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Leventis M, Deliberador T, Alshehri F, Alghamdi H. Topical oxygen therapy as a novel strategy to promote wound healing and control the bacteria in implantology, oral surgery and periodontology: A review. Saudi Dent J 2024; 36:841-854. [PMID: 38883907 PMCID: PMC11178966 DOI: 10.1016/j.sdentj.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 06/18/2024] Open
Abstract
Globally, oral infections and inflammatory lesions persist as substantial public health concerns, necessitating the introduction of novel oral treatment protocols. Oral diseases are linked to various causative factors, with dental plaque/biofilm resulting from inadequate hygiene practices playing a predominant role. The strategic implementation of novel topical therapies holds promise for effectively controlling the biofilms, addressing oral infections and promoting enhanced oral wound healing. This review aims to providing a comprehensive overview of the available evidence pertaining to the potential efficacy of topical oxygen and lactoferrin-releasing biomaterials, exemplified by the blue®m formula, as novel oral care interventions within the scope of contemporary implantology, oral surgery and periodontology.
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Affiliation(s)
- Minas Leventis
- Department of Oral and Maxillofacial Surgery, Dental School, National and Kapodistrian University of Athens, Greece
| | - Tatiana Deliberador
- Department of Periodontics, Saveetha Dental College, Chennai, India, and Latin American Institute of Dental Research and Education - ILAPEO, Curitiba/PR, Brazil
| | - Fahad Alshehri
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Hamdan Alghamdi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Motta M, Avila A, Samuels S, Weiss M, Levene T. The Impact of Preoperative Chlorhexidine Baths on Surgical Site Infections and Readmissions in Pediatric Patients Undergoing Laparoscopic Cholecystectomy. Am Surg 2024; 90:1105-1107. [PMID: 38061359 DOI: 10.1177/00031348231220587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Affiliation(s)
- Monique Motta
- Division of Pediatric General Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Azalia Avila
- Division of Pediatric General Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Shenae Samuels
- Division of Pediatric General Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Michael Weiss
- Division of Pediatric Emergency Medicine, Memorial Healthcare System, Hollywood, FL, USA
| | - Tamar Levene
- Division of Pediatric General Surgery, Memorial Healthcare System, Hollywood, FL, USA
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Moraes GS, Tozetto NM, Pedroso TAA, de Mattos MA, Urban AM, Paludo KS, Dos Santos FA, Neppelenbroek KH, Urban VM. Anti-Candida activity and in vitro toxicity screening of antifungals complexed with β-cyclodextrin. J Appl Toxicol 2024; 44:747-755. [PMID: 38198744 DOI: 10.1002/jat.4575] [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: 04/01/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
The emergence of resistant fungal species and the toxicity of currently available antifungal drugs are relevant issues that require special consideration. Cyclodextrins inclusion complexes could optimize the antimicrobial activity of such drugs and create a controlled release system with few side effects. This study aimed to assess the in vitro toxicity and antifungal effectiveness of nystatin (Nys) and chlorhexidine (Chx) complexed or not with β-cyclodextrin (βCD). First, a drug toxicity screening was performed through the Artemia salina bioassay. Then, the minimum inhibitory concentrations (MICs) against Candida albicans were determined with the broth microdilution test. After MICs determination, the cytotoxicity of the drugs was evaluated through the methyl-thiazolyl-tetrazolium (MTT) and neutral red (NR) assays and through cell morphology analysis. The PROBIT analysis was used to determine the median lethal concentration (LC50), and the cell viability values were submitted to one-way analysis of variance(ANOVA)/Tukey (α = 0.05). Overall, the βCD-complexed antifungals were less toxic against A. salina than their raw forms, suggesting that inclusion complexes can reduce the toxicity of drugs. The MICs obtained were as follows: Nys 0.5 mg/L; Nys:βCD 4 mg/L; Chx 4 mg/L; and Chx:βCD 8 mg/L. Chx showed significant cytotoxicity (MTT: 12.9 ± 9.6%; NR: 10.6 ± 12.5%) and promoted important morphological changes. Cells exposed to the other drugs showed viability above 70% with no cellular damage. These results suggest that antifungals complexed with βCD might be a biocompatible option for the treatment of Candida-related infections.
