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2.
Trials ; 22(1): 540, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404473

RESUMO

OBJECTIVES: To compare the efficacy of chlorhexidine-alcohol and povidone-iodine as preoperative antiseptic skin preparation for prevention of surgical site infection (SSI) after cesarean delivery (CD). MATERIALS AND METHODS: A total of 311 eligible women who underwent CS were recruited in the study after fulfilling all the eligibility and exclusion criteria. Patients were randomized into two groups (153 in chlorhexidine-alcohol group and 158 in povidone-iodine group) by a computer-generated randomization table. Patients were followed for a period of 30 days in postoperative period to monitor for SSI. RESULTS: The rate of SSI in the chlorhexidine-alcohol group is 5.4% and that of the povidone-iodine group is 8.6%. E. coli, K. pneumoniae, and Acinetobacter baumannii were the most common organisms isolated. E. coli was found in 9.5% of the total SSI cases. CONCLUSIONS: The study found that the patients who received chlorhexidine-alcohol as skin antiseptic had less chance of developing SSI than those who received povidone-iodine; however, it did not reach a statistical significance. TRIAL REGISTRATION: Clinical Trials Registry of India CTRI/2018/05/014294 . Registered on May 31, 2018.


Assuntos
Anti-Infecciosos Locais , Povidona-Iodo , Anti-Infecciosos Locais/efeitos adversos , Antissepsia , Clorexidina/efeitos adversos , Escherichia coli , Feminino , Humanos , Projetos Piloto , Povidona-Iodo/efeitos adversos , Gravidez , Cuidados Pré-Operatórios , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle
4.
Rom J Ophthalmol ; 65(2): 120-124, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34179575

RESUMO

Endophthalmitis remains a serious complication following intraocular procedures. Preoperative prophylactic measures for endophthalmitis decrease the morbidity associated with this disease and represent a standard of care prior to ophthalmic surgery. The literature supports as measures for ocular antisepsis: povidone-iodine solution for ocular surface preparation, chlorhexidine in patients with iodine allergy and application of topical antibiotics. Povidone-iodine is regarded as the most effective antiseptic associated with significant reduction in ocular surface bacterial counts. Currently, the recommended preoperative management is the application of 5% povidone-iodine solution in the conjunctival fornix, prior to surgery. This paper reviews the preoperative measures for ocular antisepsis, used in order to decrease the risk of culture-proven endophthalmitis.


Assuntos
Anti-Infecciosos Locais , Endoftalmite , Antissepsia , Túnica Conjuntiva , Endoftalmite/prevenção & controle , Humanos , Povidona-Iodo
5.
Arch Dis Child Fetal Neonatal Ed ; 106(6): 643-648, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34108192

RESUMO

OBJECTIVE: To evaluate whether 1% aqueous chlorhexidine gluconate (CHG) when compared with 2% aqueous chlorhexidine gluconate is non-inferior for neonatal skin antisepsis. DESIGN: Parallel, blinded, non-inferiority randomised trial. SETTING: Level III, academic, neonatal intensive care unit. PATIENTS: Infants born at 260/7 to 426/7 weeks of gestation from June 2019 to December 2019. INTERVENTIONS: Participants were randomised to skin antisepsis by either 1% aqueous CHG or 2% aqueous CHG. MAIN OUTCOME MEASURES: The primary outcome was the proportion of negative skin swab cultures after skin antisepsis. Secondary outcomes were local skin reactions at 0, 6, 12 and 24 hours and plasma chlorhexidine levels in a subset of the study population. RESULTS: A total of 308 neonates with a median gestation age of 34 (31-37) weeks and mean birth weight of 2029 g were randomised on 685 occasions (1% CHG: n=341; 2% CHG: n=344). 93.0% of the post-antisepsis skin swabs were sterile in 1% CHG group compared with 95.6% of the swabs in the 2% CHG group (risk difference -2.7%, 95% CI -6.2% to +0.8%). The lower bound of 95% CI crossed the pre-specified absolute non-inferiority limit of 5%. Neonates developed mild dermatitis on 16 (2.3%) occasions. There was no significant difference in median plasma CHG levels in the two groups, 19.6 (12.5-36.4) and 12.6 (8.7-26.6) ng/mL, respectively. CONCLUSIONS: Application of 1% aqueous CHG was not shown to be non-inferior to 2% chlorhexidine aqueous for skin antisepsis in neonates. There were no severe skin-related adverse events in either of the two groups. TRIAL REGISTRATION NUMBER: CTRI/2019/06/019822; (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=33453&EncHid=&userName=CTRI/2019/06/019822).


