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Rhee Y, Simms AT, Schoeny M, Baker AW, Baker MA, Gohil S, Rhee C, Talati NJ, Warren DK, Welbel S, Lolans K, Bell PB, Fukuda C, Hayden MK, Lin MY. Relationship between chlorhexidine gluconate concentration and microbial colonization of patients' skin. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38804007 DOI: 10.1017/ice.2024.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To characterize the relationship between chlorhexidine gluconate (CHG) skin concentration and skin microbial colonization. DESIGN Serial cross-sectional study. SETTING/PARTICIPANTS Adult patients in medical intensive care units (ICUs) from 7 hospitals; from 1 hospital, additional patients colonized with carbapenemase-producing Enterobacterales (CPE) from both ICU and non-ICU settings. All hospitals performed routine CHG bathing in the ICU. METHODS Skin swab samples were collected from adjacent areas of the neck, axilla, and inguinal region for microbial culture and CHG skin concentration measurement using a semiquantitative colorimetric assay. We used linear mixed effects multilevel models to analyze the relationship between CHG concentration and microbial detection. We explored threshold effects using additional models. RESULTS We collected samples from 736 of 759 (97%) eligible ICU patients and 68 patients colonized with CPE. On skin, gram-positive bacteria were cultured most frequently (93% of patients), followed by Candida species (26%) and gram-negative bacteria (20%). The adjusted odds of microbial recovery for every twofold increase in CHG skin concentration were 0.84 (95% CI, 0.80-0.87; P < .001) for gram-positive bacteria, 0.93 (95% CI, 0.89-0.98; P = .008) for Candida species, 0.96 (95% CI, 0.91-1.02; P = .17) for gram-negative bacteria, and 0.94 (95% CI, 0.84-1.06; P = .33) for CPE. A threshold CHG skin concentration for reduced microbial detection was not observed. CONCLUSIONS On a cross-sectional basis, higher CHG skin concentrations were associated with less detection of gram-positive bacteria and Candida species on the skin, but not gram-negative bacteria, including CPE. For infection prevention, targeting higher CHG skin concentrations may improve control of certain pathogens.
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Affiliation(s)
- Yoona Rhee
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Andrew T Simms
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Michael Schoeny
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Meghan A Baker
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Shruti Gohil
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Chanu Rhee
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Naasha J Talati
- Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David K Warren
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - Sharon Welbel
- Division of Infectious Diseases, Cook County Health, Chicago, IL, USA
| | - Karen Lolans
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Pamela B Bell
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Christine Fukuda
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Mary K Hayden
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Michael Y Lin
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
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Večerková L, Mašková L, Knejzlík Z, Kašpar O, Tokárová V. Development of spray-dried powder hand sanitiser with prolonged effectivity. Sci Rep 2024; 14:4827. [PMID: 38413707 PMCID: PMC10899249 DOI: 10.1038/s41598-024-55503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
Since the outbreak of the COVID-19 pandemic, the use of hand sanitisers has become an inseparable part of our personal hygiene. However, the short-term effect and the need for frequent application are shortcomings that impair the overall protection. Another aspect is that repeated use of some products (typically alcohol-based) may cause skin irritation or eventually more severe health problems. This work proposes spray-drying as a suitable method for the preparation of swellable chitosan carriers, allowing for encapsulation and sustained release of antibacterial chlorhexidine digluconate as a model active substance. After application to hands, micron-sized particles preferentially accommodate space between epidermal ridges, protected against attrition. Thanks to their small size (d < 10 µm), particles are comfortable to carry since they are not recognisable by somatosensory receptors. The performance of formulations with various amounts of chlorhexidine and cross-linker was tested and compared with selected commercial disinfectants available on the Czech market (ethanol gel and alcoholic solution with chlorhexidine) against E. coli and S. epidermidis. The real-life performance was investigated with twelve volunteers performing various activities for up to 2 h. Finally, a replica of the human index finger with accurately captured micro-topology was proposed and compared with volunteers' fingers concerning the total amount of adhered and detached particles.
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Affiliation(s)
- Lucie Večerková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic
| | - Lucie Mašková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic
| | - Zdeněk Knejzlík
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Flemingovo náměstí 542/2, 160 00, Prague 6, Czech Republic
| | - Ondřej Kašpar
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic
| | - Viola Tokárová
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic.