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Affiliation(s)
| | | | | | | | | | - Katia Sabrina Paludo
- Department of Structural, Molecular, and Genetic Biology, State University of Ponta Grossa, Ponta Grossa, Brazil
| | | | - Karin Hermana Neppelenbroek
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Dejoux A, de Chaisemartin L, Bruhns P, Longrois D, Gouel-Chéron A. Neuromuscular blocking agent induced hypersensitivity reaction exploration: an update. Ugeskr Laeger 2023; 40:95-104. [PMID: 36301083 DOI: 10.1097/eja.0000000000001765] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Acute hypersensitivity reactions (AHRs) occurring in present-day anaesthesia can have severe, sometimes fatal, consequences and their incidence is increasing. The most frequent allergens responsible for AHR during anaesthesia are neuromuscular blocking agents (NMBAs) (70% of the cases) followed by antibiotics (18%), patent blue dye and methylene blue dye (5%), and latex (5%). Following an AHR, strategies for subsequent anaesthetic procedures (especially the choice of an NMBA) may be difficult to formulate due to inconclusive diagnostic analysis in up to 30% of AHRs. Current diagnosis of AHR relies on the detection of mast cell degranulation products and drug-specific type E immunoglobulins (IgE) in order to document an IgE-mediated anaphylaxis (IgE endotype). Nonetheless, other IgE-independent pathways can be involved in AHR, but their detection is not currently available in standard situations. The different mechanisms (endotypes) involved in peri-operative AHR may contribute to the inconclusive diagnostic work-up and this generates uncertainty concerning the culpable drug and strategy for subsequent anaesthetic procedures. This review provides details on the IgE endotype; an update on non-IgE related endotypes and the novel diagnostic tools that could characterise them. This detailed update is intended to provide explicit clinical reasoning tools to the anaesthesiologist faced with an incomplete AHR diagnostic work-up and to facilitate the decision-making process regarding anaesthetic procedures following an AHR to NMBAs.
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Affiliation(s)
- Alice Dejoux
- From the Institut Pasteur, Université de Paris, Unit of Antibodies in Therapy and Pathology, Inserm UMR1222 (AD, LdC, PB, AGC), Immunology Department, DMU BIOGEM, Bichat Hospital, AP-HP (LdC), Université Paris-Saclay, Inserm, Inflammation, Microbiome and Immunosurveillance, Châtenay-Malabry (LdC), Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP (DL, AGC), Université de Paris, FHU PROMICE (DL), Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat-Claude Bernard and Louis Mourier Hospitals, APHP (DL), INSERM1148, Paris, France (DL), and Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA (AGC)
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Barrett JP, Raby E, Wood F, Coorey R, Ramsay JP, Dykes GA, Ravensdale JT. An in vitro study into the antimicrobial and cytotoxic effect of Acticoat™ dressings supplemented with chlorhexidine. Burns 2022; 48:941-951. [PMID: 34649749 DOI: 10.1016/j.burns.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 01/06/2023]
Abstract
Burn injuries can cause traumatic and debilitating physical trauma, with burn wounds prone to bacterial infection. This study examined in vitro the effectiveness of the silver nanoparticle based antimicrobial dressing, Acticoat™, in combination with a range of antimicrobial compounds against Staphylococcus aureus and Pseudomonas aeruginosa and investigated potential cytotoxic effects in multi-layered differentiated keratinocyte models. Acticoat™ with chlorhexidine was found to be highly effective against S. aureus and P. aeruginosa across a 3 day incubation period on pig skin models. MTT assays and histological staining of keratinocyte models revealed Acticoat™ had a cytotoxic effect following initial contact with the cells and cytotoxicity was exacerbated when dressings were coated with chlorhexidine and antimicrobial peptide formulations. Spectrophotometric analysis suggested that the silver nanoparticles may mobilise from the dressing as nanoclusters or silver salts, which may relate to the observed cytotoxicity. The bacterial strains used in this study showed a substantial tolerance to Acticoat™ with biofilm-like communities observed on the dressing surfaces. This could be mitigated with chlorhexidine, albeit with an increase in cytotoxicity. The clinical significance of these findings in terms of infection control and wound healing remain to be determined; the potential benefit of bactericidal activity must be balanced against cytotoxicity, and the prevalence and potential transmission of the silver tolerant phenotype must also be assessed.
