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4.
Intern Emerg Med ; 13(3): 375-383, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29427181

RESUMO

Toxic alcohols are a group of substances containing a hydroxyl group not meant to be ingested. They are the cause of a significant number of accidental and non-accidental exposures. Toxic alcohol poisoning can be associated with a significant degree of morbidity and mortality if not promptly recognized and treated. This review describes the clinical presentation and an approach to the recognition and management for toxic alcohol poisoning. Toxic alcohols classically refer to a group of alcohols not meant for ingestion. Methanol, ethylene glycol, and isopropyl alcohol are readily available in common hardware and household materials. Toxic alcohols are ingested for a variety of reasons including accidental exposures, intentional inebriation, homicide and suicide. The patient with an altered mental status or concerning history warrants consideration of this potentially deadly ingestion. Treatment considerations include alcohol dehydrogenase blockade and hemodialysis. Toxic alcohol poisoning can be an elusive diagnosis. This review evaluates toxic alcohol poisoning signs and symptoms and an approach to diagnosis and management.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Álcoois/efeitos adversos , 2-Propanol/efeitos adversos , Consumo de Bebidas Alcoólicas/fisiopatologia , Consumo de Bebidas Alcoólicas/psicologia , Álcoois/metabolismo , Álcoois/farmacocinética , Antídotos/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Etanol/uso terapêutico , Etilenoglicol/efeitos adversos , Fomepizol , Humanos , Metanol/efeitos adversos , Pirazóis/uso terapêutico , Diálise Renal/métodos
5.
Arch Dis Child Fetal Neonatal Ed ; 103(2): F101-F106, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29074717

RESUMO

OBJECTIVE: To determine whether 2% chlorhexidine gluconate-70% isopropyl alcohol (CHX-IA) is superior to 10% aqueous povidone-iodine (PI) in preventing catheter-related blood stream infection (CR-BSI) when used to clean insertion sites before placing central venous catheters (CVCs) in preterm infants. DESIGN: Randomised controlled trial. SETTING: Two neonatal intensive care units (NICUs). PATIENTS: Infants <31 weeks' gestation who had a CVC inserted. INTERVENTIONS: Insertion site was cleaned with CHX-IA or PI. Caregivers were not masked to group assignment. MAIN OUTCOME MEASURES: Primary outcome was CR-BSI determined by one microbiologist who was masked to group assignment. Secondary outcomes included skin reactions to study solution and thyroid dysfunction. RESULTS: We enrolled 304 infants (CHX-IA 148 vs PI 156) in whom 815 CVCs (CHX-IA 384 vs PI 431) were inserted and remained in situ for 3078 (CHX-IA 1465 vs PI 1613) days. We found no differences between the groups in the proportion of infants with CR-BSI (CHX-IA 7% vs PI 5%, p=0.631), the proportion of CVCs complicated by CR-BSI or the rate of CR-BSI per 1000 catheter days. Skin reaction rates were low (<1% CVC insertion episodes) and not different between the groups. More infants in the PI group had raised thyroid-stimulating hormone levels and were treated with thyroxine (CHX-IA 0% vs PI 5%, p=0.003). CONCLUSIONS: We did not find a difference in the rate of CR-BSI between preterm infants treated with CHX-IA and PI, and more infants treated with PI had thyroid dysfunction. However, our study was not adequately powered to detect a difference in our primary outcome and a larger trial is required to confirm our findings. TRIAL REGISTRATION: This study was registered with the EU clinical trials register before the first patient was enrolled (Eudract 2011-002962-19). (https://www.clinicaltrialsregister.eu).


Assuntos
2-Propanol/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/métodos , Clorexidina/análogos & derivados , Povidona-Iodo/administração & dosagem , 2-Propanol/efeitos adversos , 2-Propanol/química , Anti-Infecciosos Locais/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/efeitos adversos , Clorexidina/química , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Povidona-Iodo/efeitos adversos , Dermatopatias/prevenção & controle
6.
J Am Assoc Lab Anim Sci ; 56(5): 562-569, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28903829

