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Ockerman KM, Cox EA, Wiesemann G, Nichols DS, Murad GJA, Ching J, Sorice-Virk S. Healing Exposed Calvarial Hardware Using Negative-Pressure Wound Therapy and Vashe Wound Solution: Case Report. Adv Skin Wound Care 2023; 36:385-391. [PMID: 37224465 DOI: 10.1097/01.asw.0000926628.10995.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The management of cranioplasty infections has historically been explantation followed by delayed reimplantation/reconstruction. This treatment algorithm necessitates surgery, tissue expansion, and prolonged disfigurement. In this report, the authors describe a treatment approach consisting of serial vacuum-assisted closure (VAC) with hypochlorous acid (HOCl) solution (Vashe Wound Solution; URGO Medical) as a salvage strategy. METHODS A 35-year-old man who sustained head trauma, neurosurgical complications, and severe syndrome of the trephined (SOT; devastating neurologic decline treated by cranioplasty) underwent titanium cranioplasty with free flap. Three weeks postoperation, he presented with pressure-related wound dehiscence/partial flap necrosis, exposed hardware, and bacterial infection. Given the severity of his precranioplasty SOT, hardware salvage was critical. He was treated with serial VAC with HOCl solution for 11 days followed by VAC for 18 days and definitive split-thickness skin graft placement over resulting granulation tissue. Authors also conducted a literature review of cranial reconstruction infection management. RESULTS The patient remained healed 7 months postoperatively without recurrent infection. Importantly, his original hardware was retained, and his SOT remained resolved. Findings from the literature review support the use of conservative modalities to salvage cranial reconstructions without hardware removal. CONCLUSIONS This study investigates a new strategy for managing cranioplasty infections. The VAC with HOCl solution regimen was effective in treating the infection and salvaging the cranioplasty, thus obviating the complications associated with explantation, new cranioplasty, and recurrence of SOT. There is limited literature on the management of cranioplasty infections using conservative treatments. A larger study to better determine the efficacy of VAC with HOCl solution is underway.
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Affiliation(s)
- Kyle M Ockerman
- At the University of Florida College of Medicine, Gainesville, Florida, USA, Kyle M. Ockerman, BS, and Gayle Wiesemann, BS, are Medical Students; Gregory J. A. Murad, MD, is Full Clinical Professor, Department of Neurosurgery; Jessica Ching, MD, is Assistant Professor, Division of Plastic and Reconstructive Surgery; and Sarah Sorice-Virk, MD, is Assistant Professor, Division of Plastic and Reconstructive Surgery. At Stanford University School of Medicine, Palo Alto, California, Elizabeth A. Cox, MD, is Resident, Division of Plastic and Reconstructive Surgery. At Duke University School of Medicine, Durham, North Carolina, D. Spencer Nichols, MD, is Resident, Division of Plastic and Reconstructive Surgery
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Castro CR, Duran BA, González CL. Preparación del lecho de la herida: limpieza segura y eficaz con ácido hipocloroso pH 5.5. J Wound Care 2022; 31:22-31. [PMID: 36789924 DOI: 10.12968/jowc.2022.31.latam_sup_5.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Sinopsis: El objetivo de la limpieza del lecho de la herida es favorecer la remoción de materia extraña, rehidratar el lecho y acelerar el proceso de cicatrización, considerando siempre una evaluación holística del paciente. La limpieza es un paso fundamental en la preparación del lecho de la herida. En los últimos años, se ha intensificado la búsqueda y elaboración de soluciones limpiadoras con el potencial de promover la curación mediante la eliminación de barreras locales para la curación, sin comprometer el tejido sano y/o en formación. Entre ellas, el ácido hipocloroso (HOCl) puro pH 5.5 cumple con los objetivos de la preparación del lecho de la herida y de limpieza terapéutica de forma biocompatible, segura, eficaz y natural. Este artículo tiene por objetivo realizar una revisión de la evidencia existente en relación con las soluciones limpiadoras y los beneficios del HOCl puro pH 5.5. Conflicto de interés: CRC declara no tener conflicto de interés. BAD y CLG son empleadas de Laboratorio UrgoMedical Chile.