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Integrated genomic, epidemiologic investigation of Candida auris skin colonization in a skilled nursing facility. Nat Med 2021; 27:1401-1409. [PMID: 34155414 DOI: 10.1038/s41591-021-01383-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/05/2021] [Indexed: 02/06/2023]
Abstract
Candida auris is a fungal pathogen of high concern due to its ability to cause healthcare-associated infections and outbreaks, its resistance to antimicrobials and disinfectants and its persistence on human skin and in the inanimate environment. To inform surveillance and future mitigation strategies, we defined the extent of skin colonization and explored the microbiome associated with C. auris colonization. We collected swab specimens and clinical data at three times points between January and April 2019 from 57 residents (up to ten body sites each) of a ventilator-capable skilled nursing facility with endemic C. auris and routine chlorhexidine gluconate (CHG) bathing. Integrating microbial-genomic and epidemiologic data revealed occult C. auris colonization of multiple body sites not targeted commonly for screening. High concentrations of CHG were associated with suppression of C. auris growth but not with deleterious perturbation of commensal microbes. Modeling human mycobiome dynamics provided insight into underlying alterations to the skin fungal community as a possible modifiable risk factor for acquisition and persistence of C. auris. Failure to detect the extensive, disparate niches of C. auris colonization may reduce the effectiveness of infection-prevention measures that target colonized residents, highlighting the importance of universal strategies to reduce C. auris transmission.
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4
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Dijksteel GS, Nibbering PH, Ulrich MMW, Middelkoop E, Boekema BKHL. SPS-neutralization in tissue samples for efficacy testing of antimicrobial peptides. BMC Infect Dis 2019; 19:1093. [PMID: 31888515 PMCID: PMC6937930 DOI: 10.1186/s12879-019-4700-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background Accurate determination of the efficacy of antimicrobial agents requires neutralization of residual antimicrobial activity in the samples before microbiological assessment of the number of surviving bacteria. Sodium polyanethol sulfonate (SPS) is a known neutralizer for the antimicrobial activity of aminoglycosides and polymyxins. In this study, we evaluated the ability of SPS to neutralize residual antimicrobial activity of antimicrobial peptides [SAAP-148 and pexiganan; 1% (wt/v) in PBS], antibiotics [mupirocin (Bactroban) and fusidic acid (Fucidin) in ointments; 2% (wt/wt))] and disinfectants [2% (wt/wt) silver sulfadiazine cream (SSD) and 0.5% (v/v) chlorhexidine in 70% alcohol]. Methods Homogenates of human skin models that had been exposed to various antimicrobial agents for 1 h were pipetted on top of Methicillin-resistant Staphylococcus aureus (MRSA) on agar plates to determine whether the antimicrobial agents display residual activity. To determine the optimal concentration of SPS for neutralization, antimicrobial agents were mixed with PBS or increasing doses of SPS in PBS (0.05–1% wt/v) and then 105 colony forming units (CFU)/mL MRSA were added. After 30 min incubation, the number of viable bacteria was assessed. Next, the in vitro efficacy of SAAP-148 against various gram-positive and gram-negative bacteria was determined using PBS or 0.05% (wt/v) SPS immediately after 30 min incubation of the mixture. Additionally, ex vivo excision wound models were inoculated with 105 CFU MRSA for 1 h and exposed to SAAP-148, pexiganan, chlorhexidine or PBS for 1 h. Subsequently, samples were homogenized in PBS or 0.05% (wt/v) SPS and the number of viable bacteria was assessed. Results All tested antimicrobials displayed residual activity in tissue samples, resulting in a lower recovery of surviving bacteria on agar. SPS concentrations at ≥0.05% (wt/v) were able to neutralize the antimicrobial activity of SAAP-148, pexiganan and chlorhexidine, but not of SSD, Bactroban and Fucidin. Finally, SPS-neutralization in in vitro and ex vivo efficacy tests of SAAP-148, pexiganan and chlorhexidine against gram-positive and gram-negative bacteria resulted in significantly higher numbers of CFU compared to control samples without SPS-neutralization. Conclusions SPS was successfully used to neutralize residual activity of SAAP-148, pexiganan and chlorhexidine and this prevented an overestimation of their efficacy.
