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1.
Adv Wound Care (New Rochelle) ; 11(1): 1-9, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33563102

RESUMO

Objective: Hand hygiene using either 4% chlorhexidine gluconate (CHG) or natural soap during hand rubbing, followed by alcohol-based 1% CHG sanitizer lotion in the operating room was compared to assess bacterial reduction, skin moisture, skin texture, and hand hygiene using qualitative questionnaires. Approach: A crossover study with 36 professional scrub nurses at two medical centers was performed to compare 4% CHG followed by alcohol-based 1% CHG sanitizer lotion, the Two-stage method with handwashing using natural soap followed by alcohol-based 1% CHG sanitizer lotion, and the Waterless method, after a period of 10 days of use. The study completely followed CONSORT, www.consort-statement.org. Results: There was no significant difference in bacterial reduction based on the bacterial colony-forming units between the two methods. The skin moisture and skin roughness scores were not significantly different between the two methods. The Waterless method was significantly better than the Two-stage method regarding "foaming," "quality," "longevity" (p < 0.0001, p < 0.0001, and p < 0.0001, respectively), but "disappearance" was significantly better by the Two-stage method (p = 0.0095) during washing and rubbing. Immediately after washing and rubbing, the Waterless method was significantly better regarding "tightness" and "moisture," whereas the Two-stage method was significantly better regarding "stickiness" (p = 0.0114, p = <0.0001, and 0.0059, respectively) Innovation: The Waterless method using natural soap during handwashing followed by alcohol-based 1% CHG sanitizer lotion was as effective as the Two-stage method of 4% CHG followed by alcohol-based 1% CHG sanitizer lotion. Conclusion: Handwashing using natural soap is simple and superior to hand scrubbing in several aspects.


Assuntos
Bactérias/efeitos dos fármacos , Clorexidina/análogos & derivados , Etanol/administração & dosagem , Desinfecção das Mãos/métodos , Higiene das Mãos , Salas Cirúrgicas , Pele/microbiologia , Sabões/farmacologia , Anti-Infecciosos Locais , Clorexidina/administração & dosagem , Clorexidina/farmacologia , Contagem de Colônia Microbiana , Estudos Cross-Over , Desinfecção/métodos , Emolientes , Desinfecção das Mãos/normas , Humanos , Avaliação de Resultados em Cuidados de Saúde
2.
J Infect Chemother ; 28(1): 29-34, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34674944

RESUMO

OBJECTIVES: As a newly emerging pathogen, Candida auris has spread rapidly and caused a serious invasive infection. Candida auris often appeared high resistance to classical antifungal drugs. Drug combination therapy is emerging as an effective and well-established strategy to relieve drug resistance problems. The objective of present work was to examine the activity of fluconazole in combination with chlorhexidine acetate against Candida auris isolates. METHODS: Antiplanktonic activity was studied using the EUCAST methodology and growth curve assay. Antibiofilm effectiveness was determined by the crystal violet method, checkerboard microdilution assay, scanning electron microscopy, and confocal laser scanning microscopy. RESULTS: The results indicated that the 80% minimal inhibitory concentrations for fluconazole alone against Candida auris were 2-32 mg/L and for chlorhexidine acetate were 2-8 mg/L. The combination of fluconazole with chlorhexidine acetate exhibited synergism with the growth curve assay. In addition, the checkerboard microdilution assay presented that fluconazole was strongly synergistic with chlorhexidine acetate (sFICI <0.1875) in inhibiting the growth of Candida auris biofilms. The scanning electron microscopy and confocal laser scanning microscopy further exhibited the alteration of morphology of the cells and architecture of the biofilms. CONCLUSION: The combination therapy of fluconazole and chlorhexidine acetate provides a new potential strategy for the treatment of clinical Candida auris infection.