Assuntos
Antissepsia/métodos , Clorexidina/análogos & derivados , Doenças do Recém-Nascido , Dermatopatias Bacterianas , Pele/microbiologia , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/efeitos adversos , Relação Dose-Resposta a Droga , Erupção por Droga/diagnóstico , Erupção por Droga/etiologia , Monitoramento de Medicamentos/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/prevenção & controle , Masculino , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/prevenção & controle , Resultado do Tratamento
7.
AORN J ; 113(6): 667-672, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34048036
9.
Antimicrob Resist Infect Control ; 10(1): 27, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522957

RESUMO

BACKGROUND: The skin commensal Cutibacterium avidum has been recognized as an emerging pathogen for periprosthetic joint infections (PJI). One currently assumes that the early occurring PJIs are a consequence of skin commensals contaminating the peri-implant tissue during surgery. We addressed whether standard skin antisepsis with povidone-iodine/alcohol before total hip arthroplasty (THA) is effective to eliminate colonizing bacteria with focus on C. avidum. METHODS: In a single-center, prospective study, we screened all patients for skin colonizing C. avidum in the groin before THA. Only in the patients positive for C. avidum, we preoperatively repeated skin swabs after the first and third skin antisepsis and antibiotic prophylaxis. We also obtained dermis biopsies for microbiology and fluorescence in situ hybridization (FISH). RESULTS: Fifty-one out of 60 patients (85%) were colonized on the skin with various bacteria, in particular with C. avidum in 12 out of 60. Skin antisepsis eliminated C. avidum in eight of ten (20%) colonized patients undergoing THA. Deeper skin (dermis) biopsies were all culture negative, but FISH detected single positive ribosome-rich C. avidum in one case near sweat glands. CONCLUSION: Standard skin antisepsis was not effective to completely eliminate colonizing C. avidum on the skin in the groin of patients undergoing THA. Colonizing with C. avidum might pose an increased risk for PJI when considering a THA. Novel more effective antisepsis strategies are needed. Trial registration No clinical trial.


Assuntos
Antissepsia , Propionibacteriaceae/efeitos dos fármacos , Infecções Relacionadas à Prótese/prevenção & controle , Pele/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Artroplastia de Quadril , Feminino , Virilha , Hospitais Universitários , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Prospectivos , Controle de Qualidade , Fatores de Risco , Suíça
12.
Br J Nurs ; 30(1): 8-14, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33433273

RESUMO

This article discusses the importance of effective skin antisepsis prior to the insertion of peripheral intravenous catheters (PIVCs) and how best clinical practice is promoted by application of an appropriate method of skin disinfection integrated effectively with a proprietary aseptic non touch technique, or other standard aseptic technique. Historically under-reported, incidence of infection and risk to patients from PIVCs is now increasingly being recognised, with new research and evidence raising concern and helping to drive new clinical guidance and improvement. The risks posed by PIVCs are particularly significant given increasing PIVC dwell times, due to cannula removal now being determined by new guidance for clinical indication, rather than predefined time frames. Clinical 'best practice' is considered in context of the evidence base, importantly including availability and access to appropriate skin antisepsis products. In the UK, and other countries, ChloraPrep is the only skin antisepsis applicator licensed as a drug to disinfect skin and help prevent infections before invasive medical procedures, such as injections, blood sampling, insertion of PIVCs and minor or major surgery.


Assuntos
Antissepsia , Cateterismo Periférico , Pele , Antissepsia/métodos , Cateterismo Periférico/enfermagem , Enfermagem Baseada em Evidências , Humanos
13.
Infect Control Hosp Epidemiol ; 42(11): 1382-1384, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33478620

RESUMO

A crossover trial was conducted to compare hand rub and hand scrub-brush methods for reducing bacterial loads when using propan-1-ol-60% according to European regulations. Both methods significantly reduced the bacterial load immediately after antisepsis, but only the hand rub method achieved significant bacterial load reduction 3 hours after the procedure.


Assuntos
Anti-Infecciosos Locais , Antissepsia , Carga Bacteriana , Estudos Cross-Over , Mãos , Desinfecção das Mãos , Humanos
14.
Rev Col Bras Cir ; 48: e20202633, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470369

RESUMO

OBJECTIVE: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. METHOD: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. RESULTS: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. CONCLUSION: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.