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Affiliation(s)
- Gabrielle Sherella Dijksteel
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands. .,Department of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centres, Free University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Peter H Nibbering
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Magda M W Ulrich
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centres, Free University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Esther Middelkoop
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centres, Free University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Bouke K H L Boekema
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands
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Sicairos-Ruelas EE, Gerba CP, Bright KR. Efficacy of copper and silver as residual disinfectants in drinking water. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2019; 54:146-155. [PMID: 30686111 DOI: 10.1080/10934529.2018.1535160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 06/09/2023]
Abstract
Contamination events and biofilms can decrease the amount of free chlorine available in drinking water systems. The efficacy of 100 μg/L silver and 400 μg/L copper, individually and combined, were evaluated as secondary, longer-lasting residual disinfectants against Salmonella enterica serovar Typhimurium, Escherichia coli, Listeria monocytogenes, and Mycobacterium fortuitum at 24 °C and 4 °C. A >5.0-log10 reduction was observed in E. coli and L. monocytogenes after three hours and S. Typhimurium following seven hours of exposure to silver. M. fortuitum was the most resistant species to silver (1.11-log10 after seven hours). Copper did not significantly reduce S. Typhimurium and E. coli at 24 °C; ≥2.80-log10 reductions were observed in the Gram-positive L. monocytogenes and M. fortuitum. Longer exposure times were required at 4 °C to achieve significant reductions in all species. A synergistic effect was observed when silver and copper were combined at 24 °C. In addition, silver was not affected by the presence of organic matter at concentrations that completely inhibited 0.2 mg/L chlorine. The results of this study suggest that combinations of silver and copper show promise as secondary residual disinfectants. They may also be used in conjunction with low chlorine levels or other disinfectants to provide additional, long-lasting residuals in distribution systems.
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Affiliation(s)
- Enue E Sicairos-Ruelas
- a Water and Energy Sustainable Technology Center , The University of Arizona , Tucson , Arizona , USA
| | - Charles P Gerba
- a Water and Energy Sustainable Technology Center , The University of Arizona , Tucson , Arizona , USA
| | - Kelly R Bright
- a Water and Energy Sustainable Technology Center , The University of Arizona , Tucson , Arizona , USA
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6
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Uzuner H, Karadenizli A, Er D, Osmani A. Investigation of the efficacy of alcohol-based solutions on adenovirus serotypes 8, 19 and 37, common causes of epidemic keratoconjunctivitis, after an adenovirus outbreak in hospital. J Hosp Infect 2018; 100:e30-e36. [DOI: 10.1016/j.jhin.2018.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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7
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Marbach H, Vizcay-Barrena G, Memarzadeh K, Otter JA, Pathak S, Allaker RP, Harvey RD, Edgeworth JD. Tolerance of MRSA ST239-TW to chlorhexidine-based decolonization: Evidence for keratinocyte invasion as a mechanism of biocide evasion. J Infect 2018; 78:119-126. [PMID: 30367885 DOI: 10.1016/j.jinf.2018.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/30/2018] [Accepted: 10/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Information on genetic determinants of chlorhexidine tolerance (qacA carriage and MIC) in vitro is available, although evidence of the clinical impact and mechanisms remain poorly understood. We investigated why, following chlorhexidine intervention, prevalent epidemic MRSA ST22 and ST36 clones declined at an ICU, whilst an ST239-TW clone did not. The chlorhexidine tolerant ST239-TW phenotypes were assessed for their protein binding, cell adhesion and intracellular uptake potential. METHODS Six ST22, ST36 and ST239-TW bloodstream infection isolates with comparable chlorhexidine MICs were selected from a 2-year outbreak in an ICU at Guy's and St. Thomas' Hospital. Isolates were tested for fibrinogen and fibronectin binding, and adhesion/internalization into human keratinocytes with and without biocide. RESULTS Binding to fibrinogen and fibronectin, adhesion and intracellular uptake within keratinocytes (P < 0.001) and intracellular survival in keratinocytes under chlorhexidine pressure (ST22 3.18%, ST36 4.57% vs ST239-TW 12.79%; P < 0.0001) was consistently higher for ST239-TW. CONCLUSIONS We present evidence that MRSA clones with similarly low in vitro tolerance to chlorhexidine exhibit different in vivo susceptibilities. The phenomenon of S. aureus adhesion and intracellular uptake into keratinocytes could therefore be regarded as an additional mechanism of chlorhexidine tolerance, enabling MRSA to evade infection control measures.
