The use of iodine as an antiseptic agent

A novel cationic β-cyclodextrin decorated with a choline-like pendant exhibits Iodophor, Mucoadhesive and bactericidal properties

Iodine is a vital microelement and a powerful antiseptic with a rapid and broad spectrum of action. The development of iodophor compounds to improve the solubility and stability of iodine is still challenging. Here, we report the synthesis of a novel cationic β-cyclodextrin bearing a choline-like pendant (β-CD-Chol) designed to complex and deliver iodine to bacterial cells. The characterization of β-CD-Chol and the investigation of the inclusion complex with iodine were performed by NMR spectroscopy, mass spectrometry, UV-vis spectrophotometry, isothermal titration calorimetry, and dynamic light scattering. The functionalization with the positively charged unit conferred improved water-solubility, mucoadhesivity, and iodine complexation efficiency to the β-CD scaffold. The water-soluble β-CD-Chol/iodine complex efficiently formed both in solution and by solid-vapor reaction. The solid complex exhibited a significant stability for months. Iodine release from the inclusion complex was satisfactory and the bactericidal activity was proved against a Staphylococcus epidermidis strain. The absence of cytotoxicity tested on human keratinocytes and the improved mucoadhesivity make β-CD-Chol a promising drug delivery system and an appealing iodophor candidate for iodine-based antisepsis including mucosa disinfection.

Use of the Dialkylcarbamoylchloride Dressing in the Care of Central Venous Access Exit Site in a Pediatric and Neonatal Population

Dialkylcarbamoylchloride dressing is a fatty acid derivative that has been shown in vitro to bind a number of pathogenic microorganisms. The purpose of this prospective study was to evaluate the safety and the efficacy of this technology in the care of the exit site of central venous catheter in a paediatric and neonatal population.

METHODS

The study was conducted from September 2020 to December 2022 at the Infermi Hospital in Rimini. Central venous catheters were placed using the SIC bundle for insertion. Dialkylcarbamoylchloride dressing was placed below the subcutaneous anchoring at the time of CVC placement and at each dressing change. Data about the catheters and the exit site were recorded and then compared with an historical cohort.

RESULTS

118 catheters were placed during the studied period. The dialkylcarbamoylchloride dressing was well-tolerated. No case of systemic or local infection was recorded. The comparison with the historical cohort showed a reduction in the rate of exit site infection (p value 0.03).

CONCLUSION

Dialkylcarbamoylchloride dressing is well-tolerated in paediatric and neonatal population. It represents a promising tool as a strategy for infection prevention.

A novel role of topical iodine in skin: Activation of the Nrf2 pathway

For a long time iodine has been used as an active dermal agent in the treatment of inflammatory, immune-mediated and infectious diseases. Moreover, topical iodine application has been reported to provide protection against sulfur-mustard-induced skin lesions, heat-induced and acid-induced skin burns in both haired guinea-pigs and mouse ear swelling models. However, the exact mechanism of action underlying these benefits of iodine has not yet been elucidated. In the current study, a novel mechanism of action by which iodine provides skin protection and relief, based on its electrophilic nature, is suggested. This study demonstrates that both iodine and iodide are capable of activating the Nrf2 pathway in human skin. As a result, skin protection against UVB-induced damage was acquired and the secretion of pro-inflammatory cytokines (IL-6, IL-8) from LPS-challenged skin was reduced. Iodide role in the enhanced activation of this pathway is demonstrated. The mode of action by which iodine and iodide activate the Nrf2 pathway is discussed.

The effect of scrubbing hands with iodine-containing solutions on urinary iodine concentrations of the operating room staff

BACKGROUND

Excessive iodine exposure is associated with thyroid dysfunction and thyroid autoimmunity. Most surgical hand-scrub solutions contain large amounts of iodine, and transcutaneous and mucosal absorption of iodine from these antiseptic solutions has been demonstrated. In this study we determined the effect of hand scrubbing with iodine-containing surgical hand-scrub solutions on urinary iodine concentrations (UICs) in operating room staff.