Assuntos
Candida , Fluconazol , Antifúngicos/farmacologia , Biofilmes , Candidíase Invasiva , Clorexidina/farmacologia , Fluconazol/farmacologia , Testes de Sensibilidade Microbiana , Suspensões
3.
J Pediatr Orthop ; 42(1): e39-e44, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34545019

RESUMO

BACKGROUND: Adult literature has demonstrated chlorhexidine (CH) superiority at preventing surgical-site infections when compared with povidone-iodine (P-I). The purpose of this study is to compare the rate of postoperative infections after preoperative skin cleansing with either CH or P-I in pediatric orthopaedic surgery in an effort to identify superiority. METHODS: We retrospectively identified all patients (18 y and below) that underwent orthopaedic surgery at our institution in 2015, when P-I was the preoperative skin antisepsis of choice, and in 2018, when a change in protocol resulted in more frequent use of CH. Open fractures, infections, neuromuscular, and tumor surgeries were excluded. Orthopaedic surgeries were classified according to their subspecialty (sports-related/upper extremity, hip and lower extremity, trauma-related, or spine procedure). A 1:1 propensity score matching was conducted within each procedure group on the basis of age, sex, and year using nearest-neighbor matching. Spine procedures could not be matched and were subsequently excluded from analyses. RESULTS: Propensity score matching matched 1416 CH cases with 1416 P-I controls. The infection rate for CH was 19 infections per 1000 cases (27/1416; 1.9%) compared with an infection rate of 11 infections per 1000 cases (16/1416; 1.1%) for P-I subjects. No difference was detected in infection rate across preoperative skin antisepsis groups (P=0.12). Moreover, it was found that CH and P-I resulted in significantly equivalent infection rates to within ±1.5% (P=0.004). When stratified by procedure type, CH used in sports/upper extremity procedures resulted in 29 more infections per 1000 cases compared with P-I use (16/450; 3/450; P=0.005). No difference was detected in infection rate across CH and P-I skin antisepsis groups in lower extremity procedures (9/792; 8/792; P=1.00) or in trauma-related procedures (3/174; 4/174; P=1.00). CONCLUSIONS: CH and P-I are both protective against postoperative infections after sports/upper extremity, lower extremity, and trauma-related pediatric orthopaedic procedures. P-I may provide improved protection over CH as a preoperative skin antisepsis in upper extremity and sports-related procedures. LEVEL OF EVIDENCE: Level III-comparative cohort.


Assuntos
Anti-Infecciosos Locais , Procedimentos Ortopédicos , Adulto , Criança , Clorexidina , Humanos , Procedimentos Ortopédicos/efeitos adversos , Povidona-Iodo/uso terapêutico , Cuidados Pré-Operatórios , Estudos Retrospectivos , Pele , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
4.
J Oral Rehabil ; 49(1): 103-113, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34625985

RESUMO

BACKGROUND: Alveolar osteitis (AO) is a poorly understood, common, painful complication following exodontia. It is sometimes managed by inappropriate prescription of antibiotics which contributes to the global threat of antimicrobial resistance. Use of intra-alveolar chlorhexidine also presents a serious risk of anaphylaxis to the patient. OBJECTIVE: This scoping review aims to investigate the aetiology, prevention and management of AO and highlight the extent of inappropriate prescribing and intra-alveolar chlorhexidine use. DESIGN: A scoping review was undertaken using the PRISMA guidelines. Medline, Ovid and Pubmed were searched between 2010 and 2020, from which 63 studies were selected for review that related to the aetiology, prevention or management of AO. Data were analysed for frequency of studies reporting information on risk factors for aetiology, prevention strategies and management including inappropriate management using antibiotic prescribing and intra-alveolar chlorhexidine. RESULTS: Impaired immune response, surgical technique and age were identified as significant factors in the development of AO, while there is conflicting evidence regarding the effects of smoking and gender. With regard to prevention, the use of prophylactic antibiotics is not supported within the literature. Saline irrigation and eugenol pastes used preventively have been shown to be cheap and effective alternatives to chlorhexidine with no adverse effects. Hyaluronic acid and low-level laser therapies showed a significant reduction in pain and soft-tissue inflammation in the management of AO compared to Alveogyl. CONCLUSIONS: Further understanding of the pathophysiology of AO is needed, in addition to large high-quality RCTs or long-term observational studies into the aetiology, prevention, and management of AO to produce up-to-date evidence-based clinical guidelines. Clinicians should also be mindful of their contribution to growing antimicrobial resistance and avoid inappropriate prescribing of antibiotics. Saline should replace chlorhexidine as the intra-alveolar irrigant of choice.


Assuntos
Alvéolo Seco , Clorexidina , Alvéolo Seco/etiologia , Alvéolo Seco/prevenção & controle , Humanos , Dente Serotino , Fumar , Extração Dentária
5.
BJS Open ; 5(6)2021 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-34915557

RESUMO

INTRODUCTION: Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. METHODS: This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone-iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. RESULTS: A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. CONCLUSION: The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary.