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Affiliation(s)
- Helene Marbach
- Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Science, King's College London, UK
| | - Gema Vizcay-Barrena
- Centre for Ultrastructural Imaging, King's College London, Guy's Campus, London, UK
| | - Kaveh Memarzadeh
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan A Otter
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research (CIDR), King's College London & Guy's and St. Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Smriti Pathak
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research (CIDR), King's College London & Guy's and St. Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Robert P Allaker
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard D Harvey
- Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Science, King's College London, UK.
| | - Jonathan D Edgeworth
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research (CIDR), King's College London & Guy's and St. Thomas' NHS Foundation Trust (GSTT), London, UK
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Boucher C, Henton MM, Becker PJ, Kirberger RM, Hartman MJ. Comparative efficacy of three antiseptics as surgical skin preparations in dogs. Vet Surg 2018; 47:792-801. [PMID: 30004127 DOI: 10.1111/vsu.12913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 03/06/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the antimicrobial efficacy of a 2% chlorhexidine gluconate and 70% ethanol solution (CG+A) with that of F10 Skin Prep Solution (F10) and electrochemically activated water (EAW) when used as a surgical preparation in canine patients. STUDY DESIGN Prospective randomized clinical study. SAMPLE POPULATION One hundred sixteen dogs presented for ovariohysterectomy. METHODS Dogs were randomly divided into 1 of the 3 antiseptic groups (CG+A, F10, EAW). Skin samples with replicating organism detection and counting plates were taken at 4 different perioperative sites and time intervals (postskin preparation, postskin antisepsis, 2 hours after the second sample, and at the end of surgery) during ovariohysterectomies performed by students. The colony forming unit (CFU) counts from each sample were quantified according to the level of bacterial contamination. Zero CFU was defined as no contamination, 1-12 CFU was defined as low contamination, and greater than 12 CFU was defined as high contamination. The 3 antiseptics were compared with respect to the level of contamination. RESULTS There was no difference in the level of colonization between the antiseptics at the first sampling time (P = .454). However, the level of contamination for CG+A was lower compared with F10 and EAW at the second, third, and fourth sampling times (P = .001, P = .01, P = .02, respectively). CONCLUSION CG+A was more effective at achieving a zero CFU count and low levels of contamination compared with F10 and EAW for surgical preparation in dogs undergoing ovariohysterectomy. CLINICAL SIGNIFICANCE This study does not provide evidence to support the use of F10 and EAW instead of CG+A for the surgical skin preparation of dogs undergoing ovariohysterectomy.
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Affiliation(s)
- Charles Boucher
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | | | - Piet J Becker
- Research Office, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Robert M Kirberger
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Marthinus J Hartman
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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9
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Kampf G. Aqueous chlorhexidine for surgical hand disinfection? J Hosp Infect 2018; 98:378-379. [DOI: 10.1016/j.jhin.2017.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
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10
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Differential Effects of Chlorhexidine Skin Cleansing Methods on Residual Chlorhexidine Skin Concentrations and Bacterial Recovery. Infect Control Hosp Epidemiol 2018; 39:405-411. [PMID: 29493475 DOI: 10.1017/ice.2017.312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bathing intensive care unit (ICU) patients with 2% chlorhexidine gluconate (CHG)-impregnated cloths decreases the risk of healthcare-associated bacteremia and multidrug-resistant organism transmission. Hospitals employ different methods of CHG bathing, and few studies have evaluated whether those methods yield comparable results. OBJECTIVE To determine whether 3 different CHG skin cleansing methods yield similar residual CHG concentrations and bacterial densities on skin. DESIGN Prospective, randomized 2-center study with blinded assessment. PARTICIPANTS AND SETTING Healthcare personnel in surgical ICUs at 2 tertiary-care teaching hospitals in Chicago, Illinois, and Boston, Massachusetts, from July 2015 to January 2016. INTERVENTION Cleansing skin of one forearm with no-rinse 2% CHG-impregnated polyester cloth (method A) versus 4% CHG liquid cleansing with rinsing on the contralateral arm, applied with either non-antiseptic-impregnated cellulose/polyester cloth (method B) or cotton washcloth dampened with sterile water (method C). RESULTS In total, 63 participants (126 forearms) received method A on 1 forearm (n=63). On the contralateral forearm, 33 participants received method B and 30 participants received method C. Immediately and 6 hours after cleansing, method A yielded the highest residual CHG concentrations (2500 µg/mL and 1250 µg/mL, respectively) and lowest bacterial densities compared to methods B or C (P<.001). CONCLUSION In healthy volunteers, cleansing with 2% CHG-impregnated cloths yielded higher residual CHG concentrations and lower bacterial densities than cleansing with 4% CHG liquid applied with either of 2 different cloth types and followed by rinsing. The relevance of these differences to clinical outcomes remains to be determined. Infect Control Hosp Epidemiol 2018;39:405-411.