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Affiliation(s)
- Joshua P Barrett
- School of Medicine, Curtin University, Perth, Western Australia, Australia; Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Edward Raby
- Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Fiona Wood
- Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Ranil Coorey
- School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Joshua P Ramsay
- School of Medicine, Curtin University, Perth, Western Australia, Australia; Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Gary A Dykes
- School of Agriculture and Food Sciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Joshua T Ravensdale
- School of Medicine, Curtin University, Perth, Western Australia, Australia; Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
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Rezzadeh K, Parikh H, Guanche I, Debbi E, Rajaee S, Schwarzkopf R, Paiement G. Clean or Dirty? A Systematic Review of Splash Basin Use and Its Infectious Potential in Orthopaedic Surgery. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:82-89. [PMID: 36601221 PMCID: PMC9769359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Splash basins are used in orthopaedic surgery cases to wash and hold instrumentsintraoperatively. This systematic review aims to summarize information on contamination of splash basins intraoperatively. Methods A systematic review was conducted using the following search terms: "splash basin" or "splash bucket." Two authors independently reviewed the literature. Studies were included if they reported on intraoperative splash basin contamination rates. Studies were excluded if they were not relevant to orthopaedic surgery, non-English articles, or repeat studies yielded by different online databases. Results There were seven studies included in this review. The median contamination rate of sterile water or physiologic saline splash basins was 23.9% [range: 2%-74%]. The addition of surgical antiseptics to sterile water splash basins was associated with 0% contamination rates in two studies. The most frequent splash basin contaminants identified in bacterial culture were coagulase negative staphylococcus (50%) and staphylococcus aureus (10%). Conclusion The splash basin appears to be a frequent source of contamination in the operating room. Many studies suggest abandoning splash basin use altogether, although the efficacy of alternative methods such as cleaning instruments with lap pads in avoiding contamination of the sterile field has not been studied. Further investigation into surgical teams' use of the splash basin and the contents of the splash basin as they relate to contamination rates may help advance our understanding of optimal use of this surgical tool. Shorter case durations and dilute surgical antiseptics in splash basins appear associated with lower splash basin contamination risk. Level of Evidence: V.
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Affiliation(s)
- Kevin Rezzadeh
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Harin Parikh
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Isabella Guanche
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Eytan Debbi
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Sean Rajaee
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Ran Schwarzkopf
- Department of Orthopaedics, Division of Arthroplasty, NYU Langone Medical Center, New York, New York, USA
| | - Guy Paiement
- Department of Orthopaedics, Division of Arthroplasty, Cedars Sinai Medical Center, Los Angeles, California, USA
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Abstract
Identifying the culprit medication in cases of perioperative anaphylaxis can be extremely challenging. A detailed and accurate history, coupled with the appropriate testing, plays a key role in discovering the etiology of perioperative anaphylaxis. We present the case of a 48-year-old woman with a cranial meningioma who was scheduled for surgery. Chlorhexidine, midazolam, lidocaine, propofol, fentanyl, rocuronium, and furosemide were administered during the perioperative period. She developed hypotension, urticaria, bronchospasm, and other symptoms of anaphylaxis soon after general anesthesia. The serum tryptase level obtained during anaphylaxis was 119 ng/mL (normal, <11.4 ng/mL). Epinephrine was administered, and the surgery was canceled, with no cause identified. For the next surgical attempt, she was pretreated with diphenhydramine and ranitidine, and the neuromuscular blocker was withheld. Again, she developed hypotension consistent with anaphylaxis, and epinephrine was administered. She was referred for consultation. A detailed and accurate history was obtained. The baseline serum tryptase level was 6.4 ng/mL. Skin-prick puncture tests were completed, and a diagnosis was made. The surgical team was instructed to avoid the culprit medication, and the cranial surgery was successful. Although difficult, cases of perioperative anaphylaxis can be solved with a detailed history, keen detective work, and appropriate testing.
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Affiliation(s)
- Nicholas C. Kolinsky
- From the Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida; and
| | - Richard F. Lockey
- University of South Florida Morsani College of Medicine, Tampa, Florida
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Stawarz-Janeczek M, Kryczyk-Poprawa A, Muszyńska B, Opoka W, Pytko-Polończyk J. Disinfectants Used in Stomatology and SARS-CoV-2 Infection. Eur J Dent 2021; 15:388-400. [PMID: 33694135 PMCID: PMC8184310 DOI: 10.1055/s-0041-1724154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Effective disinfection is a basic procedure in medical facilities, including those conducting dental surgeries, where treatments for tissue discontinuity are also performed, as it is an important element of infection prevention. Disinfectants used in dentistry and dental and maxillofacial surgery include both inorganic (hydrogen peroxide, sodium chlorite-hypochlorite) and organic compounds (ethanol, isopropanol, peracetic acid, chlorhexidine, eugenol). Various mechanisms of action of disinfectants have been reported, which include destruction of the structure of bacterial and fungal cell membranes; damage of nucleic acids; denaturation of proteins, which in turn causes inhibition of enzyme activity; loss of cell membrane integrity; and decomposition of cell components. This article discusses the most important examples of substances used as disinfectants in dentistry and presents the mechanisms of their action with particular focus on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The search was conducted in ScienceDirect, PubMed, and Scopus databases. The interest of scientists in the use of disinfectants in dental practice is constantly growing, which results in the increasing number of publications on disinfection, sterilization, and asepsis. Many disinfectants often possess several of the abovementioned mechanisms of action. In addition, disinfectant preparations used in dental practice either contain one compound or are frequently a mixture of active compounds, which increases their range and effectiveness of antimicrobial action. Currently available information on disinfectants that can be used to prevent SARS-CoV-2 infection in dental practices was summarized.