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Prevalence and Antimicrobial Resistance of Paeniclostridium sordellii in Hospital Settings. Antibiotics (Basel) 2021; 11:antibiotics11010038. [PMID: 35052916 PMCID: PMC8772839 DOI: 10.3390/antibiotics11010038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022] Open
Abstract
(1) Background: The purpose of this study was to determine the prevalence of clostridia strains in a hospital environment in Algeria and to evaluate their antimicrobial susceptibility to antibiotics and biocides. (2) Methods: Five hundred surface samples were collected from surfaces in the intensive care unit and surgical wards in the University Hospital of Tlemcen, Algeria. Bacterial identification was carried out using MALDI-TOF-MS, and then the minimum inhibitory concentrations (MICs) of various antimicrobial agents were determined by the E-test method. P. sordellii toxins were searched by enzymatic and PCR assays. Seven products intended for daily disinfection in the hospitals were tested against Clostridium spp. spore collections. (3) Results: Among 100 isolates, 90 P. sordellii were identified, and all strains were devoid of lethal and hemorrhagic toxin genes. Beta-lactam, linezolid, vancomycin, tigecycline, rifampicin, and chloramphenicol all proved effective against isolated strains. Among all strains tested, the spores of P. sordellii exhibited remarkable resistance to the tested biocides compared to other Clostridium species. The (chlorine-based 0.6%, 30 min), (glutaraldehyde solution 2.5%, 30 min), and (hydrogen peroxide/peracetic acid 3%, 15 min) products achieved the required reduction in spores. (4) Conclusions: Our hospital’s current cleaning and disinfection methods need to be optimized to effectively remove spores from caregivers’ hands, equipment, and surfaces.
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Konya I, Nishiya K, Yano R. Effectiveness of bed bath methods for skin integrity, skin cleanliness and comfort enhancement in adults: A systematic review. Nurs Open 2021; 8:2284-2300. [PMID: 33724709 PMCID: PMC8363374 DOI: 10.1002/nop2.836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 12/27/2022] Open
Abstract
Aim To evaluate the effectiveness of bed bath methods for skin integrity, skin cleanliness and comfort enhancement in adults. Design A systematic review based on the PRISMA guidelines. Methods We searched for quantitative studies published between 2004–2020, using the PubMed, MEDLINE and CINAHL. The remaining 25 studies were appraised by the JBI tool. Results Only four of the included studies were of high quality. Studies of above moderate quality demonstrated that disposable towels were as effective as cotton towels for skin lesions and bacterial removal. Applying a hot towel maintained the skin barrier function and provided warmth; cotton towels were effective for cleaning even with weak pressure, and post‐bed bath moisturizer treatment contributed to skin integrity. Conclusion Although various methods have been examined, the available evidence is inadequate for establishing best practices. It is necessary to verify empirical research with rigorous methodology involving elderly inpatients and to develop instruments that measure patients' comfort.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kotone Nishiya
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Herruzo R, Herruzo I. Antimicrobial efficacy of a very stable hypochlorous acid formula compared with other antiseptics used in treating wounds: in-vitro study on micro-organisms with or without biofilm. J Hosp Infect 2020; 105:289-294. [PMID: 31987843 DOI: 10.1016/j.jhin.2020.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many antiseptics have been used to treat wounds. AIM To compare the microbicidal efficacy of ClHO (Clortech®) with other antiseptics used on wounds, healthy skin and mucous membranes. METHODS The microbicidal efficacy of 13 antiseptic products on eight micro-organisms (three Gram-positive; three Gram-negative; two yeasts) inoculated on organic germ-carriers was studied. In addition, the loss of efficacy against Staphylococcus aureus and Pseudomonas aeruginosa with biofilm was assessed with the six best-performing products. FINDINGS Chlorhexidine (1%) had the highest microbicidal effect at 1 min. At 5 min, 500 and 1500 mg/L ClHO showed similar, or better, activity than the other antiseptics studied. The ClHO concentration of 300 mg/L achieved this same efficacy at 10 min. The product that lost the most efficacy due to biofilm was 1% chlorhexidine, while 1% PVP-I and ClHO at either 300 or 500 mg/L were moderately affected by biofilm. The most effective in the presence of biofilm was ClHO at 1500 mg/L. CONCLUSIONS ClHO at medium-low concentrations (300 or 500 mg/L) is a good antiseptic that can be used on wounds and mucous membranes for 5-10 min. Lower concentrations of ClHO, as well as of the other antiseptics studied, were less effective or more altered by the biofilm. ClHO at a concentration of 1500 mg/L is very effective in the presence or absence of biofilm that can be used on healthy skin for 5 min.