Assuntos
Clorexidina , Povidona-Iodo , Adulto , Antissepsia , Criança , Clorexidina/uso terapêutico , Humanos , Cuidados Pré-Operatórios , Estudos Prospectivos , Extremidade Superior/cirurgia
6.
Stomatologiia (Mosk) ; 100(6): 24-28, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34953184

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effectiveness of hyaluronic acid and chlorhexidine mouthwash in the treatment of peri-implant mucositis. MATERIAL AND METHODS: Clinical and microbiological studies were conducted before and 14 days, 1, 3 and 6 months after the periodontal treatment in 46 patients (144 implants with fixed dentures) with peri-implant mucositis. The patients were divided into 3 groups: test, comparison and control. Basic periodontal therapy in all groups included professional cleaning and individual oral hygiene training. Test group (15 patients) received basic periodontal therapy plus 0.20% chlorhexidine with hyaluronic acid mouthwash, the comparison group (15 patients) - basic periodontal therapy +0.05% chlorhexidine mouthwash. In control group (16 patients), treatment was limited to basic periodontal therapy only. RESULTS: At the initial stages of observations, there was a statistically significant improvement in the clinical indices in all treatment groups (p<0.001). The use of 0.20% chlorhexidine with hyaluronic acid mouthwash revealed a higher quality of treatment. After 6 months of observation, the clinical features in patients of the control group was almost similar to the state before treatment. The patients of the test group had a more pronounced elimination of facultative and periodontal pathogens in comparison with other groups. CONCLUSION: The use of 0.20% chlorhexidine with hyaluronic acid containing mouthwash allows the clinician to achieve a better results in the treatment of peri-implant mucositis. The evaluation the oral microflora in patients with peri-implant mucositis can be used as a prognostic criterion for the outcomes of rehabilitation.


Assuntos
Clorexidina/uso terapêutico , Implantes Dentários , Ácido Hialurônico/uso terapêutico , Antissépticos Bucais/uso terapêutico , Mucosite , Peri-Implantite , Estomatite , Implantes Dentários/efeitos adversos , Humanos , Mucosite/tratamento farmacológico , Peri-Implantite/tratamento farmacológico , Índice Periodontal , Estomatite/tratamento farmacológico
7.
Int J Oral Maxillofac Implants ; 36(6): 1188-1197, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34919620

RESUMO

PURPOSE: This study investigated the impact of 0.12% chlorhexidine gluconate mouthwash on dental implants with periimplant mucositis and contralateral teeth with gingivitis at 6 months of follow-up after nonsurgical treatment. MATERIALS AND METHODS: This was a secondary analysis of data from a previous controlled, randomized, double-blinded clinical trial of 30 patients diagnosed with peri-implant mucositis and gingivitis in contralateral teeth, at 6 months following treatment. Patients were randomly assigned into a test group (basic periodontal therapy + 0.12% chlorhexidine mouthwash) or a control group (basic periodontal therapy + placebo). Therapy consisted of an adaptation of the full-mouth scaling and root planing protocol. The clinical parameters of visible Plaque Index, Gingival Bleeding Index, probing depth, bleeding on probing, keratinized mucosa width, and gingival and peri-implant phenotype were evaluated at baseline and at 1, 3, and 6 months posttherapy. Data were analyzed using Poisson multilevel regression analysis with a significance level of .05. RESULTS: The study analyzed 47 implants and contralateral teeth (376 sites) in the test group and 49 implants and contralateral teeth (392 sites) in the control group. No differences were found between the groups at the patient level. At the site level, the teeth and implants presented statistical differences in bleeding on probing, probing depth, and keratinized mucosa width at 3 months for both treatment groups. However, no difference was observed in bleeding on probing in the test group (P = .484) at 6 months, whereas the control group demonstrated increased bleeding on probing (indicating more inflammation) at implant sites than at teeth sites (P = .039). Additionally, implant sites with a thin peri-implant phenotype (P < .001) and located posteriorly (P = .002) presented greater inflammation. CONCLUSION: Use of a 0.12% chlorhexidine mouthwash for 14 days was beneficial for implant sites with peri-implant mucositis, compared to contralateral teeth sites with gingivitis, as indicated by the reduced percentage of teeth with bleeding on probing.