METHODS

The study included 117 surgeons and surgical nurses from two different hospitals who often used surgical hand-scrub solutions as the iodine exposure group and 92 age-matched hospital staff from nonsurgical units of the same hospitals as the controls. In the iodine exposure group, 39 subjects (from hospital 1) used iodine-containing hand scrub solutions intermittently, and the remaining 78 in the surgical staff (from hospital 2) used only iodine-containing hand-scrub solutions. Morning spot urine specimens were collected from all participants for the analysis of UIC.

RESULTS

The operating room staff had significantly higher UICs compared to the control group (142 μg/L [12-822 μg/L] vs. 89 μg/L [10-429 μg/L], p<0.001). UICs from 39% of the subjects from hospital 2 were found to reach levels higher than 300 μg/L.

CONCLUSION

Scrubbing with iodine-containing solutions might lead to iodine excess among surgical staff. Further studies investigating the effects of hand scrubbing with iodine-containing products on thyroid function and on thyroid antibodies of the operating room staff are needed to determine the consequences of this high iodine exposure.

A critical review of modern and emerging absorbent dressings used to treat exuding wounds

Wound management has progressed significantly over the last five decades. This emanates from a greater understanding of wound healing, technological progression and improved clinical and scientific research. There are currently a plethora of absorbent dressings on the wound care market which claim to have the ability to manage exudates whilst encouraging healing. However, it is becoming clear, from analysing randomised controlled trials, that some of these absorbent dressings are not meeting their expectations when applied in a clinical setting. Many clinicians now feel that there should be more focus, not only on a dressing's ability to manage exudate efficiently, but on a dressing's ability to proactively encourage healing and thus exudate reduction will ensue. This paper proposes to critically review modern and emerging absorbent wound care dressings used to manage exuding wounds and discuses some advances in this area.

Recent advances in topical wound care

There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ‘magical dressings’. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

Principles of wound care in patients with epidermolysis bullosa

Epidermolysis bullosa comprises a series of hereditary skin fragility disorders characterized by blister formation in response to minor friction or trauma. Acute and chronic wounds are part of the daily life of many epidermolysis bullosa patients. To offer proper care, health care providers need to understand the wound healing process, recognize the different types of wounds these patients may present, and be able to select among a wide variety of wound care products to optimize healing.

Silver: an age-old treatment modality in modern times

The use of silver as an antimicrobial for infection spans hundreds of years. The ancient Greeks and Romans used silver to disinfect their water and food supplies. Silver was also used in ancient times to treat burns and wounds as a wound dressing. Silver solutions were approved by the U.S. Food and Drug Administration in the 1920s. Since that time, silver has established itself as an effective and well-known treatment modality for and in the prevention of high-risk infection in clinical wound care (http://int.hansaplast.com/med-info/wound-care-beautiful-healing/silver-tech.html).

The science of wound bed preparation

The concept of wound bed preparation (WBP) heralded a new era in terms of how we treat wounds. It emphasized the difference between acute and chronic wounds, and it cemented the idea that the processes involved in the healing of acute wounds do not apply completely to the healing of chronic wounds. The arbitrary division of the normal healing process into the phases of hemostasis, inflammation, proliferation, and maturation addresses the events in acute wound healing. We have realized that the impediments to healing in chronic wounds lead to a failure to progress through these phases and are independent factors that make the chronic wound a much more complex condition. A major advance in resolving or addressing the chronic wound has been the concept of WBP. WBP allows us to address the problems of wound healing individually the presence of necrotic tissue, hypoxia, high bacterial burden, corrupt matrix, and senescent cells within the wound bed. In WBP we can optimize our therapeutic agents to accelerate endogenous healing or to increase the effectiveness of advanced therapies.

Anti-biofilm efficacy of nitric oxide-releasing silica nanoparticles

The ability of nitric oxide (NO)-releasing silica nanoparticles to kill biofilm-based microbial cells is reported. Biofilms of Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Candida albicans were formed in vitro and exposed to NO-releasing silica nanoparticles. Replicative viability experiments revealed that >or= 99% of cells from each type of biofilm were killed via NO release, with the greatest efficacy (>or= 99.999% killing) against gram-negative P. aeruginosa and E. coli biofilms. Cytotoxicity testing demonstrated that the highest dose of NO-releasing silica nanoparticles inhibited fibroblast proliferation to a lesser extent than clinical concentrations of currently administered antiseptics (e.g., chlorhexidine) with proven wound-healing benefits. This study demonstrates the promise of employing nanoparticles for delivering an antimicrobial agent to microbial biofilms.