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11
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Böttcher B, Sarg B, Lindner HH, Nagl M. Inactivation of microbicidal active halogen compounds by sodium thiosulphate and histidine/methionine for time-kill assays. J Microbiol Methods 2017; 141:42-47. [DOI: 10.1016/j.mimet.2017.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
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12
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Banovic F, Olivry T, Bäumer W, Paps J, Stahl J, Rogers A, Jacob M. Diluted sodium hypochlorite (bleach) in dogs: antiseptic efficacy, local tolerability and in vitro effect on skin barrier function and inflammation. Vet Dermatol 2017; 29:6-e5. [PMID: 28906043 DOI: 10.1111/vde.12487] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diluted sodium hypochlorite represents an inexpensive and widely available topical antiseptic, but there are no tolerability and efficacy data in veterinary dermatology. OBJECTIVES To determine the in vivo antibacterial effect and tolerability of topical diluted bleach application and to assess its in vitro effect on skin barrier lipids and anti-inflammatory properties on keratinocytes. METHODS Topical hypochlorite at 0.05% and tap water were applied to both sides of the thorax of four healthy dogs. The anti-inflammatory effect on canine keratinocytes was determined by real-time polymerase chain reaction; skin barrier integrity was assessed by evaluating stratum corneum lipid changes in canine stratified epidermal constructs. RESULTS The cell viability of primary keratinocytes treated with water and diluted hypochlorite at 0.005 and 0.01%, reduced the percentage of viable cells by 10%. The exposure of primary keratinocytes to 0.005% diluted hypochlorite significantly reduced the induction of inflammatory genes chemokine ligand-2 (CCL2; P = 0.015) and thymus and activation-regulated chemokine (TARC/CCL17, P = 0.032). There were no changes in skin lipid ceramide and nonceramide fractions in stratified epidermal constructs cultured for 17 days with 0.05% hypochlorite. Topical hypochlorite at 0.05% and tap water were well-tolerated without signs of skin irritation. Although a marked reduction in bacterial counts was seen within 20 min of diluted bleach application compared to the tap water control, this was only marginally significant (P = 0.06). CONCLUSIONS AND CLINICAL IMPORTANCE The results indicate that a topical diluted bleach solution, at either 0.05 or 0.005% hypochlorite concentrations, is a well-tolerated antiseptic that also exhibits anti-inflammatory properties.
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Affiliation(s)
- Frane Banovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA, 30602, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Wolfgang Bäumer
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Judy Paps
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Jessica Stahl
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, D-30559, Hannover, Germany
| | - Ana Rogers
- Department of Population Health and Pathology, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
| | - Megan Jacob
- Department of Population Health and Pathology, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA
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Hardy JM, Owen TJ, Martinez SA, Jones LP, Davis MA. The effect of nail characteristics on surface bacterial counts of surgical personnel before and after scrubbing. Vet Surg 2017; 46:952-961. [DOI: 10.1111/vsu.12685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 01/25/2017] [Accepted: 02/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jade M. Hardy
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Washington State University; Pullman Washington
| | - Tina J. Owen
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Washington State University; Pullman Washington
| | - Steven A. Martinez
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Washington State University; Pullman Washington
| | - Lisa P. Jones
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Washington State University; Pullman Washington
| | - Margaret A. Davis
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Washington State University; Pullman Washington
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14
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Verwilghen D. The World Health Organization's Clean Hands Save Lives: A concept applicable to equine medicine as Clean Hands Save Horses. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- D. Verwilghen
- Section of Medicine and Surgery; Department of Large Animals Sciences; University of Copenhagen; Denmark
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15
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Uri M, Buckley LM, Marriage L, McEwan N, Schmidt VM. A pilot study comparingin vitroefficacy of topical preparations against veterinary pathogens. Vet Dermatol 2016; 27:152-e39. [DOI: 10.1111/vde.12306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Maarja Uri