Assuntos
Gengivite , Mucosite , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Gengivite/prevenção & controle , Humanos , Antissépticos Bucais/uso terapêutico , Análise Multinível
8.
BMC Health Serv Res ; 21(1): 1249, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34794442

RESUMO

BACKGROUND: Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. METHODS: We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. RESULTS: The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. CONCLUSIONS: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.


Assuntos
Anti-Infecciosos Locais , Clorexidina , Humanos , Mortalidade Infantil , Recém-Nascido , Quênia/epidemiologia , Cordão Umbilical
9.
Braz Dent J ; 32(3): 1-9, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34755783

RESUMO

Decontamination of the root canal (RC) system is essential for successful endodontic therapy. In this in vitro study, it was evaluated the disinfection potential of an electrofulguration device, the Endox® Endodontic System (EES), in RC infected with Enterococcus faecalis. Sixty-five human lower premolars were instrumented with MTwo® system. The specimens were distributed into six experimental groups (n = 10), according to the irrigation protocol: 2% chlorhexidine gel (CHX); CHX + EES; 5.25% sodium hypochlorite (NaOCl); NaOCl + EES; saline solution (SS); and SS + EES. Five specimens were untreated (control). RC samples were collected before (C1) and after EES treatment (C2), after chemo-mechanical preparation (CMP) (C3), and after final EES treatment (C4). All samples were plated for colony forming units (CFU/mL) onto solid media. The data were analyzed by Wilcoxon and Friedman tests for intragroup comparisons and by Kruskal Wallis test followed by Dunn's test for intergroup comparisons (α = 0.05). Treatment with the EES did not significantly reduce the number of CFU/mL as compared to baseline levels (C1 vs. C2, p> 0.05). After CMP (C3), all groups showed a significantly reduced amount of CFU/mL (p <0.05), with no difference between CHX- and NaOCl-treated samples (p >0.05). Lastly, treatment with the EES following CMP (C4) did not significantly reduce the amount of CFU/mL (C3 vs. C4, p> 0.05). To conclude, the use of the Endox® Endodontic System did not result in considerable bacterial reduction at all operative times, while treatment with NaOCl and CHX was equally efficient for this purpose.


Assuntos
Cavidade Pulpar , Irrigantes do Canal Radicular , Clorexidina , Enterococcus faecalis , Humanos , Preparo de Canal Radicular , Hipoclorito de Sódio
10.
Braz Dent J ; 32(3): 10-20, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34755784

RESUMO

The host defense response to microbial challenge emerging from the root canal system leads to apical periodontitis. The aim of this study was to evaluate the expression of inflammatory cytokines and Nitric Oxide (NO) by macrophages after interaction with Enterococcus faecalis in the: plankton and dislodged biofilm mode; intact biofilm mode stimulated by calcium hydroxide (CH), CH and chlorhexidine (CHX) or Triple Antibiotic Paste (TAP). For this purpose, culture of macrophages from monocytes in human peripheral blood (N=8) were exposed to the different modes of bacteria for 24 hours. Subsequently, the cytokines, such as, Tumor Necrotic Factor- alfa (TNF-α), interleukin (IL)-1ß, IL-6, IL-10; and NO were quantified by Luminex xMAP and Greiss reaction, respectively. In addition to the potential therapeutic effects of the intracanal medication, their antimicrobial activity against Enterococcus faecalis biofilm were also tested in vitro by confocal microscopy. The experiments` data were analyzed by the Kruskal-Wallis test with the Dunn post hoc test (α < 0.05). Bacteria in dislodged biofilm mode were shown to be more aggressive to the immune system than bacteria in plankton mode and negative control, inducing greater expression of NO and TNF-α. Relative to bacteria in intact biofilm mode, the weakest antimicrobial activity occurred in Group CH. In Groups CH/CHX and TAP the percentage of dead bacteria was significantly increased to the same extent. Interestingly, the biofilm itself did not induce the release of pro-inflammatory cytokines - except for NO - while the biofilm treated with TAP and CH based pastes enhanced the levels of IL-6 and TNF-α; and IL-1 ß, respectively. In contrast, the levels of a potent anti-inflammatory (IL-10) were increased in Group TAP.