Assuntos
Anti-Infecciosos Locais/farmacologia , Antissepsia/métodos , Clorexidina/farmacologia , Etanol/farmacologia , Pele/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Anestesia Epidural , Raquianestesia , Anti-Infecciosos Locais/administração & dosagem , Etanol/administração & dosagem , Humanos
16.
J Microbiol Biotechnol ; 31(1): 25-32, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33263333

RESUMO

Inflammatory reactions activated by lipopolysaccharide (LPS) of gram-negative bacteria can lead to severe septic shock. With the recent emergence of multidrug-resistant gram-negative bacteria and a lack of efficient ways to treat resulting infections, there is a need to develop novel anti-endotoxin agents. Antimicrobial peptides have been noticed as potential therapeutic molecules for bacterial infection and as candidates for new antibiotic drugs. We previously designed the 9-meric antimicrobial peptide Pro9-3 and it showed high antimicrobial activity against gram-negative bacteria. Here, to further examine its potency as an anti-endotoxin agent, we examined the antiendotoxin activities of Pro9-3 and elucidated its mechanism of action. We performed a dye-leakage experiment and BODIPY-TR cadaverine and limulus amebocyte lysate assays for Pro9-3 as well as its lysine-substituted analogue and their enantiomers. The results confirmed that Pro9-3 targets the bacterial membrane and the arginine residues play key roles in its antimicrobial activity. Pro9-3 showed excellent LPS-neutralizing activity and LPS-binding properties, which were superior to those of other peptides. Saturation transfer difference-nuclear magnetic resonance experiments to explore the interaction between LPS and Pro9-3 revealed that Trp3 and Tlr7 in Pro9-3 are critical for attracting Pro9-3 to the LPS in the gram-negative bacterial membrane. Moreover, the anti-septic effect of Pro9-3 in vivo was investigated using an LPS-induced endotoxemia mouse model, demonstrating its dual activities: antibacterial activity against gram-negative bacteria and immunosuppressive effect preventing LPS-induced endotoxemia. Collectively, these results confirmed the therapeutic potential of Pro9-3 against infection of gram-negative bacteria.


Assuntos
Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Endotoxemia/tratamento farmacológico , Imunoglobulinas/farmacologia , Imunoglobulinas/uso terapêutico , Animais , Peptídeos Catiônicos Antimicrobianos/farmacologia , Antissepsia , Modelos Animais de Doenças , Endotoxinas , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Lipopolissacarídeos/efeitos adversos , Proteínas de Membrana , Camundongos , Testes de Sensibilidade Microbiana , Choque Séptico/tratamento farmacológico
17.
Anaesth Crit Care Pain Med ; 40(1): 100790, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33285282

RESUMO

BACKGROUND: Multimodal analgesia, including a regional technique using perineural catheters (PNCs), is recommended for the treatment of moderate-to-severe acute postoperative pain. Perineural catheters are at risk of bacterial colonisation. In this study, we compared the cutaneous antiseptic efficacy of 2% alcoholic chlorhexidine and povidone-iodine-alcohol for preventing the bacterial colonisation of PNCs in orthopaedic surgery. METHODS: We performed a randomised, controlled trial, comparing two cutaneous antisepsis strategies, one based on 2% alcoholic chlorhexidine and the other on povidone-iodine-5% alcohol, for placed PNCs before orthopaedic surgery. The primary endpoint was the incidence of catheter bacterial colonisation (threshold > 1000 colony-forming units/ml). The secondary endpoints were the incidence of catheter-related infections and the adverse effects of the antiseptic solutions. RESULTS: From November 2016 to May 2018, we included 113 patients in this study. The use of alcoholic chlorhexidine was associated with a lower incidence of catheter colonisation (15.5% (n = 9) versus 32.7% (n = 18); OR: 0.28 [0.09-0.77], p = 0.01). No catheter-related infections or adverse effects of antiseptic solutions were observed in either group. The risk factors associated with colonisation were a duration of catheter use ≥ 3 days (p = 0.04) and obesity (p = 0.005). The most frequently identified bacterium was Staphylococcus epidermidis. CONCLUSION: Skin disinfection with 2% alcoholic chlorhexidine decreases bacterial colonisation rates for placed perineural catheters.