- Small Animal Veterinary Teaching Hospital; University of Liverpool; Leahurst Chester High Road Neston CH64 7TE UK
| | - Laura M. Buckley
- Small Animal Veterinary Teaching Hospital; University of Liverpool; Leahurst Chester High Road Neston CH64 7TE UK
| | - Louise Marriage
- Small Animal Veterinary Teaching Hospital; University of Liverpool; Leahurst Chester High Road Neston CH64 7TE UK
| | - Neil McEwan
- Small Animal Veterinary Teaching Hospital; University of Liverpool; Leahurst Chester High Road Neston CH64 7TE UK
| | - Vanessa M. Schmidt
- Small Animal Veterinary Teaching Hospital; University of Liverpool; Leahurst Chester High Road Neston CH64 7TE UK
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Kampf G. Effect of Chlorhexidine Probably Overestimated Because of Lack of Neutralization after Sampling. Infect Control Hosp Epidemiol 2015; 30:811-2; author reply 812-3. [DOI: 10.1086/597522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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So BKL, Chu CCY, Ho PL, Chow KH, Leung JNS, Lee IYM, Lin CK, Lee CK. Evaluation of two chlorhexidine - alcohol-based skin disinfectants in blood donation setting. Vox Sang 2013; 106:316-21. [DOI: 10.1111/vox.12107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B. K. L. So
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - C. C. Y. Chu
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - P. L. Ho
- Carol Yu Center for Infection and Department of Microbiology; the University of Hong Kong; Hong Kong SAR China
| | - K. H. Chow
- Carol Yu Center for Infection and Department of Microbiology; the University of Hong Kong; Hong Kong SAR China
| | - J. N. S. Leung
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - I. Y. M. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - C. K. Lin
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - C. K. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
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Kampf G, Reichel M, Hollingsworth A, Bashir M. Efficacy of surgical hand scrub products based on chlorhexidine is largely overestimated without neutralizing agents in the sampling fluid. Am J Infect Control 2013; 41:e1-5. [PMID: 23287283 DOI: 10.1016/j.ajic.2012.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/18/2012] [Accepted: 07/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical hand antiseptics often contain chlorhexidine gluconate (CHG). There are doubts that the full effect measured for these products might only be achieved after sampling because of a lack of valid neutralizing agents (NAs) in the sampling fluid. METHODS We measured the efficacy of Avagard CHG and Hibiclens for 11 applications over 5 days according to the manufacturers' instructions. NAs were added to the sampling fluid and the dilution fluid (group 1) or to only the dilution fluid (group 2). In a third group, NAs were added to the dilution fluid only, and cream was applied after the final scrub on days 1 to 4. Neutralization was validated according to American Society for Testing and Materials International standard 1054 using Staphylococcus epidermidis. RESULTS When NAs were not added to the sampling fluid, both products were very effective, with a mean log(10) reduction in flora of 3.32 ± 0.53 for Avagard and 3.68 ± 0.52 for Hibiclens on day 5. When NAs were included in the sampling fluid, however, the immediate efficacy was significantly lower, at 2.75 ± 0.55 and 3.14 ± 0.50, respectively. A lack of NAs in the sampling fluid resulted in overestimation of efficacy by a factor of between 0.3 and 1.1 log(10). CONCLUSION Efficacy studies carried out without NAs in the sampling fluid for products with CHG should be critically assessed.
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Horner C, Mawer D, Wilcox M. Reduced susceptibility to chlorhexidine in staphylococci: is it increasing and does it matter? J Antimicrob Chemother 2012; 67:2547-59. [DOI: 10.1093/jac/dks284] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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20
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Postma DF, Sankatsing SUC, Thijsen SFT, Endeman H. Effects of chlorhexidine oral decontamination on respiratory colonization during mechanical ventilation in intensive care unit patients. Infect Control Hosp Epidemiol 2012; 33:527-30. [PMID: 22476283 DOI: 10.1086/665325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We conducted a retrospective cohort study to assess respiratory colonization before and after the use of chlorhexidine oral decontamination among a cohort of intensive care unit patients who received mechanical ventilation. We observed a decrease in the prevalence of Enterobacteriaceae and an increase in the incidence of fungal colonization. Chlorhexidine oral decontamination might have a differential effect on respiratory colonization.
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Affiliation(s)
- Douwe F Postma
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands.