RESUMO

Laboratory mice (Mus musculus) are prone to develop hypothermia during anesthesia for surgery, thus potentially impeding anesthetic recovery, wound healing, and future health. The core body temperatures of isoflurane-anesthetized mice are influenced by the choice of supplemental heat sources; however, the contribution of various surgical scrubs on the body temperatures of mice under gas anesthesia has not been assessed. We sought to quantify the effect of using alcohol (70% isopropyl alcohol [IPA]) compared with saline to rinse away surgical scrub on the progression of hypothermia in anesthetized mice (n = 47). IPA, room-temperature saline, or warmed saline (37 °C) was combined with povidone-iodine and then assessed for effects on core (rectal) and surface (infrared) temperatures. Agents were applied to a 2×2-cm shaved abdominal area of mice maintained on a water-recirculating blanket (at 38 °C) under isoflurane anesthesia (1.5% to 2.0% at 0.6 L/min) for 30 min. Although all scrub regimens significantly decreased body temperature at the time of application, treatments that included povidone-iodine led to the coldest core temperatures, which persisted while mice were anesthetized. Compared with room-temperature saline and when combined with povidone-iodine, warming of saline did not ameliorate heat loss. IPA alone demonstrated the most dramatic cooling of both surface and core readings at application but generated an unanticipated warming (rebound) phase during which body temperatures equilibrated with those of controls within minutes of application. Although alcohol is inappropriate as a stand-alone agent for surgical skin preparation, IPA is a viable alternative to saline-based rinses in this context, and its use should be encouraged within institutional guidance for rodent surgical procedures without concern for prolonged hypothermia in mice.


Assuntos
2-Propanol/efeitos adversos , Temperatura Corporal , Hipotermia Induzida/veterinária , Povidona-Iodo , Cuidados Pré-Operatórios/veterinária , Cloreto de Sódio/efeitos adversos , Anestésicos Inalatórios/farmacologia , Animais , Fármacos Dermatológicos/farmacologia , Feminino , Temperatura Alta , Humanos , Isoflurano/farmacologia , Masculino , Camundongos
7.
PLoS One ; 11(9): e0162762, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27622502

RESUMO

PURPOSES: The objectives of this paper are to study the impact of low level isopropyl alcohol exposure on blood pressure and to explore its potential mechanism. METHODS: This cross-sectional study was based on a prospective occupational cohort in south China, which focusing on occupational risk factors related cardiovascular health problems. A total of 283 participants (200 low isopropyl alcohol exposed workers and 83 controls) was finally enrolled in this study. Linear regression models were used to analyze the relationship between arterial blood pressures and low level isopropyl alcohol exposure. We used mediation method to explore possible mediated roles of neurogenic factors. RESULTS: Systolic blood pressure (SBP, 123±10 vs. 118±11), diastolic blood pressure (DBP, 79±7 vs. 74±7) and mean blood pressure (MBP, 93±8 vs. 89±9) were different between the exposed group and the control group (p < 0.01). After adjusting for covariates, the difference was still significant. Besides, isopropyl alcohol and smoking had an interactive effect on DBP and MBP (p < 0.05). Furthermore, we observed a mediated effect of 5-hydroxyindole acetic acid (5-HIAA) on isopropyl alcohol exposure induced arterial blood pressure increase, which accounted for about 25%. CONCLUSIONS: Our results suggest that low level isopropyl alcohol exposure is a potential risk factor for the increased arterial blood pressure and 5-HIAA partly mediates the association between low level isopropyl alcohol exposure and arterial blood pressures.


Assuntos
2-Propanol/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Ácido Hidroxi-Indolacético/urina , Hipertensão/induzido quimicamente , 2-Propanol/administração & dosagem , 2-Propanol/análise , Adolescente , Adulto , Poluentes Ocupacionais do Ar/efeitos adversos , Poluentes Ocupacionais do Ar/análise , China , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Hipertensão/urina , Masculino , Exposição Ocupacional , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
8.
J Drugs Dermatol ; 15(7): 870-3, 2016 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27391638

