin]. / Efficacité de deux antiseptiques destinés à la désinfection de la peau saine.

In Switzerland, antiseptics must be checked for their "in use" efficacy before being admitted by the Federal Office of Public Health (FOPH). Betadine solution standardized and Merfen tincture widely used in Swiss hospitals for skin disinfection, were compared following federal prescriptions. Tests were performed by the technique of Williamson and Kligman modified by Fleurette and Transy. After comparison of statistical data (t test at 5% probability) we concluded that both products in these defined conditions present similar efficacy and obey to prescriptions of FOPH.

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.

Cierre de la aponeurosis con sutura continua de polypropylene / Suture of the fascial plane with continous Polypropylene

La tecnica utilizada para saturar la aponeurosis en 500 laparotomias consecutivas (1976-1984) realizadas en el Centro Medico de Caracas, fue la sutura continua con polypropylene No. 1, con nudos subaponeuroticos, y refuerzos con puntos en figura de 8 del mismo material, cada 10 cm. Todas las heridas se irrigaron con solucion de Iodopovidona diluido. Las incisiones fueron: 24 supraumbilicales (4,8%), 108 infraumbilicales (21,6%), 102 supra e infraumbilicales (20,4%), 171 subcostales (34.2%) y 95 tipo Davis (19,0%) realizadas en 333 mujeres (66,6%) y 167 hombres (33,4%) en edades que oscilaban entre 5 y 89 anos; 171 fueron utilizadas debido a enfermedades del pancreas, higado y vias biliares (34,2%), 24 del tracto gastroduodenal (4.8%), 23 del intestino delgado (4,6%), 39 del colon y recto (7,8%), 119 por afecciones ginecologicas (23,8%), 95 por apendicectomias (19,0%) y 29 (5,8%) por otro tipo de patologia. Aunque no exista una tecnica ideal, la sutura continua con polypropylene como queda descrita, resulta atractiva porque ofrece: 1) Seguridad para el paciente, estabilidad a corto y largo plazo, y baja tasa de complicaciones, 2) Facilidad para el cirujano, quien encontrara que la sutura continua con polypropylene reforzado es una tecnica sencilla y rapida de realizar

Suitability of a propanolic PVP-iodophor preparation as preoperative skin disinfectant: germicidal activity and chemical stability.

The preparation Solutio Betadini propanolica 3% w/w, used as a pre-operative skin disinfectant was examined for its germicidal activity and its chemical stability. The additive activity of iodine and propanol resulted in a wide range of antimicrobial activity against bacteria, including bacterial spores, and fungi, with a rapid onset and sustained duration of action. The solution is easily manufactured and analyzed, its stability is guaranteed for 6 months. Because of its staining property, there is no need of coloured additives to mark the disinfected area. In addition, no skin irritations by the disinfectant were observed so far. Thus, the preparation fulfills the essential requirements for preoperative skin disinfectants and is suitable for the preparation and the compounding in hospital pharmacies.

A microbiological in-use comparison of surgical hand-washing agents.

Seven different surgical hand-scrub agents (one triclosan compound, two hexachlorophene compounds, and four iodophors) were evaluated under in-use conditions by five persons for efficacy in degerming the hands and forearms prior to performing a total of 215 total hip arthroplasties. With all of the compounds tested there was a significant reduction (p less than or equal to 0.001) of indigenous skin microflora from prescrub levels at both the post-scrub and postoperative points. The two hexachlorophene compounds in general revealed a bacteriostatic effect whereas the triclosan compound and the four iodophors did not. A hexachlorophene compound applied as a foam demonstrated excellent bacteriocidal and bacteriostatic action, was less time-consuming and easier to use than compounds applied as scrubs, and did not alter a low (0.47 per cent) in-use infection rate over a period of three years.