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Affiliation(s)
- Magdalena Stawarz-Janeczek
- Department of Integrated Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Kryczyk-Poprawa
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Bożena Muszyńska
- Department of Pharmaceutical Botany, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Włodzimierz Opoka
- Department of Inorganic and Analytical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Jolanta Pytko-Polończyk
- Department of Integrated Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Chlorhexidine Gluconate Bathing Reduces the Incidence of Bloodstream Infections in Adults Undergoing Inpatient Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:262.e1-262.e11. [PMID: 33781532 DOI: 10.1016/j.jtct.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/09/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
Bloodstream infections (BSIs) occur in 20% to 45% of inpatient autologous and allogeneic hematopoietic cell transplant (HCT) patients. Daily bathing with the antiseptic chlorhexidine gluconate (CHG) has been shown to reduce the incidence of BSIs in critically ill patients, although very few studies include HCT patients or have evaluated the impact of compliance on effectiveness. We conducted a prospective cohort study with historical controls to assess the impact of CHG bathing on the rate of BSIs and gut microbiota composition among adults undergoing inpatient HCT at the Duke University Medical Center. We present 1 year of data without CHG bathing (2016) and 2 years of data when CHG was used on the HCT unit (2017 and 2018). Because not all patients adhered to CHG, patients were grouped into four categories by rate of daily CHG usage: high (>75%), medium (50% to 75%), low (1% to 49%), and none (0%). Among 192 patients, univariate trend analysis demonstrated that increased CHG usage was associated with decreased incidence of clinically significant BSI, defined as any BSI requiring treatment by the medical team (high, 8% BSI; medium, 15.2%; low, 15.6%; no CHG, 30.3%; P = .003), laboratory-confirmed BSI (LCBI; P = .03), central line-associated BSI (P = .04), and mucosal barrier injury LCBI (MBI-LCBI; P = .002). Multivariate analysis confirmed a significant effect of CHG bathing on clinically significant BSI (P = .023) and MBI-LCBI (P = .007), without consistently impacting gut microbial diversity. Benefits of CHG bathing were most pronounced with >75% daily usage, and there were no adverse effects attributable to CHG. Adherence to daily CHG bathing significantly decreases the rate of bloodstream infection following HCT.
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Reis INR, do Amaral GCLS, Mendoza AAH, das Graças YT, Mendes-Correa MC, Romito GA, Pannuti CM. Can preprocedural mouthrinses reduce SARS-CoV-2 load in dental aerosols? Med Hypotheses 2020; 146:110436. [PMID: 33288313 PMCID: PMC7691843 DOI: 10.1016/j.mehy.2020.110436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
Dental professionals work closely with patients and present an increased risk of person-to-person transmission of SARS-CoV-2. Moreover, the use of ultrasonic scalers, air–water syringes, and slow and high-speed handpieces, which are common in the dental office, generate spatter and aerosol. The use of preprocedural mouthrinses has been proposed to reduce the viral load in saliva and oropharyngeal tissues, thus decreasing viral load in dental aerosol. Although some mouthrinses demonstrates an antiviral effect, there is limited evidence about the clinical efficacy of any mouthrinse in the reduction of SARS-CoV-2 in the dental aerosol. We hypothesized that mouthrinses may reduce SARS-CoV-2 viral load in the oropharynx and its fluids reducing viral load in dental aerosol. The potential use of mouthrinses is discussed, along with proposal of in vitro and clinical studies, in order to evaluate this hypothesis. If this hypothesis holds true, dental professionals and patients may benefit from the routine use of preprocedural mouthrinses.