The science of wound bed preparation

The concept of wound bed preparation (WBP) heralded a new era in terms of how we treat wounds. It emphasized the difference between acute and chronic wounds, and it cemented the idea that the processes involved in the healing of acute wounds do not apply completely to the healing of chronic wounds. The arbitrary division of the normal healing process into the phases of hemostasis, inflammation, proliferation, and maturation addresses the events in acute wound healing. We have realized that the impediments to healing in chronic wounds lead to a failure to progress through these phases and are independent factors that make the chronic wound a much more complex condition. A major advance in resolving or addressing the chronic wound has been the concept of WBP. WBP allows us to address the problems of wound healing individually-the presence of necrotic tissue, hypoxia, high bacterial burden, corrupt matrix, and senescent cells within the wound bed. In WBP we can optimize our therapeutic agents to accelerate endogenous healing or to increase the effectiveness of advanced therapies.

Iodine revisited

Iodine is an antiseptic that has been used in wound care for more than 150 years. Traditional formulations of iodine had serious limitations that were reduced in later products. Much has been written about iodine and opinions on its clinical efficacy are divided. There have been reviews of the chemical properties of iodine, its antimicrobial activity, human physiology, cytotoxicity and its clinical effectiveness, but few have addressed all these aspects. With the recent development of iodine-containing wound care products and the continued publication of laboratory and clinical studies, it seems timely to reassess the evidence relating to the effectiveness of iodine for treating wounds. This literature review attempts to provide an appropriate chemical and physiological background of the characteristics of iodine in order to provide a sound basis for understanding the available microbiological and clinical data. It will show that understanding the factors that contribute to the activity and potential cytotoxicity of iodine are important in evaluating the clinical evidence. Although definitive studies are needed, the sustained delivery of low doses of free iodine offers the potential to inhibit a broad range of microbial species without selecting for resistant strains or inducing cytotoxic effects.

What is the evidence for tissue regeneration impairment when using a formulation of PVP-I antiseptic on open wounds?

Wound care and the use of antiseptics has long been the subject of much debate within the health professional's literature. This study was undertaken to determine the range of literature available on povidone-iodine (PVP-I) antiseptic use and the evidence supporting the outcomes reported. A range of articles was collected and divided into subgroups based on hierarchy of evidence and the five evidence dimensions [1]. Using the READER scoring tool, articles were evaluated and given a numerical award between 4 and 25 as a determinant of their quality in method, statistical analysis and outcome measures, with those scoring 12.5 or higher (from a possible 25) deemed as offering a satisfactory level of evidence. Statistical analysis on the results prior to applying the READER scoring tool found that overall 49% of articles did not support PVP-I use. However, this situation changed when the quality of evidence was limited to articles scoring >12.5. The higher-scored articles showed a 71% support for the continued use of PVP-I. The outcome of this study shows that there is reason for further debate over the use of PVP-I.

TIME principles of chronic wound bed preparation and treatment

Managing chronic wounds has progressed from merely assessing the wound to understanding the underlying cellular abnormalities and associated clinical problems. The concept of wound bed preparation offers a systematic approach to removing barriers to healing such as tissue (non-viable), infection/inflammation, moisture (imbalance) and edge (non-advancing or undermining). The principles of wound bed preparation as outlined in the tissue, infection, moisture, edge (TIME) table are explained in this article, with examples and recommended treatment interventions. The TIME table is recommended for use at the bedside when assessing patients with wounds.