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21
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Verwilghen D, Grulke S, Kampf G. Presurgical hand antisepsis: concepts and current habits of veterinary surgeons. Vet Surg 2012; 40:515-21. [PMID: 21736594 DOI: 10.1111/j.1532-950x.2011.00846.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques. STUDY DESIGN Survey of veterinary surgical specialists. SAMPLE POPULATION Diplomates of the American (ACVS) and European Colleges of Veterinary Surgeons (ECVS). METHODS An internet-based survey of hand preparation methods before surgical procedures was conducted of 1300 listed ACVS and ECVS Diplomates. RESULTS A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution. CONCLUSIONS Contrary to current recommendations of the World Health Organization and scientific evidence supporting use of hydro-alcoholic rubs for presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps.
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Affiliation(s)
- Denis Verwilghen
- Department of Clinical Sciences of Companion Animals and Equids, Faculty of Veterinary Medicine of Liege, Liege, Belgium.
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22
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Verwilghen DR, Mainil J, Mastrocicco E, Hamaide A, Detilleux J, van Galen G, Serteyn D, Grulke S. Surgical hand antisepsis in veterinary practice: Evaluation of soap scrubs and alcohol based rub techniques. Vet J 2011; 190:372-7. [DOI: 10.1016/j.tvjl.2010.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/12/2010] [Accepted: 12/19/2010] [Indexed: 11/28/2022]
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23
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Montville R, Schaffner DW. A meta-analysis of the published literature on the effectiveness of antimicrobial soaps. J Food Prot 2011; 74:1875-82. [PMID: 22054188 DOI: 10.4315/0362-028x.jfp-11-122] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of this research was to conduct a systematic quantitative analysis of the existing data in the literature in order to determine if there is a difference between antimicrobial and nonantimicrobial soaps and to identify the methodological factors that might affect this difference. Data on hand washing efficacy and experimental conditions (sample size, wash duration, soap quantity, challenge organism, inoculum size, and neutralization method) from published studies were compiled and transferred to a relational database. A total of 25 publications, containing 374 observations, met the study selection criteria. The majority of the studies included fewer than 15 observations with each treatment and included a direct comparison between nonantimicrobial soap and antimicrobial soap. Although differences in efficacy between antimicrobial and nonantimicrobial soap were small (∼0.5-log CFU reduction difference), antimicrobial soap produced consistently statistically significantly greater reductions. This difference was true for any of the antimicrobial compounds investigated where n was >20 (chlorhexidine gluconate, iodophor, triclosan, or povidone). Average log reductions were statistically significantly greater (∼2 log CFU) when either gram-positive or gram-negative transient organisms were deliberately added to hands compared with experiments done with resident hand flora (∼0.5 log CFU). Our findings support the importance of using a high initial inoculum on the hands, well above the detection limit. The inherent variability in hand washing seen in the published literature underscores the importance of using a sufficiently large sample size to detect differences when they occur.
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Affiliation(s)
- Rebecca Montville
- Food Science Department, Rutgers University, New Brunswick, New Jersey 08901, USA
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Neihaus SA, Hathcock TL, Boothe DM, Goring RL. Presurgical Antiseptic Efficacy of Chlorhexidine Diacetate and Providone-Iodine in the Canine Preputial Cavity. J Am Anim Hosp Assoc 2011; 47:406-12. [DOI: 10.5326/jaaha-ms-5681] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antiseptic flushing of the canine prepuce and its exclusion from the surgical field are recommended before abdominal surgery to reduce the risk of bacterial contamination. The authors cultured the preputial cavity of 60 dogs prior to and following flushing with 0.05% chlorhexidine diacetate, 1% povidone-iodine, or 0.9% saline control. Bacterial growth was evaluated using a semiquantitative method, and bacterial organisms were subsequently identified. There were no significant differences between povidone-iodine and the saline control in any of the variables assessed. Chlorhexidine resulted in a significant decrease in the proportion of positive postflush cultures compared with povidone-iodine. Although not significant, the difference in adverse reactions between povidone-iodine (25%) and chlorhexidine diacetate (5%) suggests clinical relevance. Based on the results of this study, a 2 min flush with 0.05% chlorhexidine diacetate is recommended for presurgical preparation of the preputial cavity.