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Affiliation(s)
- R Herruzo
- Departamento de Medicina Preventiva Salud Publica y Microbiología, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
| | - I Herruzo
- Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
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Konya I, Yamaguchi S, Sugimura N, Matsuno C, Yano R. Effects of differences in wiping pressure applied by nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations. Jpn J Nurs Sci 2020; 17:e12316. [PMID: 31943810 DOI: 10.1111/jjns.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/03/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022]
Abstract
AIM To clarify the actual condition and examine the effects of differences in wiping pressure applied by clinical nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations. METHODS For the purposes of the present quasi-experimental interventional study, "wiping pressure" was defined as the "force applied vertically to the skin surface during bed baths." Two types of bed baths, one using ordinary wiping (pressure: 23-25 mmHg) and the other using weak wiping (pressure: 12-14 mmHg), were performed on the forearms (right and left) of 30 healthy adult men and women, and the effects on transepidermal water loss, stratum corneum hydration, cleanliness, and subjective evaluations were examined. RESULTS The results showed no differences between ordinary and weak wiping pressure in regard to the effects on skin barrier function and cleanliness. In terms of subjective evaluations, a significant association was seen between wiping pressure and the "sensation of having dirt removed" (P = .036). Regarding "degree of pain," some participants reported that the wiping pressure felt "slightly painful" under both conditions (ordinary: 31.1%; weak: 10.7%), while some with sensitive skin reported feeling pain even during weak wiping pressure. CONCLUSIONS The results of the present study suggest that skin assessments should be performed before and after bed baths, and that wiping pressure should be controlled and evaluated while considering the patient's feelings.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Shinya Yamaguchi
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Naotaka Sugimura
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | | | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan
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Boyce S, Chang P, Warner P. Burn Dressings and Skin Substitutes. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hygienemaßnahmen bei Clostridioides difficile-Infektion (CDI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:906-923. [DOI: 10.1007/s00103-019-02959-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Meneghetti KL, do Canto Canabarro M, Otton LM, Dos Santos Hain T, Geimba MP, Corção G. Bacterial contamination of human skin allografts and antimicrobial resistance: a skin bank problem. BMC Microbiol 2018; 18:121. [PMID: 30249183 PMCID: PMC6154792 DOI: 10.1186/s12866-018-1261-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 09/17/2018] [Indexed: 01/15/2023] Open
Abstract
Background Bacterial contamination remains the major problem in skin banks, even after antimicrobial treatment, and results in high rates of tissue discarding. This study aimed to analyze bacterial contamination in 32 human skin allografts from the skin bank of Dr. Roberto Corrêa Chem from the Hospital Complex Santa Casa de Misericórdia de Porto Alegre. These samples were already discarded due to microbial contamination. The identification of the bacteria isolated from skin allografts was performed by matrix assisted laser desorption ionization–time of flight. The antimicrobial susceptibility of the isolates to six different classes of antimicrobials was determined using the disk-diffusion agar method, and the evaluation of the inhibitory potential was determined by the minimal inhibitory concentration (50/90) of antimicrobials already used in the skin bank and those that most isolates were susceptible to. Results A total of 21 (65.6%) skin samples were contaminated with Gram-positive bacteria: 1 (4.7%) with Paenibacillus sp., 12 (61.9%) with Bacillus sp., 6 (28.5%) with Staphylococcus sp., and 2 (9.5%) with Bacillus sp. and Staphylococcus sp. Several resistance profiles, including multiresistance, were found among the isolates. Most of the isolates were susceptible to at least one of the antimicrobials used in the skin bank. All isolates were susceptible to amikacin, gentamicin, and tetracycline, which demonstrated the best inhibitory activities against the isolates and were considered as potential candidates for new antimicrobial treatments. Conclusions Bacillus, Paenibacillus, and Staphylococcus were isolated from the skin allografts, thus demonstrating the predominance of Gram-positive bacteria contamination. Other factors not related to the resistance phenotype may also be involved in the persistence of bacterial isolates in the skin allografts after antibiotic treatment. Gentamicin, amikacin, and tetracycline can be considered as an option for a more effective treatment cocktail. Electronic supplementary material The online version of this article (10.1186/s12866-018-1261-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karine Lena Meneghetti
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Micaela do Canto Canabarro
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Letícia Muner Otton
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Thaís Dos Santos Hain
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Mercedes Passos Geimba
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Gertrudes Corção
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil.