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Affiliation(s)
- Isabella Neme Ribeiro Reis
- Department of Estomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Brazil; Institute of Tropical Medicine of São Paulo, Faculty of Medicine, University of São Paulo, Brazil.
| | - Guilherme Castro Lima Silva do Amaral
- Department of Estomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Brazil; Institute of Tropical Medicine of São Paulo, Faculty of Medicine, University of São Paulo, Brazil.
| | - Aldrin André Huamán Mendoza
- Department of Estomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Brazil; Institute of Tropical Medicine of São Paulo, Faculty of Medicine, University of São Paulo, Brazil.
| | - Yasmin Teixeira das Graças
- Department of Estomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Brazil; Institute of Tropical Medicine of São Paulo, Faculty of Medicine, University of São Paulo, Brazil.
| | - Maria Cássia Mendes-Correa
- Department of Estomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Brazil; Institute of Tropical Medicine of São Paulo, Faculty of Medicine, University of São Paulo, Brazil.
| | - Giuseppe Alexandre Romito
- Department of Estomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Brazil; Institute of Tropical Medicine of São Paulo, Faculty of Medicine, University of São Paulo, Brazil.
| | - Claudio Mendes Pannuti
- Department of Estomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Brazil; Institute of Tropical Medicine of São Paulo, Faculty of Medicine, University of São Paulo, Brazil.
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Charadram N, Maniewicz S, Maggi S, Petrovic M, Kossioni A, Srinivasan M, Schimmel M, Mojon P, Müller F. Development of a European consensus from dentists, dental hygienists and physicians on a standard for oral health care in care-dependent older people: An e-Delphi study. Gerodontology 2020; 38:41-56. [PMID: 33073408 DOI: 10.1111/ger.12501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study aimed to obtain a consensus on oral health policy, access to dental care, oral hygiene measures and training levels. BACKGROUND Poor oral health is widespread in care-dependent older people, but no consensus for a minimum standard of oral health care exists yet. METHODS The e-Delphi approach was applied to a selected panel of interdisciplinary experts. Data analysis was based on three measurements: (a) ≥70% of experts' opinion fall into category "agree or strongly agree," (b) median score on the 5-point Likert scale ≥4, (c) interquartile range ≤1. RESULTS A total of 31 experts from 17 European countries participated in this survey. Agreement was achieved for a compulsory dental examination when an elder is admitted to a long-term care (LTC) facility. Older people should brush their teeth twice/day and regularly clean interproximal spaces and oral mucosa. Dentures should be rinsed after meals and cleaned twice/day. The use of denture cleansing tablets was considered necessary. Dentures should be removed before sleeping and stored dry. A 5000 ppm fluoride toothpaste should be applied daily in elder with high caries risk. A short report on the oral health status of the elder should be included in the geriatric assessment. All experts concluded that the knowledge and the training in oral health care for caregivers and family members of care-dependent older people were imperative. CONCLUSIONS Using the e-Delphi method, multidisciplinary healthcare professionals from different countries agreed on certain cardinal recommendations for a standard oral health care for care-dependent older people.
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Affiliation(s)
- Nattida Charadram
- Division of Gerodontology and removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sabrina Maniewicz
- Division of Gerodontology and removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Stefania Maggi
- Aging Branch, CNR Institute of Neuroscience, Padua, Italy
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Anastassia Kossioni
- Division of Gerodontology, Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Murali Srinivasan
- Clinic of General-, Special Care-, and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Schimmel
- Division of Gerodontology, Department of Reconstructive Dentistry and Gerodontology, School of dental medicine, University of Bern, Bern, Switzerland
| | - Philippe Mojon
- Division of Gerodontology and removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frauke Müller
- Division of Gerodontology and removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Chlorhexidine Hypersensitivity: A Case Report of Delayed Reactions Associated with Epidermal Preparations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2945. [PMID: 32983757 PMCID: PMC7489580 DOI: 10.1097/gox.0000000000002945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
Chlorhexidine is a topical antiseptic that is generally well tolerated in patients, making it a common preparatory substance in various surgical settings. Sparse case reports have identified immediate hypersensitivity reactions after exposure to this substance, especially in patients with a history of atopy. The purpose of this case report is to describe 3 unique presentations of delayed hypersensitivity to epidermal chlorhexidine preparation. Patients undergoing breast surgery by a single surgeon between December 2018 and January 2019 were retrospectively reviewed for incidence of dermatologic complications. Medical and surgical history of patients as well as dermatologic hypersensitivity course were collected. Three patients presented with a delayed hypersensitivity to the epidermal chlorhexidine surgical preparation, ChloraPrep. Each patient developed an erythematous, pruritic maculopapular rash in the distribution of the chlorhexidine application. This occurred beyond the immediate postoperative period—ranging from postoperative days 5 to 35. Initial treatment included the use of 1% hydrocortisone along with a systemic antihistamine. If there was no improvement in symptoms after 3 days, we transitioned patients to 0.5% triamcinolone ointment. If there was no improvement after 5 days on triamcinolone, the patient was reexamined and systemic steroids were prescribed. In each of our cases, all skin changes had resolved within 7–10 days of initial symptoms. Our findings highlight a series of delayed adverse reactions to epidermal chlorhexidine occurring beyond the intraoperative and immediate postoperative period. This case report serves to recognize a unique presentation pattern to ensure that all patients are accurately diagnosed and promptly treated via a systematic treatment algorithm.