Assuntos
Biofilmes , Plâncton , Antibacterianos , Bactérias , Hidróxido de Cálcio , Clorexidina , Enterococcus faecalis , Humanos , Irrigantes do Canal Radicular
11.
J Indian Soc Pedod Prev Dent ; 39(3): 310-315, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34810350

RESUMO

Background: Mouth rinses are solutions or liquids used to rinse the mouth to have a therapeutic effect by relieving infection or preventing dental caries due to their antimicrobial properties. Aims: This study was carried out to compare the effect of 0.12% chlorhexidine mouth rinse and 0.5% green tea extract mouth rinse on the colony-forming units (CFUs) of Streptococcus mutans in plaque in children. Materials and Methods: The sample for the study consisted of fifty schoolchildren aged 8-12 years with four or more (decay component) of decayed, missing, and filled teeth index. Children were divided randomly into two groups and were asked to rinse with the prescribed mouth rinse twice daily for 2 weeks under supervision. The plaque samples were collected at baseline (prerinsing) and postrinsing and tested for the CFUs of S. mutans. Results: The results of the study indicate that there was a statistically significant reduction (pre- and postrinsing) in S. mutans colony count in both the study groups. There was no statistically significant difference in the reduction of S. mutans colony count between 0.12% chlorhexidine mouth rinse group and 0.5% green tea mouth rinse group. Conclusion: Green tea mouth rinse is effective against S. mutans - one of the major dental plaque microorganisms.


Assuntos
Cárie Dentária , Placa Dentária , Criança , Clorexidina , Contagem de Colônia Microbiana , Cárie Dentária/prevenção & controle , Placa Dentária/tratamento farmacológico , Placa Dentária/prevenção & controle , Humanos , Antissépticos Bucais , Extratos Vegetais/farmacologia , Streptococcus mutans , Chá
12.
J Contemp Dent Pract ; 22(8): 914-921, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34753844

RESUMO

AIM: To evaluate the efficacy of an innovative herbal licorice mouthwash on reducing salivary Streptococcus mutans levels versus chlorhexidine mouthwash in high caries risk patients. METHODOLOGY: A total number of 52 high caries risk patients were assigned to this study. Patients were randomly divided into two groups (n = 26) according to the type of mouthwash (G): Patients in group G1 used the mouthwash containing chlorhexidine, while patients in group G2 used the mouthwash containing the innovative licorice extract. Afterward, each group was further divided into three subgroups according to the time (T): T0 represents the baseline, T1 represents the time immediately after using the mouthwash, and T2 represents the time 1 week after using the mouthwash. Furthermore, pH and plaque index were recorded. Data were statistically analyzed using a Chi-square test for categorical data, Shapiro-Wilk test for numerical data, and one-way repeated measures ANOVA followed by Bonferroni post hoc test for intragroup comparisons. The significance level was set at p ≤0.05 for all tests. Statistical analysis was performed with IBM® SPSS® Statistics version 26 for Windows. RESULTS: It was found that in high caries risk patients, there was no significant difference between licorice and chlorhexidine mouthwashes regarding Streptococcus bacterial count. Moreover, it was found that licorice mouthwash stimulates salivary flow, and thus, it raises salivary pH in patients with high caries risk. However, the plaque index of chlorhexidine showed better results. Additionally, there was a positive weak correlation between bacterial count and plaque index. CONCLUSIONS: Licorice mouthwash may demonstrate a promising antibacterial effect that can be a suitable alternative for current synthetic mouthwashes. CLINICAL SIGNIFICANCE: Natural herbal mouthwash could be incorporated in dental preventive measures and could be used as cavity-fighting compound. It introduces a minimal health hazard substitute for conventional synthetic preventive measures.


Assuntos
Clorexidina , Glycyrrhiza , Clorexidina/uso terapêutico , Suscetibilidade à Cárie Dentária , Humanos , Antissépticos Bucais/uso terapêutico , Extratos Vegetais/uso terapêutico , Streptococcus mutans
13.
Intensive Care Med ; 47(11): 1295-1302, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34609548