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Deschênes P, Chano F, Dionne LL, Pittet D, Longtin Y. Efficacy of the World Health Organization-recommended handwashing technique and a modified washing technique to remove Clostridium difficile from hands. Am J Infect Control 2017; 45:844-848. [PMID: 28526314 DOI: 10.1016/j.ajic.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/02/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The efficacy of the World Health Organization (WHO)-recommended handwashing technique against Clostridium difficile is uncertain, and whether it could be improved remains unknown. Also, the benefit of using a structured technique instead of an unstructured technique remains unclear. METHODS This study was a prospective comparison of 3 techniques (unstructured, WHO, and a novel technique dubbed WHO shortened repeated [WHO-SR] technique) to remove C difficile. Ten participants were enrolled and performed each technique. Hands were contaminated with 3 × 106 colony forming units (CFU) of a nontoxigenic strain containing 90% spores. Efficacy was assessed using the whole-hand method. The relative efficacy of each technique and of a structured (either WHO or WHO-SR) vs an unstructured technique were assessed by Mann-Whitney U test and Wilcoxon signed-rank test. RESULTS The median effectiveness of the unstructured, WHO, and WHO-SR techniques in log10 CFU reduction was 1.30 (interquartile range [IQR], 1.27-1.43), 1.71 (IQR, 1.34-1.91), and 1.70 (IQR, 1.54-2.42), respectively. The WHO-SR technique was significantly more efficacious than the unstructured technique (P = .01). Washing hands with a structured technique was more effective than washing with an unstructured technique (median, 1.70 vs 1.30 log10 CFU reduction, respectively; P = .007). CONCLUSIONS A structured washing technique is more effective than an unstructured technique against C difficile.
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Deyneko A, Cordeiro F, Berlin L, Ben-David D, Perna S, Longtin Y. Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study. BMC Infect Dis 2016; 16:203. [PMID: 27184488 PMCID: PMC4867524 DOI: 10.1186/s12879-016-1535-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 05/04/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The impact of sink location on hand washing compliance after contact with patients with Clostridium difficile infection (CDI) is poorly understood. The aim of this study is to determine the location of hand wash sinks available to healthcare workers (HCWs) after caring for patients with CDI and to assess the impact on hand washing compliance. METHODS We performed a cross-sectional study in a 637-bed tertiary care hospital, Canada. HCW hand hygiene compliance after contact with CDI patients was measured through direct unobtrusive observations. Location of sinks in relation with the patients' rooms was assessed on the day of diagnosis. Predictors of compliance were assessed through univariate and multivariate logistic regression. RESULTS 247 hand hygiene opportunities following care of a CDI patient were observed. Glove use compliance was 85.4 % (211/247), but hand washing compliance after care of CDI patients was only 14.2 % (35/247). Hand rubbing was performed instead of hand washing in 33.2 % of opportunities (82/247). The median distance between the patient zone of CDI patients and the nearest sink was 13.1 m (interquartile range, 7.6-23.2). Sinks were directly visible upon exiting the patient's room on only 33.2 % (82/247) occasions. By multivariate analysis, an increasing distance between the patient zone and the nearest sink was inversely associated with hand washing compliance (adjusted OR, 0.90, 95 % CI, 0.84-0.97; P = 0.008), while proper timing of glove removal upon leaving the patient zone was directly associated with hand washing compliance (adjusted OR, 14.87; 95 % CI, 1.93-114.43; P = 0.01). CONCLUSIONS Hand washing compliance following contact with patients with C. difficile infections was low. Poor access to sinks is associated with decreased hand washing compliance. Improvement strategies are urgently needed.
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Affiliation(s)
- Alexander Deyneko
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Fernanda Cordeiro
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Laurie Berlin
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Debby Ben-David
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada.,Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Silvana Perna
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Yves Longtin
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada. .,McGill University Faculty of Medicine, Montreal, Canada.
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Kundrapu S, Sunkesula V, Jury I, Deshpande A, Donskey CJ. A Randomized Trial of Soap and Water Hand Wash Versus Alcohol Hand Rub for Removal of Clostridium difficile Spores from Hands of Patients. Infect Control Hosp Epidemiol 2016; 35:204-6. [DOI: 10.1086/674859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nerandzic MM, Sankar C T, Setlow P, Donskey CJ. A Cumulative Spore Killing Approach: Synergistic Sporicidal Activity of Dilute Peracetic Acid and Ethanol at Low pH Against Clostridium difficile and Bacillus subtilis Spores. Open Forum Infect Dis 2015; 3:ofv206. [PMID: 26885539 PMCID: PMC4751341 DOI: 10.1093/ofid/ofv206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/29/2015] [Indexed: 01/05/2023] Open
Abstract
The synergistic combination of dilute peracetic acid and ethanol at low pH provides a novel approach for development of a rapid and effective method for reducing C. difficile spores on skin. Background. Alcohol-based hand sanitizers are the primary method of hand hygiene in healthcare settings, but they lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We previously demonstrated that acidification of ethanol induced rapid sporicidal activity, resulting in ethanol formulations with pH 1.5–2 that were as effective as soap and water washing in reducing levels of C difficile spores on hands. We hypothesized that the addition of dilute peracetic acid (PAA) to acidified ethanol would enhance sporicidal activity while allowing elevation of the pH to a level likely to be well tolerated on skin (ie, >3). Methods. We tested the efficacy of acidified ethanol solutions alone or in combination with PAA against C difficile and Bacillus subtilis spores in vitro and against nontoxigenic C difficile spores on hands of volunteers. Results. Acidification of ethanol induced rapid sporicidal activity against C difficile and to a lesser extent B subtilis. The addition of dilute PAA to acidified ethanol resulted in synergistic enhancement of sporicidal activity in a dose-dependent fashion in vitro. On hands, the addition of 1200–2000 ppm PAA enhanced the effectiveness of acidified ethanol formulations, resulting in formulations with pH >3 that were as effective as soap and water washing. Conclusions. Acidification and the addition of dilute PAA induced rapid sporicidal activity in ethanol. Our findings suggest that it may be feasible to develop effective sporicidal ethanol formulations that are safe and tolerable on skin.