RESUMO

INTRODUCTION: Irritation, such as burning and stinging, on the site of application, is a common side effect of topical dermatologic products including creams, lotions, sprays, and foams. This effect may be more pronounced when applying products to atopic or psoriatic skin. The composition of the vehicle may affect the extent of the irritation. This study compared the irritation and erythema potential of 7 different topical dermatologic products to determine the products with the least likelihood of causing discomfort when applied.
METHODS: Seven sites on the anterior leg of 30 subjects were dry shaven with 10 upward strokes. Subjects rated the stinging of petrolatum (negative control), isopropyl alcohol (positive control), Cetaphil Lotion, triamcinolone 0.1% cream, triamcinolone 0.2% spray, betamethasone foam, and clobetasol 0.05% spray, 1 minute after product application, using a scale of 0 (no symptoms) to 10 (intolerable stinging/burning). The investigator assessed erythema at the sites 30 minutes after application of the products using a scale of 0 (none) to 4 (severe).
RESULTS: Stinging rating score of each product was statistically significant from one another. Petrolatum produced the least stinging (0) and isopropyl alcohol the most (10). Stinging with triamcinolone spray, Cetaphil Lotion, and triamcinolone cream ranked in the lower half of the rating scale (all below 5). Betamethasone foam and clobetal spray ranked the highest at >7. When corrected for the erythema caused by shaving, triamcinolone spray and Cetaphil Lotion produced the least amount of erythema of all the products tested.
DISCUSSION: Rapid evaporation of the volatile vehicle of triamcinolone spray and the non-irriating nature of the medication left behind may contribute to its low erythema and stinging. This product may be an appropriate choice for patients with compromised skin but who require the advantages and conveniences of a spray vehicle.

J Drugs Dermatol. 2016;15(7):870-873.


Assuntos
Betametasona/efeitos adversos , Clobetasol/efeitos adversos , Dermatite Irritante/diagnóstico , Propilenoglicóis/efeitos adversos , Dodecilsulfato de Sódio/efeitos adversos , Triancinolona/efeitos adversos , 2-Propanol/administração & dosagem , 2-Propanol/efeitos adversos , Administração Cutânea , Betametasona/administração & dosagem , Clobetasol/administração & dosagem , Dermatite Irritante/etiologia , Método Duplo-Cego , Combinação de Medicamentos , Humanos , Vaselina/administração & dosagem , Vaselina/efeitos adversos , Propilenoglicóis/administração & dosagem , Distribuição Aleatória , Creme para a Pele/administração & dosagem , Creme para a Pele/efeitos adversos , Dodecilsulfato de Sódio/administração & dosagem , Triancinolona/administração & dosagem
9.
Emerg Med Pract ; 18(9 Suppl Points & Pearls): S1-S2, 2016 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-28745842

RESUMO

Identifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic alcohol exposure include ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropanol. Treatment considerations include the antidotes fomepizole and ethanol, and hemodialysis for removal of the parent compound and its toxic metabolites. Additional interventions include adjunctive therapies that may improve acidosis and enhance clearance of the toxic alcohol or metabolites. This issue reviews common sources of alcohol exposure, basic mechanisms of toxicity, physical examination and laboratory findings that may guide rapid assessment and management, and indications for treatment. [Points & Pearls is a digest of Emergency Medicine Practice].


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/fisiopatologia , 2-Propanol/efeitos adversos , 2-Propanol/envenenamento , Alcoolismo/epidemiologia , Antídotos/farmacologia , Antídotos/uso terapêutico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Etanol/farmacologia , Etanol/uso terapêutico , Etilenoglicol/efeitos adversos , Etilenoglicol/toxicidade , Etilenoglicóis/efeitos adversos , Etilenoglicóis/envenenamento , Fomepizol , Humanos , Metanol/efeitos adversos , Metanol/envenenamento , Propilenoglicol/efeitos adversos , Propilenoglicol/toxicidade , Pirazóis/farmacologia , Pirazóis/uso terapêutico , Diálise Renal/métodos
10.
Australas J Dermatol ; 55(4): 296-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25179004

RESUMO

We report a case of a 12-year-old girl with severe allergic contact dermatitis following neurosurgery secondary to topical use of isopropyl alcohol swabs. Alcohol swabs should not be overlooked as potential allergens. In our case, it was initially assumed that the cause of her reaction was either tapes or topical local anaesthetic.


Assuntos
2-Propanol/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Complicações Pós-Operatórias/induzido quimicamente , Lobectomia Temporal Anterior , Criança , Epilepsia do Lobo Temporal/cirurgia , Dermatoses Faciais/induzido quimicamente , Feminino , Humanos
11.
Regul Toxicol Pharmacol ; 69(3): 408-15, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24852492