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13
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Addressing the challenges in antisepsis: focus on povidone iodine. Int J Antimicrob Agents 2020; 56:106064. [DOI: 10.1016/j.ijantimicag.2020.106064] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/21/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
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14
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Antiseptic efficacy of an innovative perioperative surgical skin preparation: A confirmatory FDA phase 3 analysis. Infect Control Hosp Epidemiol 2020; 41:653-659. [PMID: 32131912 PMCID: PMC7282856 DOI: 10.1017/ice.2020.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND An innovative approach to perioperative antiseptic skin preparation is warranted because of potential adverse skin irritation, rare risk of serious allergic reaction, and perceived diminished clinical efficacy of current perioperative antiseptic agents. The results of a confirmatory US Food and Drug Administration (FDA) phase 3 efficacy analysis of a recently approved innovative perioperative surgical skin antiseptic agent are discussed. METHODS The microbial skin flora on abdominal and groin sites in healthy volunteers were microbiologically sampled following randomization to either ZuraGard, a 2% chlorhexidine/70% isopropyl alcohol preparation (Chloraprep), or a control vehicle (alcohol-free ZuraGard). Mean log10 reduction of colony-forming units (CFU) was assessed at 30 seconds, 10 minutes, and 6 hours. RESULTS For combined groin sites (1,721 paired observations) at all time points, the mean log10 CFU reductions were significantly greater in the ZuraGard group than in the Chloraprep group (P < .02). Mean log10 CFU reductions across combined abdominal and groin sites at all time points (3,277 paired observations) were significantly greater in the ZuraGard group than in the Chloraprep group (P < .02). CONCLUSIONS A confirmatory FDA phase 3 efficacy analysis of skin antisepsis in human volunteers documented that ZuraGard was efficacious in significantly reducing the microbial burden on abdominal and groin test sites, exceeding that of Chloraprep. No significant adverse reactions were observed following the application of ZuraGard. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT02831998 and NCT02831816.
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Efficacy and safety of a novel antimicrobial preoperative skin preparation. Infect Control Hosp Epidemiol 2019; 40:1157-1163. [PMID: 31385562 DOI: 10.1017/ice.2019.200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Alternatives to skin preparation with conventional preoperative antiseptics are required because of adverse reactions and the potential emergence of resistance. Here, we present 2 phase 2 studies of ZuraGard (ZG), a novel formulation of isopropyl alcohol and functional excipients developed for preoperative skin antisepsis. METHODS Microbial skin flora on abdominal and inguinal sites in healthy volunteers were quantitatively assessed following application of ZG versus a negative control (ZV) and a chlorhexidine/alcohol preparation, Chloraprep (CP). In trial 1, ZG administered for both recommended and abbreviated application times was compared with CP and ZV via bacterial reductions at 10 minutes, and 6 hours, 12 hours, and 24 hours following application. In trial 2, the 10-minute postapplication responder rates (RRs) for ZG, participants with abdominal ≥2 log10 per cm2, and inguinal ≥3 log10 per cm2 reductions in colony-forming units (CFU) were compared to RRs of participants treated with CP. RESULTS In trial 1, ZG at the recommended application time reduced mean bacterial counts by ~3.18 log10 CFU/cm2 and ~2.98 log10 CFU/cm2 at abdominal and inguinal sites, respectively. Qualitatively similar reductions were observed for the abbreviated ZG application time and all CP applications. Application of ZV was ineffective. In trial 2, 10-minute RRs for ZG and CP exceeded 90% at abdominal sites. At inguinal sites, RRs were 83.3% for ZG and 86.7% for CP. No skin irritation or other adverse events were observed. CONCLUSIONS ZG matched CP efficacy under these experimental conditions with immediate and persistent microbial reductions, including abbreviated application times. Further clinical studies of this novel preoperative antiseptic are merited.