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Affiliation(s)
| | - Thriveen Sankar C
- Case Western Reserve University School of Medicine , Cleveland, Ohio
| | - Peter Setlow
- Department of Molecular, Microbial and Structural Biology , University of Connecticut Health Center , Farmington
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Ohio
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Nerandzic MM, Sunkesula VCK, C. TS, Setlow P, Donskey CJ. Unlocking the Sporicidal Potential of Ethanol: Induced Sporicidal Activity of Ethanol against Clostridium difficile and Bacillus Spores under Altered Physical and Chemical Conditions. PLoS One 2015; 10:e0132805. [PMID: 26177038 PMCID: PMC4503543 DOI: 10.1371/journal.pone.0132805] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/19/2015] [Indexed: 01/05/2023] Open
Abstract
Background Due to their efficacy and convenience, alcohol-based hand sanitizers have been widely adopted as the primary method of hand hygiene in healthcare settings. However, alcohols lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We hypothesized that sporicidal activity could be induced in alcohols through alteration of physical or chemical conditions that have been shown to degrade or allow penetration of spore coats. Principal Findings Acidification, alkalinization, and heating of ethanol induced rapid sporicidal activity against C. difficile, and to a lesser extent Bacillus thuringiensis and Bacillus subtilis. The sporicidal activity of acidified ethanol was enhanced by increasing ionic strength and mild elevations in temperature. On skin, sporicidal ethanol formulations were as effective as soap and water hand washing in reducing levels of C. difficile spores. Conclusions These findings demonstrate that novel ethanol-based sporicidal hand hygiene formulations can be developed through alteration of physical and chemical conditions.
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Affiliation(s)
- Michelle M. Nerandzic
- Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- * E-mail:
| | - Venkata C. K. Sunkesula
- Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Thriveen Sankar C.
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Peter Setlow
- Department of Molecular Biology and Biophysics, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Curtis J. Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
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Isaacson D, Haller B, Leslie H, Roemer M, Winston L. Novel handwashes are superior to soap and water in removal of Clostridium difficile spores from the hands. Am J Infect Control 2015; 43:530-2. [PMID: 25952050 DOI: 10.1016/j.ajic.2015.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 11/27/2022]
Abstract
We examined the efficacy of 5 experimental handwash formulations in removing nontoxigenic Clostridium difficile spores from the hands of health care workers. Handwashing with sand resulted in an additional 0.5-log reduction in spore recovery compared with the current standard of soap and water.
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Abstract
Asymptomatic carriage of toxigenic strains of Clostridium difficile is common in health care facilities and the community. However, infection control efforts have traditionally focused almost entirely on symptomatic patients. There is now growing concern that asymptomatic carriers may be an underappreciated source of transmission. This article provides an overview of the pathogenesis and epidemiology of C difficile colonization, reviews the evidence that asymptomatic carriers shed spores and contribute to transmission, and examines practical issues related to prevention of transmission from carriers.
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Utility of a commercial PCR assay and a clinical prediction rule for detection of toxigenic Clostridium difficile in asymptomatic carriers. J Clin Microbiol 2013; 52:315-8. [PMID: 24153132 DOI: 10.1128/jcm.01852-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A commercial PCR assay of perirectal swab specimens detected 17 (68%) of 25 asymptomatic carriers of toxigenic Clostridium difficile, including 93% with skin and/or environmental contamination. A clinical prediction rule, followed by PCR screening, could be used to identify carriers at high risk of C. difficile shedding.
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