RESUMO

The coherence between occupational exposure limits (OELs) and their corresponding biological limit values (BLVs) was evaluated for 2-propanol and acetone. A generic human PBPK model was used to predict internal concentrations after inhalation exposure at the level of the OEL. The fraction of workers with predicted internal concentrations lower than the BLV, i.e. the 'false negatives', was taken as a measure for incoherence. The impact of variability and uncertainty in input parameters was separated by means of nested Monte Carlo simulation. Depending on the exposure scenario considered, the median fraction of the population for which the limit values were incoherent ranged from 2% to 45%. Parameter importance analysis showed that body weight was the main factor contributing to interindividual variability in blood and urine concentrations and that the metabolic parameters Vmax and Km were the most important sources of uncertainty. This study demonstrates that the OELs and BLVs for 2-propanol and acetone are not fully coherent, i.e. enforcement of BLVs may result in OELs being violated. In order to assess the acceptability of this "incoherence", a maximum population fraction at risk of exceeding the OEL should be specified as well as a minimum level of certainty in predicting this fraction.


Assuntos
2-Propanol/efeitos adversos , 2-Propanol/química , Acetona/efeitos adversos , Acetona/química , Exposição por Inalação/análise , Exposição Ocupacional/análise , Administração por Inalação , Peso Corporal/efeitos dos fármacos , Humanos , Modelos Biológicos , Método de Monte Carlo , Níveis Máximos Permitidos , Incerteza
12.
Pharmacotherapy ; 33(11): e333-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23649958

RESUMO

Warfarin, an anticoagulant with a narrow therapeutic window, is largely metabolized by cytochrome P450 2C9. Isopropyl alcohol has been shown to inhibit the activity of this enzyme. Use of topical isopropyl alcohol as a rubefacient may place patients at risk for systemic exposure. Isopropyl alcohol's effect on the international normalized ratio (INR) has not been well characterized. We describe five patients who experienced INR elevations after topical application of isopropyl alcohol. Each patient's INR was therapeutic for at least seven visits prior to becoming supratherapeutic. All patients confirmed drug adherence and denied medication or dietary changes. Seventy percent isopropyl alcohol was used in all cases over a large body surface area of intact skin multiple times daily for several days. All patients experienced a 10% or greater increase in their INR compared to previous levels. On discontinuation of isopropyl alcohol, each patient's INR returned to and remained in therapeutic range for the next 2 months. Prediction of isopropyl alcohol's effect of the INR is confound by several factors, notably the BSA covered, concentration of alcohol in the product, contact time with the skin, and skin integrity. It is important that clinicians inquire about the use of isopropyl alcohol and educate patients about its potential risk in those receiving warfarin therapy.


Assuntos
2-Propanol/administração & dosagem , Anticoagulantes/administração & dosagem , Interações de Medicamentos , Coeficiente Internacional Normatizado/tendências , Varfarina/administração & dosagem , 2-Propanol/efeitos adversos , Administração Cutânea , Adulto , Anticoagulantes/farmacocinética , Interações de Medicamentos/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Varfarina/farmacocinética
13.
Pediatr Dermatol ; 30(6): e281-2, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22471753

RESUMO

We report a case of allergic contact dermatitis to WEBCOL(®) alcohol prep pads in a healthy 17-year-old girl who showed no reaction to the individual components of the prep pads upon provocative use testing. Although several case reports have described allergic contact dermatitis to isopropyl alcohol, there have been no reports of allergic contact dermatitis to alcohol prep pads sterilized with gamma irradiation, a common sterilization technique capable of producing volatile products in this type of alcohol prep pad.


Assuntos
2-Propanol/efeitos adversos , 2-Propanol/efeitos da radiação , Dermatite Alérgica de Contato/etiologia , Raios gama/efeitos adversos , Esterilização/métodos , Adolescente , Dermatite Alérgica de Contato/diagnóstico , Feminino , Humanos , Testes do Emplastro
15.
J Diabetes Sci Technol ; 6(1): 81-5, 2012 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-22401326

RESUMO

BACKGROUND: Monitoring blood glucose levels is an integral part of routine diabetes management. To minimize the risk of transmission of bloodborne pathogens during monitoring, the Centers for Disease Control and Prevention (CDC) recommends that glucose meters be disinfected after each use whenever they are used to test multiple patients. The objective of this study is to assess the compatibility of some common disinfectants with certain blood glucose meter systems. METHODS: We tested six disinfectants for adverse impact on meter performance or the exterior meter surfaces. The disinfectants tested were 0.525% sodium hypochlorite, 20% 2-propanol and 10% ethanol, 17.2% isopropanol, 55% isopropanol, 70% isopropanol, and hydrogen peroxide. To assess meter performance, we tested OneTouch® Ultra® blood glucose monitoring systems with control solution before and after application of either water or disinfectant. To assess the effect on exterior meter surfaces, we performed a soaking test to simulate long-term exposure to disinfectant. RESULTS: Paired t-test results showed that the control solution data associated with disinfectant and with water application were not significantly different for each meter type. However, most of the meter types were adversely affected by hydrogen peroxide and/or by the higher concentrations of alcohol-based disinfectants. CONCLUSIONS: Although none of the six disinfectants affected meter performance, hydrogen peroxide and isopropanol >20% adversely affected the exterior surfaces of the tested meters. When complying with CDC instructions for meter disinfection, users should use caution and choose disinfectants that have been validated by the meter manufacturer.