RESUMO

PURPOSE: Oral chlorhexidine is used widely for mechanically ventilated patients to prevent pneumonia, but recent studies show an association with excess mortality. We examined whether de-adoption of chlorhexidine and parallel implementation of a standardized oral care bundle reduces intensive care unit (ICU) mortality in mechanically ventilated patients. METHODS: A stepped wedge cluster-randomized controlled trial with concurrent process evaluation in 6 ICUs in Toronto, Canada. Clusters were randomized to de-adopt chlorhexidine and implement a standardized oral care bundle at 2-month intervals. The primary outcome was ICU mortality. Secondary outcomes were time to infection-related ventilator-associated complications (IVACs), oral procedural pain and oral health dysfunction. An exploratory post hoc analysis examined time to extubation in survivors. RESULTS: A total of 3260 patients were enrolled; 1560 control, 1700 intervention. ICU mortality for the intervention and control periods were 399 (23.5%) and 330 (21.2%), respectively (adjusted odds ratio [aOR], 1.13; 95% confidence interval [CI] 0.82 to 1.54; P = 0.46). Time to IVACs (adjusted hazard ratio [aHR], 1.06; 95% CI 0.44 to 2.57; P = 0.90), time to extubation (aHR 1.03; 95% CI 0.85 to 1.23; P = 0.79) (survivors) and oral procedural pain (aOR, 0.62; 95% CI 0.34 to 1.10; P = 0.10) were similar between control and intervention periods. However, oral health dysfunction scores (- 0.96; 95% CI - 1.75 to - 0.17; P = 0.02) improved in the intervention period. CONCLUSION: Among mechanically ventilated ICU patients, no benefit was observed for de-adoption of chlorhexidine and implementation of an oral care bundle on ICU mortality, IVACs, oral procedural pain, or time to extubation. The intervention may improve oral health.


Assuntos
Pacotes de Assistência ao Paciente , Pneumonia Associada à Ventilação Mecânica , Clorexidina , Humanos , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial
14.
Crit Care Nurse ; 41(5): e1-e8, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34595499

RESUMO

BACKGROUND: Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care-associated infections, which affect patients' lives and health care systems in various ways. OBJECTIVE: To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care-associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. METHODS: A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care-associated infections. RESULTS: Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care-associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care-associated infections. CONCLUSION: A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care-associated infections in intensive care unit and non-intensive care unit hospital settings.


Assuntos
Anti-Infecciosos Locais , Infecção Hospitalar , Banhos , Clorexidina/análogos & derivados , Estado Terminal , Infecção Hospitalar/prevenção & controle , Atenção à Saúde , Humanos , Unidades de Terapia Intensiva
15.
Sci Rep ; 11(1): 20502, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654867

RESUMO

The COVID-19 is difficult to contain due to its high transmissibility rate and a long incubation period of 5 to 14 days. Moreover, more than half of the infected patients were young and asymptomatic. Virus transmission through asymptomatic patients is a major challenge to disease containment. Due to limited treatment options, preventive measures play major role in controlling the disease spread. Gargling with antiseptic formulation may have potential role in eliminating the virus in the throat. Four commercially available mouthwash/gargle formulations were tested for virucidal activity against SARS-CoV-2 in both clean (0.3 g/l BSA) and dirty (0.3 g/l BSA + 3 mL/L human erythrocytes) conditions at time points 30 and 60 s. The virus was isolated and propagated in Vero E6 cells. The cytotoxicity of the products to the Vero E6 was evaluated by kill time assay based on the European Standard EN14476:2013/FprA1:2015 protocol. Virus titres were calculated as 50% tissue culture infectious dose (TCID50/mL) using the Spearman-Karber method. A reduction in virus titer of 4 log10 corresponds to an inactivation of ≥ 99.99%. Formulations with cetylperidinium chloride, chlorhexidine and hexitidine achieved > 4 log10 reduction in viral titres when exposed within 30 s under both clean and dirty conditions. Thymol formulations achieved only 0.5 log10 reduction in viral titres. In addition, salt water was not proven effective. Gargle formulations with cetylperidinium chloride, chlorhexidine and hexetidine have great potential in reducing SAR-CoV-2 at the source of entry into the body, thus minimizing risk of transmission of COVID-19.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/prevenção & controle , Eritrócitos/virologia , Antissépticos Bucais , SARS-CoV-2/efeitos dos fármacos , Animais , Anti-Infecciosos Locais , Antivirais , Cetilpiridínio , Clorexidina/análogos & derivados , Clorexidina/química , Chlorocebus aethiops , Eritrócitos/efeitos dos fármacos , Humanos , Timol/química , Células Vero , Carga Viral , Água
16.
Am J Dent ; 34(5): 273-276, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34689451