Controlling wound bioburden with a novel silver-containing HydrofiberR dressing

Clinicians now recognize that both aerobic and anaerobic microorganisms have the ability to degrade or damage host tissue at a wound site through the production of a variety of enzymes and toxins. Silver-containing dressings offer one method for controlling this polymicrobial wound bioburden, and research efforts are currently ongoing to determine their efficacy against aerobic, anaerobic, and antibiotic-resistant microorganisms. The current study aimed to determine the antimicrobial activity of a new silver-containing Hydrofiber dressing (AQUACEL Ag) on both aerobic and anaerobic microorganisms, using the zone-of-inhibition method. This method provides a measure of the ability of the dressing to make available a sufficient concentration of silver to have an antimicrobial effect. To some extent this test mimics the clinical use of the dressing and predicts its microbicidal activity at the wound-dressing interface. The results show that the silver-containing dressing makes silver available at a dressing-agar interface at a concentration that is effective against a broad range of aerobic, anaerobic, and antibiotic-resistant microorganisms. In the context of wound healing, the results showing antimicrobial activity against antibiotic-resistant microorganisms are particularly important, as the control and eradication of these organisms is a major concern within the health care profession.

Descriptive evaluation of Alione hydrocapillary dressing

It is widely recognized that a moist wound environment enhances epithelial migration and resurfacing, as well as promoting autolytic debridement of necrotic tissue, reducing pain, infection and scarring (Russell, 2002). However, an imbalance in the level of moisture can lead to delayed healing, or even wound extension (Kindlen and Morison, 1999). The type of wound itself can be influential in relation to the level of exudate produced. With such a diverse array of wound management products now available, the healthcare professional faces a constant dilemma in deciding what dressing is suitable for maintaining an optimal level of humidity in the wound environment. Alione, a new hydrocapillary dressing, manufactured by Coloplast, appears to overcome this impasse by being sufficiently versatile to manage varying levels of exudate in all types of wounds.

The use of povidone-iodine in superficial partial-thickness burns

Infection is of primary concern to those practitioners treating burns patients, as it is one of the primary complications associated with acute wounds and particularly with superficial partial-thickness burns. In the fight to reduce the risks, many practitioners deploy common antimicrobials agents prophylactically to help reduce risks, e.g. povidone-iodine. This review will examine the evidence to support this practice. The deployment of povidone-iodine in wound care is highly controversial, with questions being raised concerning not only the effectiveness of the product but also its safety and effect on wound healing. The use of povidone-iodine has been investigated both in vitro and in vivo, resulting in conflicting and often contradictory results. Of the work completed to date, researchers have failed to identify or control for extraneous variables which makes it difficult to compare and interpret research findings. The potential benefits or harm that the use of povidone-iodine may elicit in acute wounds is yet to be established.

How a discipline came of age: a history of wound care

As the Journal of Wound Care celebrates its tenth anniversary, now is a good time to reflect on how our discipline has grown over the years. Here, Helena Baxter charts the advances in wound management that have made such a difference to our day-to-day practice and describes the exciting developments that lie ahead.

The role of povidone-iodine in podiatric chronic wound care

This review examines the problems and limitations of existing studies into povidone-iodine, and suggests that the product should be used carefully in the management of the diabetic foot.

Flamazine is not a debriding agent

I was alarmed to read Jacky Edward's description of Flamazine as a ‘debriding’ agent with ‘the added bonus of being antimicrobial’, and to see it equated to Intrasite Gel (Vol 10(12): 815–18).

Wound colonization and infection: the role of topical antimicrobials

Infection and bacterial colonization are important factors in compromised wound healing, particularly in chronic wounds. The current "best practice" for controlling these factors is still unclear. Systemic antibiotics are generally accepted as being the preferred choice for treating infection, provided that ischaemia does not interfere. However, their widespread systemic and topical use is leading to the emergence of resistant bacterial strains such as methicillin-resistant Staphylococcus aureus. Colonization of wounds presents a double problem: possible delayed healing if out of balance with the immune system; and as a source for cross-infection. Managing colonization is not yet defined in best practice. The judicious use of dressings, notably those containing certain antiseptic agents, can be valuable in infection control and in promoting healing. This review states the case for taking the antiseptic route as part of the concerted approach to local wound management and infection control.

Case 40: ward management. Ward sister who failed to manage her ward appropriately

This article reviews the factors that impinge on the application of topical medications in wound care. The role of systemic and topical antibiotics in wound care is reviewed. Similarly, two antiseptics — iodine and silver, of great current interest in wound management — are scrutinized. The value of these topical agents in the management of wound bioburden should be ascertained from the perspective of understanding the advantages and disadvantages of their use and not established from what is currently the trend.