Assuntos
Glicemia/análise , Desinfetantes/efeitos adversos , Equipamentos e Provisões , 1-Propanol/efeitos adversos , 2-Propanol/efeitos adversos , Análise Química do Sangue/instrumentação , Análise Química do Sangue/normas , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/normas , Desinfecção/métodos , Eficiência , Equipamentos e Provisões/microbiologia , Equipamentos e Provisões/normas , Etanol/efeitos adversos , Humanos , Peróxido de Hidrogênio/efeitos adversos , Hipoclorito de Sódio/efeitos adversos , Água/farmacologia , Água/fisiologia
16.
Contact Dermatitis ; 65(2): 101-6, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21679194

RESUMO

BACKGROUND: Isopropyl alcohol is a secondary alcohol, a structural isomer of propanol, that is widely used as an industrial solvent and as a preservative and antiseptic in the clinical environment. It is known to be a mild irritant for the eyes and mucous membranes, but is considered to be a weak and infrequent sensitizer. OBJECTIVES: To show that isopropyl alcohol should be considered as a potential allergen in patients with eczema who have contact with this substance. MATERIALS AND METHODS: We present a series of 1450 patients patch tested with isopropyl alcohol during the period 1992-2011. RESULTS: Forty-four patients showed an allergic response to isopropyl alcohol. Four cases presented as occupational hand eczema. Fourteen cases were seen in patients with leg ulcers. Twenty-six patients presented with eczematous lesions following the use of products containing isopropyl alcohol to disinfect previous skin lesions. Eighty-four per cent of the patients showed sensitization to three or more allergens. Relevance was present in 84% of the patients. CONCLUSIONS: We report here the first large case series of contact allergy to isopropyl alcohol, which demonstrates that sensitization to this substance might not be as uncommon as previously thought.


Assuntos
2-Propanol/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/epidemiologia , Programas de Rastreamento/métodos , Testes do Emplastro/métodos , Solventes/efeitos adversos , Administração Tópica , Adulto , Alérgenos , Causalidade , Intervalos de Confiança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco/métodos , Sensibilidade e Especificidade , Espanha/epidemiologia , Adulto Jovem
17.
Ann Plast Surg ; 67(4): 407-12, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21407057

RESUMO

Bacterial infections cause major complications in wound healing. Local antiseptics are used for daily wound care; however, their potential toxic effects on the vasculature have not yet been thoroughly investigated. The aim of this study was to assess the effects of antiseptics on microcirculation. Investigations were performed on a standardized cremaster muscle model on rats (n = 60). The arteriolar diameter and functional capillary density (FCD) were investigated using transillumination microscopy before and 60 and 120 minutes after application of each of the following antimicrobial agents: alcohol, hydrogen peroxide, imipenem, octenidine dihydrochloride, polyhexanide, and ethacridine lactate. Although polyhexanide caused a significant arteriolar dilatation (106.25 ± 3.23 vs. 88.54 ± 6.74 µm [baseline value]) and increase of FCD compared with baseline value (12.65 ± 0.82 vs. 9.10 ± 0.50 n/0.22 mm), alcohol led to a significant decrease of both parameters (90.63 ± 10.80 vs. 52.09 ± 7.69 and 5.35 ± 0.54 vs. 1.68 ± 0.48) and was the only agent that caused arteriolar thrombosis. The FCD also increased significantly after treatment with hydrogen peroxide (10.55 ± 0.33 vs. 12.30 ± 0.48) and octenidine (6.82 ± 0.63 vs. 12.32 ± 0.63). However, no positive effect on arteriolar diameter could be found. Ethacridine lactate and imipenem did not impact either parameter. In addition to reducing bacteria, an antiseptic should be nontoxic, especially to the microcirculation. Polyhexanide seems to have a positive influence on vessel diameter and capillary density, whereas alcohol reduces both parameters. If the antimicrobial efficacy is comparable, the antiseptic with less toxic effects should be chosen, especially in critically perfused wounds.