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Affiliation(s)
- Steven A. Neihaus
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); and Department of Pathobiology (T.H.), Department of Anatomy, Physiology and Pharmacology (D.B.), Auburn University, AL
| | - Terri L. Hathcock
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); and Department of Pathobiology (T.H.), Department of Anatomy, Physiology and Pharmacology (D.B.), Auburn University, AL
| | - Dawn M. Boothe
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); and Department of Pathobiology (T.H.), Department of Anatomy, Physiology and Pharmacology (D.B.), Auburn University, AL
| | - Robert L. Goring
- Affiliated Veterinary Specialists, Orange Park, FL (S.N., R.G.); and Department of Pathobiology (T.H.), Department of Anatomy, Physiology and Pharmacology (D.B.), Auburn University, AL
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Reichel M, Heisig P, Kampf G. Identification of variables for aerobic bacterial density at clinically relevant skin sites. J Hosp Infect 2011; 78:5-10. [PMID: 21439679 DOI: 10.1016/j.jhin.2011.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/04/2011] [Indexed: 11/17/2022]
Affiliation(s)
- M Reichel
- Bode Chemie GmbH, Scientific Affairs, Hamburg, Germany.
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Kampf G, Ostermeyer C. "Persistent activity" of chlorhexidine or alcohol-based hand rubs-what is really necessary to prevent nosocomial infections? Am J Infect Control 2011; 39:255-6; author reply 256-8. [PMID: 21458687 DOI: 10.1016/j.ajic.2009.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 11/23/2009] [Accepted: 11/30/2009] [Indexed: 11/15/2022]
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Kampf G. Are the conclusions on a copper-based biocidal handrub scientifically justified? Am J Infect Control 2009; 37:691-2; author reply 692. [PMID: 19782250 DOI: 10.1016/j.ajic.2009.04.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
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Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother 2009; 53:4778-82. [PMID: 19738017 DOI: 10.1128/aac.00582-09] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The antiseptic efficacy of ethanol, isopropanol, and n-propanol at 60%, 70%, and 89.5% (all vol/vol) was analyzed after 2, 3, or 4 min of application to the forehead, back, and abdomen of 180 volunteers by the use of a standardized swab sampling method. Results of recolonization by the aerobic skin flora of the upper arms and backs of 20 volunteers were compared 72 h after treatment with 0.5%, 1%, or 2% chlorhexidine digluconate (CHG) in 89.5% n-propanol. The most effective alcohol at all skin sites was n-propanol, with a mean log(10) reduction of 1.82 after 2 min on the forehead. Efficacy against the aerobic flora of the forehead was mainly influenced by the type of alcohol (P < 0.001), followed by the concentration (P < 0.001) and the application time (P = 0.006). Ethanol and isopropanol were significantly less effective (both P < 0.001). Alcohol supplemented with 0.5% or more CHG was significantly more effective than alcohol alone in the suppression of recolonization (P < 0.05). An 89.5% solution of n-propanol was the most effective alcohol for the reduction of populations of aerobic skin flora. Its combination with CHG is appropriate whenever recolonization of the skin must be limited. Further studies are needed to determine the most effective concentration of CHG in n-propanol to provide the best protection against recolonization of the skin, e.g., for catheter site care.
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Rotter M, Sattar S, Dharan S, Allegranzi B, Mathai E, Pittet D. Methods to evaluate the microbicidal activities of hand-rub and hand-wash agents. J Hosp Infect 2009; 73:191-9. [PMID: 19729223 DOI: 10.1016/j.jhin.2009.06.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 06/16/2009] [Indexed: 11/16/2022]
Abstract
In vitro carrier tests, suspension tests, time-kill curves, and determinations of minimum inhibitory concentrations to evaluate the microbicidal activities of hand antiseptics provide only a preliminary indication of the antimicrobial spectrum and speed of action of a given formulation. Ex vivo testing with human or animal skin at human skin temperature and at contact times reflecting field conditions may give a better indication of a formulation's ability to tackle hand-transmitted pathogens. Field testing of hands for levels of skin microbiota before and after antisepsis may be easier to perform, but it is subject to many uncontrollable factors. Whereas randomised clinical trials may be the ultimate approach to assess the effectiveness of hand hygiene protocols and products in preventing microbial cross-transmission and, ultimately, infections, they can be prohibitively expensive, time-consuming, difficult to design, and therefore impractical. Hence, the primary emphasis should be on in vivo testing on human hands, using a well-designed protocol that closely simulates the recommended field use of the formulation, and possibly followed by clinical studies. The use of these method is the most likely to yield useful data on the potential of a formulation to interrupt the spread of pathogens transmitted by hands in healthcare settings. This review provides a critical assessment of the methods currently used to meet regulatory requirements for hand antiseptics in Europe and North America.
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Affiliation(s)
- M Rotter
- Institute of Hygiene and Medical Microbiology, Medical University of Vienna, Vienna, Austria
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