RESUMO

PURPOSE: To evaluate the effect of Carica papaya mouthrinse as an inhibitor of Streptococcus mutans. METHODS: This was a double blind (subject and evaluator) randomized controlled trial in 40 subjects distributed in two groups: Carica papaya mouthrinse intervention (n= 20) or chlorhexidine (n= 20). The antibacterial effect was determined by counting colony-forming units per milliliter (CFU/ml) of S. mutans in saliva sample cultures; taken both before mouthrinse, immediately after 10 minutes mouthrinsing, and 8 days after mouthrinsing. The data was statistically analyzed with Student's t-test (P ≤ 0.05). RESULTS: The difference before and immediately after (10 minutes) use of Carica papaya mouthrinse was of 764 CFUs. After 8 days use the difference was 212 CFUs. For the control group (0.12% chlorhexidine) the difference before and immediately after use (10 minutes) was 683 CFUs. After 8 days use the difference was 455 CFU. When comparing between groups applying t-test, no statistical differences were found in the (CFU/ml) of S. mutans before and after 10 minutes mouthrinse (P= 0.8060), 10 minutes and 8 days after mouthrinsing (P= 0.7104) before and 8 days after mouthrinsing (P= 0.4419). CLINICAL SIGNIFICANCE: Carica papaya could be an alternative mouthrinse for the inhibition of Streptococcus mutans.


Assuntos
Carica , Streptococcus mutans , Clorexidina/farmacologia , Humanos , Antissépticos Bucais/farmacologia , Saliva
17.
J Korean Acad Nurs ; 51(4): 414-429, 2021 Aug.
Artigo em Coreano | MEDLINE | ID: mdl-34497251

RESUMO

PURPOSE: This systematic review and meta-analysis analyzed the effects of 2% chlorhexidine bathing on the incidence of hospital-acquired infection (HAI) and multidrug-resistant organisms (MDRO) in adult intensive care units. METHODS: PubMed, CINAHL, Cochrane library, and RISS database were systematically searched, and 12 randomized studies were included in the analysis. Comprehensive Meta-Analysis version 3.0 was used to calculate the effect size using the odds ratio (OR) and a 95% confidence interval (CI). Subgroup analysis was performed according to the specific infection and intervention types. RESULTS: In general, 2% chlorhexidine bathing has a significant effect on the incidence of HAI (OR, 0.59; 95% CI, 0.40~0.86) and MDRO (OR, 0.52; 95% CI, 0.34~0.79). Subgroup analyses show 2% chlorhexidine bathing is effective in bloodstream infections (OR, 0.51; 95% CI, 0.39~0.66) but not for urinary tract infections, ventilator-associated pneumonia infections, and Clostridium difficile infections. Moreover, 2% chlorhexidine bathing alone or its combination with other interventions has a significant effect on the incidence of HAI and MDRO (OR, 0.59; 95% CI, 0.38~0.92). CONCLUSION: This meta-analysis reveals that 2% chlorhexidine bathing significantly reduces the incidence of HAI and MDRO in intensive care units. The effect of 2% chlorhexidine bathing on pediatric patients or patients at general wards should be further assessed as a cost-effective intervention for infection control.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Bacteriemia/prevenção & controle , Clorexidina/uso terapêutico , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Unidades de Terapia Intensiva , Adulto , Bacteriemia/microbiologia , Banhos , Hospitais , Humanos
18.
PLoS One ; 16(9): e0257947, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34587194

RESUMO

Prosthetic joint infections (PJI) are still an extremely concerning eventuality after joint replacement surgery; growing antibiotic resistance is also limiting the prophylactic and treatment options. Chlorhexidine (a widely used topical non-antibiotic antimicrobial compound) coatings on silica nanoparticles capable of prolonged drug release have been successfully developed and characterised. Such nanocarriers were incorporated into commercial formulation PMMA bone cement (Cemex), without adversely affecting the mechanical performance. Moreover, the bone cement containing the developed nanocarriers showed superior antimicrobial activity against different bacterial species encountered in PJI, including clinical isolates already resistant to gentamicin. Cytocompatibility tests also showed non inferior performance of the bone cements containing chlorhexidine releasing silica nanocarriers to the equivalent commercial formulation.