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Mummery TA, John M, Stokes SM. A quality improvement project to assess the use of preventative measures against acute alveolar osteitis. BDJ Open 2019; 5:10. [PMID: 31258931 PMCID: PMC6594952 DOI: 10.1038/s41405-019-0019-7] [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: 02/26/2019] [Revised: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 11/09/2022] Open
Abstract
Aims A quality improvement project was conducted in a General Dental Practice environment. The aim was to reduce the rate of Acute Alveolar Osteitis, which was locally found to be at 19.4%. Methods A range of quality improvement tools were utilised to determine and measure potential interventions, and the results from the initial Plan-Do-Study-Act cycle utilising perioperative 0.2% Chlorhexidine as a preventative method are presented. Results The use of perioperative 0.2% Chlorhexidine mouthwash showed an absolute risk reduction of 6.2%. Discussion Generalisation from the results is highly dependent on local factors, although the favourable reduction in acute alveolar osteitis and cost savings found supported the project. Conclusions This project highlights the strengths of Quality Improvement methodologies in implementing and assessing changes to improve service provision and patient outcomes.
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Affiliation(s)
| | - Miriam John
- LINCymru Clinical Lead, Quality Improvement Skills Training Section, Health Education and Improvement Wales, Cardiff, UK
| | - Susan Mary Stokes
- Dental Educator Quality Improvement, Dental Postgraduate Section Health Education Improvement Wales, Cardiff, UK
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Dick AG, Dhinsa B, Walker RP, Singh S. Delayed Allergic Reaction to ChloraPrep TM in Foot and Ankle Surgery. J Foot Ankle Surg 2019; 58:192-194. [PMID: 30448375 DOI: 10.1053/j.jfas.2018.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 02/03/2023]
Abstract
Chlorhexidine-based skin preparations are frequently used in orthopaedic surgery. We report 2 recent cases of patients suffering significant allergic reactions to ChloraPrepTM complicating routine foot and ankle surgery. We advise vigilance for this possible issue and recommend thorough removal of all preparation at the end of the procedure.
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Affiliation(s)
- Alastair G Dick
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Baljinder Dhinsa
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Roland P Walker
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Samrendu Singh
- Specialist Registrar, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Foot and Ankle Fellow, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Consultant Orthopaedic Surgeon, Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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D’Journo XB, Falcoz PE, Alifano M, Le Rochais JP, D’Annoville T, Massard G, Regnard JF, Icard P, Marty-Ane C, Trousse D, Doddoli C, Orsini B, Edouard S, Million M, Lesavre N, Loundou A, Baumstarck K, Peyron F, Honoré S, Dizier S, Charvet A, Leone M, Raoult D, Papazian L, Thomas PA. Oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate in lung cancer surgery: a randomized clinical trial. Intensive Care Med 2018; 44:578-587. [DOI: 10.1007/s00134-018-5156-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022]
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Nepomuceno NC, Barbosa MA, Bonan RF, Oliveira JE, Sampaio FC, Medeiros ES. Antimicrobial activity of PLA/PEG nanofibers containing terpinen-4-ol against Aggregatibacter actinomycetemcomitans. J Appl Polym Sci 2017. [DOI: 10.1002/app.45782] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Neymara C. Nepomuceno
- Materials and Biosystems Laboratory (LAMAB), Department of Materials Science and Engineering (DEMAT); Federal University of Paraíba (UFPB); João Pessoa PB 58.051-900 Brazil
| | - Mariângela A. Barbosa
- Post-Graduation Program in Dentistry (PPGO/CCS/UFPB); Federal University of Paraíba (UFPB); João Pessoa PB C58.051-900 Brazil
- Health Sciences Center (CCS); Federal University of Paraíba (UFPB); João Pessoa PB C58.051-900 Brazil
| | - Roberta F. Bonan
- Health Sciences Center (CCS); Federal University of Paraíba (UFPB); João Pessoa PB C58.051-900 Brazil
| | - Juliano E. Oliveira
- Department of Materials Engineering (DEMat); Federal University of Lavras (UFLA); Lavras-MG CEP 37200-000 Brazil
| | - Fábio C. Sampaio
- Post-Graduation Program in Dentistry (PPGO/CCS/UFPB); Federal University of Paraíba (UFPB); João Pessoa PB C58.051-900 Brazil
- Social and Clinical Dentistry Department (DCOS); Paraiba Federal University (UFPB), Bucal Biology Laboratory-LABIAL; João Pessoa PB 58.051-900 Brazil
| | - Eliton S. Medeiros
- Materials and Biosystems Laboratory (LAMAB), Department of Materials Science and Engineering (DEMAT); Federal University of Paraíba (UFPB); João Pessoa PB 58.051-900 Brazil