Assuntos
Anti-Infecciosos Locais , Cateteres Venosos Centrais , Antissepsia , Clorexidina , Humanos , Povidona-Iodo
18.
Equine Vet J ; 53(6): 1234-1238, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33382152

RESUMO

BACKGROUND: An alcohol-based rub has been confirmed effective at reducing bacterial counts on equine skin. Skin sites with expected high bacterial burden have not been tested or has a comparison to a common protocol been performed. OBJECTIVES: To determine if ethanol-based antisepsis reduces bacterial counts on the equine distal limb comparable to a current chlorhexidine scrub method and determine the most effective application technique for the product. STUDY DESIGN: Randomised trial. METHODS: Forty-one horses were used in the study. By horse, each limb was randomly assigned to a treatment group: 5min scrub using 4% chlorhexidine gluconate to a clipped site (CHG); 90s scrub using 80% ethanol to a clipped site (ETC); 90s contact with 80% ethanol applied as a spray to a clipped site (ETS) and 90s scrub using 80% ethanol to an unclipped site (ETUC). Samples were collected pre- and post-treatment and plated in duplicate. Bacterial counts were log10 transformed and averaged between duplicates. A linear mixed model was used to compare mean log10 CFU/mL reduction between groups. A cost-benefit analysis was performed. RESULTS: There was no significant difference in mean log10 CFU/mL reduction between CHG and ETC in either fore- or hindlimbs. In forelimbs, there was no significant difference in mean log10 CFU/mL reduction between any groups. In hindlimbs, CHG had significantly greater mean log10 CFU/mL reduction than ETUC and ETS. No significant difference in cost-benefit was found between CHG and ETC. Significant differences were noted between CHG and both ETUC and ETS. MAIN LIMITATIONS: Researchers were not blinded to treatment group during sample collection. CONCLUSIONS: This study showed no significant difference in reduction in bacterial counts on the distal limb of horses between CHG and ethonol (ET) when applied as a scrub to a clipped site and there was no significant difference in cost-benefit between these treatments.


Assuntos
Anti-Infecciosos Locais , Doenças dos Cavalos , Animais , Anti-Infecciosos Locais/farmacologia , Antissepsia , Clorexidina/farmacologia , Etanol , Cavalos , Pele , Infecção da Ferida Cirúrgica/veterinária
20.
Rev. fac. cienc. méd. (Impr.) ; 17(2): 8-16, jul.-dic. 2020. graf., tab.
Artigo em Espanhol | LILACS, BIMENA | ID: biblio-1291849

RESUMO

Las medidas de asepsia y antisepsia, son procedimientos efectivos de bajo costo en la prevención de infecciones intrahospitalarias; prácticas inadecuadas del personal constituyen un problema de salud pública. Objetivo: determinar el nivel de conocimiento y práctica en asepsia y antisepsia en personal de Sala de Operaciones, Bloque Materno Infantil, Hospital Escuela Universitario. Material y Métodos: estudio descriptivo, observacional, transversal; universo 82 personas, muestra 38 sujetos; se aplicó instrumento de observación y entrevista estructurada. Resultados: 26(68%) femenino, 12(32%) masculino, edad promedio 38 años; 16(42%) personas obtuvieron débil conocimiento, 3(8%) muy buen conocimiento; conocimiento promedio (64%), puntaje mínimo (13%), máximo (93%). Práctica lavado de manos; calificación excelente 28(74%), 6(16%) no se lavaron las manos, 21(55%) al ingresar al área quirúrgica y 11(29%) entre procedimientos. 17(45%) realizaron buen uso de indumentaria quirúrgica, 23(92%) realizaron excelente lavado quirúrgico, 13(93%) instrumentistas excelente colocación de bata estéril. 19(76%) realizaron excelente manejo de asepsia y antisepsia durante transquirúrgico. 14(100%) circulantes realizaron excelente práctica postquirúrgica. Se comparó conocimiento contra práctica, excelente práctica de lavado de manos 10(26%), pero escaso conocimientos y buena práctica de indumentaria quirúrgica, 2(5%) muy buen conocimiento, pero práctica regular en uso de indumentaria quirúrgica (p ≤ 0.001). 3(12%) con conocimiento débil, realizó práctica excelente en transquirúrgico. 2(14%) obtuvieron 100% en práctica posquirúrgica (p ≤ 0.001). Se encontró factor protector 60% y 40% factor de riesgo durante la práctica transoperatoria, IC 95%, RR: 0.4 (-0.3, 0.5) y RR: 0.6 (- 05, 0.8). Conclusión: hubo diferencias entre categorías de profesionales afectando el nivel de conocimiento y práctica de la técnica aséptica, factor de riesgo 40%. Se encontró que los que no tienen conocimiento y no practican las técnicas de asepsia, tienen 2.9 veces más probabilidad de riesgo, en relación al grupo que tiene conocimiento y realiza medidas de asepsia en el transoperatorio...(AU)


Assuntos
Humanos , Antissepsia , Assepsia , Enfermagem de Centro Cirúrgico/educação , Infecção Hospitalar/prevenção & controle
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