Assuntos
Bactérias/crescimento & desenvolvimento , Cimentos Ósseos/química , Clorexidina/farmacologia , Polimetil Metacrilato/química , Infecções Relacionadas à Prótese/microbiologia , Dióxido de Silício/química , Bactérias/efeitos dos fármacos , Linhagem Celular , Clorexidina/síntese química , Clorexidina/química , Preparações de Ação Retardada , Farmacorresistência Bacteriana/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana , Viabilidade Microbiana , Nanopartículas , Tamanho da Partícula , Infecções Relacionadas à Prótese/prevenção & controle
19.
J Shoulder Elbow Surg ; 30(12): 2671-2681, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34478863

RESUMO

BACKGROUND: The purpose of this study was to compare the efficacy of blue light therapy (BLT) and 5% topical benzoyl peroxide (BPO) gel in combination with standard chlorhexidine (CHX) preparation in eradicating Cutibacterium acnes at the deltopectoral interval measured by positive, quantitative culture findings. METHODS: Adult male volunteers were randomized to 1 of 3 treatment groups: BPO, BLT, and BPO followed by BLT. Contralateral shoulders served as matched controls. Volunteers randomized to BPO applied the gel for a total of 5 treatments. In the BLT group, a single 23-minute treatment was administered at an estimated irradiance of 40 mW/cm2 (radiant exposure, 55.2 J/cm2). In the BPO-BLT group, volunteers received both treatments as described earlier. After treatment with either BPO, BLT, or both, a single swab culture was taken from the treatment shoulder. Next, control and treatment shoulders were prepared with CHX, and cultures were taken from each shoulder. Cultures were sent for anaerobic quantitative growth analysis with both polymerase chain reaction and Sanger sequencing confirmation of presumptive C acnes colonies. RESULTS: This study enrolled 60 male volunteers, 20 per group, with no loss to follow-up. After treatment but prior to CHX administration, all culture samples in the BPO group and BLT group grew C acnes. Prior to CHX, 16 samples (80%) in the BPO-BLT group grew C acnes. On quantitative analysis, the BPO group and BPO-BLT group had significantly less growth of C acnes compared with the BLT group after treatment but prior to CHX (P < .05 for each). Following CHX administration, the BPO and BPO-BLT groups had significantly fewer positive culture findings (odds ratios of 0.03 and 0.29, respectively) and less quantity of growth compared with their control arms (P < .05). This was not seen in the BLT group. For quantitative between-group analysis, no significant synergistic effects were seen with BPO-BLT compared with BPO alone (P = .688). There was no difference in side effects between groups. CONCLUSION: The combination of topical BPO and CHX was effective at eliminating C acnes in most cases. BLT alone did not demonstrate effective antimicrobial properties against C acnes at the radiant exposure administered in this study. Combining BPO and BLT did not lead to significant synergistic antimicrobial effects. Both BPO and BLT are safe with few, transient side effects reported. More work is needed to determine whether BLT at higher radiant exposures or serial treatment results in bactericidal effects against C acnes in vivo.


Assuntos
Fármacos Dermatológicos , Articulação do Ombro , Adulto , Peróxido de Benzoíla , Clorexidina , Humanos , Masculino , Propionibacterium acnes , Pele
20.
AAPS PharmSciTech ; 22(7): 237, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34545436

RESUMO

Sealing the therapeutic agents in the root canal is considered to be an essential step in root canal therapy. The lyotropic liquid crystalline precursor (LLCP) incorporated with chlorhexidine (CHX) and silver nanoparticles (Ag-NPs) has been confirmed as a promising candidate for root canal therapy in the previous study. Importantly, the stability of the LLCP system was a significant determinant for its therapeutic effect and further application. The objective of this study was to comprehensively investigate the stability of the LLCP incorporated with CHX and Ag-NPs. The oil-water partition coefficient of CHX and Ag-NPs was measured. The water absorption and the physical stability of drug-loaded LLCP solution were studied. Stability under high temperature, high humidity, and strong light irradiation was also investigated. The results demonstrated that CHX and Ag-NPs could be entrapped in the water channel of LLCP, indicating the low tendency of drugs leakage. The drug-loaded LLCP was a pseudoplastic fluid and it showed an excellent physical stability with a sedimentation rate of 0.981 and a settling time of 26~28 h. The payload of LLCP was confirmed to weaken the water absorption behavior, which facilitated its transformation to cubic liquid crystal. The stress testing under high temperature, high humidity, and strong light irradiation also manifested that the LLCP was stable when stored under moisture-proof condition. In conclusion, the developed LLCP incorporated with CHX and Ag-NPs was highly stable during storage and qualified for further application.


Assuntos
Clorexidina , Cristais Líquidos , Nanopartículas Metálicas , Prata
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