- Post-Graduation Program in Dentistry (PPGO/CCS/UFPB); Federal University of Paraíba (UFPB); João Pessoa PB C58.051-900 Brazil
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Chlorhexidine-Alcohol Compared With Povidone-Iodine for Preoperative Topical Antisepsis for Abdominal Hysterectomy. Obstet Gynecol 2017; 130:319-327. [DOI: 10.1097/aog.0000000000002130] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kemp H, Cook T, Thomas M, Harper N. UK anaesthetists’ perspectives and experiences of severe perioperative anaphylaxis: NAP6 baseline survey † †On behalf of the members of the Sixth National Audit Project Committee on Severe Perioperative Anaphylaxis. Br J Anaesth 2017; 119:132-139. [DOI: 10.1093/bja/aex124] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/13/2022] Open
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Kow RY, Low CL, Ruben JK, Zaharul-Azri MZ, Ng MS. Life-threatening Chlorhexidine Anaphylaxis: A Case Report. Malays Orthop J 2017; 11:72-74. [PMID: 29021884 PMCID: PMC5630056 DOI: 10.5704/moj.1707.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chlorhexidine is a common antiseptic and disinfectant used in the medical field. Allergy to chlorhexidine has been reported in the literature but life-threatening anaphylactic shock is rare. We present a case of severe anaphylactic shock due to chlorhexidine occurring during surgery. Literatures suggest that profound anaphylactic shock to chlorhexidine is commonly preceded by milder, non-specific reactions. These mild symptoms are often dismissed by both the patient and physicians alike. Direct questioning of these symptoms is necessary as a part of the pre-operative assessment and the patient should be referred for further immunology testing if indicated.
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Affiliation(s)
- R Y Kow
- Department of Orthopaedics, Kuala Lipis Hospital, Kuala Lipis, Malaysia
| | - C L Low
- Department of Orthopaedics, Kuala Lipis Hospital, Kuala Lipis, Malaysia
| | - J K Ruben
- Department of Orthopaedics, Kuala Lipis Hospital, Kuala Lipis, Malaysia
| | - M Z Zaharul-Azri
- Department of Orthopaedics, Kuala Lipis Hospital, Kuala Lipis, Malaysia
| | - M S Ng
- Department of Orthopaedics, Kuala Lipis Hospital, Kuala Lipis, Malaysia
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Oakley CL, Vote BJ. Aqueous chlorhexidine (0.1%) is an effective alternative to povidone-iodine for intravitreal injection prophylaxis. Acta Ophthalmol 2016; 94:e808-e809. [PMID: 26947261 DOI: 10.1111/aos.12981] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Brendan J. Vote
- Tasmanian Eye Institute; South Launceston Tasmania Australia
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Gouel-Chéron A, Harpan A, Mertes PM, Longrois D. Management of anaphylactic shock in the operating room. Presse Med 2016; 45:774-83. [DOI: 10.1016/j.lpm.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/06/2016] [Indexed: 12/14/2022] Open
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Abstract
Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality in the USA. They are associated with a substantial increase in health care costs each year. Fortunately, many HAIs are preventable, and their eradication is a national priority. Chlorhexidine (CHG) bathing has been used as an infection prevention measure, either alone or bundled with other interventions, with mostly beneficial results. The recent surge in its use as an agent of choice for skin antisepsis has lead to concerns over emerging resistance among microorganisms. Moreover, compliance with CHG-bathing protocols is not routinely monitored. Policies developed to determine the best infection prevention practice must consider that a "one-size-fits-all" strategy may lead to the selection of CHG-tolerant microorganisms, thereby emphasizing the need for more robust guidelines and additional studies on the role of chlorhexidine bathing for the prevention of HAIs.
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Ledford DK. Reply. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:189-90. [PMID: 26772934 DOI: 10.1016/j.jaip.2015.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Dennis K Ledford
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, and James A. Haley VA Hospital, Tampa, Fla.
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Moka E, Argyra E, Siafaka I, Vadalouca A. Chlorhexidine: Hypersensitivity and anaphylactic reactions in the perioperative setting. J Anaesthesiol Clin Pharmacol 2015; 31:145-8. [PMID: 25948890 PMCID: PMC4411823 DOI: 10.4103/0970-9185.155138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital, Heraklion-Crete, Greece
| | - Eriphili Argyra
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Ioanna Siafaka
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Athina Vadalouca
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
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