Assuntos
Anti-Infecciosos Locais/efeitos adversos , Microcirculação/efeitos dos fármacos , Músculo Esquelético/irrigação sanguínea , 2-Propanol/administração & dosagem , 2-Propanol/efeitos adversos , Administração Tópica , Animais , Anti-Infecciosos Locais/administração & dosagem , Arteríolas/efeitos dos fármacos , Arteríolas/patologia , Biguanidas/administração & dosagem , Biguanidas/efeitos adversos , Capilares/efeitos dos fármacos , Capilares/patologia , Etacridina/administração & dosagem , Etacridina/efeitos adversos , Etanol/administração & dosagem , Etanol/efeitos adversos , Peróxido de Hidrogênio/administração & dosagem , Peróxido de Hidrogênio/efeitos adversos , Imipenem/administração & dosagem , Imipenem/efeitos adversos , Masculino , Piridinas/administração & dosagem , Piridinas/efeitos adversos , Ratos , Ratos Wistar
19.
N Engl J Med ; 362(1): 18-26, 2010 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-20054046

RESUMO

BACKGROUND: Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine. METHODS: We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections. RESULTS: A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups. CONCLUSIONS: Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)


Assuntos
2-Propanol/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/análogos & derivados , Povidona-Iodo/uso terapêutico , Infecção da Ferida Cirúrgica/prevenção & controle , 2-Propanol/efeitos adversos , Adulto , Análise de Variância , Anti-Infecciosos Locais/efeitos adversos , Antissepsia/métodos , Clorexidina/efeitos adversos , Clorexidina/uso terapêutico , Infecção Hospitalar/prevenção & controle , Combinação de Medicamentos , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Povidona-Iodo/efeitos adversos , Fatores de Risco , Pele/microbiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia
20.
Transfusion ; 50(1): 59-64, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19821950

RESUMO

BACKGROUND: Optimal skin disinfection ensures blood safety. In this study, efficacies of the two-step skin disinfection methods used at Canadian Blood Services (CBS) and two one-step methods produced by different manufacturers were compared. STUDY DESIGN AND METHODS: In each of the three phases of the study, two methods were compared by disinfection of the antecubital fossae of study subjects. The two-step methods were compared in Phase I: Method A (isopropyl alcohol scrub and iodine tincture ampule) and Method B (isopropyl alcohol and chlorhexidine scrub and isopropyl alcohol and chlorhexidine ampule). In Phases II and III, Method B was compared to two different one-step swab sticks containing isopropyl alcohol and chlorhexidine (Methods C and D). Contact plates were applied on each of the subjects before and after disinfection and incubated at 37 degrees C for 24 hours followed by colony counting. RESULTS: In 99% of the subjects, colonies per plate were reduced from approximately 60 to less than 10 after disinfection using any method. Method B was superior to Method A (p < 0.05) but was not significantly different from Methods C and D. Method D was implemented for skin disinfection at CBS with no significant effects on blood product contamination. Skin reactions increased from approximately 0.02% to approximately 0.62% after implementation, which were subsequently reduced to approximately 0.04%. CONCLUSION: In this study, isopropyl alcohol and chlorhexidine disinfectants were more efficacious than isopropyl alcohol and iodine. There was no difference in efficacy between one-step and two-step procedures or between methods of application. A one-step chlorhexidine and isopropyl alcohol kit has been successfully implemented at CBS.


Assuntos
Bacteriemia/prevenção & controle , Bancos de Sangue/métodos , Doadores de Sangue , Desinfecção/métodos , Flebotomia/métodos , 2-Propanol/administração & dosagem , 2-Propanol/efeitos adversos , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/efeitos adversos , Bacteriemia/transmissão , Bactérias/efeitos dos fármacos , Bancos de Sangue/normas , Canadá , Clorexidina/administração & dosagem , Clorexidina/efeitos adversos , Desinfecção/normas , Humanos , Iodo/administração & dosagem , Iodo/efeitos adversos , Técnicas Microbiológicas , Flebotomia/normas , Estudos Prospectivos , Pele/efeitos dos fármacos , Pele/microbiologia
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