1
|
Alves PJ, Gryson L, Hajjar J, Lepelletier D, Reners M, Rodríguez Salazar J, Simon A. Role of antiseptics in the prevention and treatment of infections in nursing homes. J Hosp Infect 2023; 131:58-69. [PMID: 36216172 DOI: 10.1016/j.jhin.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can lead to resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in-vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.
Collapse
Affiliation(s)
- P J Alves
- Wounds Research Laboratory, Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Portugal.
| | - L Gryson
- Belgian Defence Medical Component, Brussels, Belgium
| | - J Hajjar
- Infection Control Practitioner, Consultant, Pau, France
| | - D Lepelletier
- Hospital Hygiene Department, Nantes University Hospital, Nantes, France
| | - M Reners
- Private Dental Practice, Liège, Belgium
| | | | - A Simon
- Infection Control Team, Groupe Hospitalier Jolimont, Haine Saint-Paul, Belgium
| |
Collapse
|
2
|
Martin VT, Abdullahi Abdi M, Li J, Li D, Wang Z, Zhang X, Elodie WH, Yu B. Preoperative Intranasal Decolonization with Topical Povidone-Iodine Antiseptic and the Incidence of Surgical Site Infection: A Review. Med Sci Monit 2020; 26:e927052. [PMID: 33303729 PMCID: PMC7737406 DOI: 10.12659/msm.927052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Surgical site infection (SSI) occurs at the incisional site of a surgical procedure and usually involves the skin. The use of antibacterial courses to manage SSIs is still very challenging in clinical settings. When not used appropriately, antibacterial agents can lead to increased rates of adverse events. However, various antibacterial agents that can destroy the growth of bacteria are now available. This article aims to discuss the role of preoperative intranasal decolonization with topical povidone-iodine antiseptic in the incidence of SSI based on a review of the literature. Topical bactericidal agents can be administered intranasally before surgery to eliminate potentially harmful bacteria, including antibiotic-resistant strains of bacteria. Therefore, a few studies have recommended the use of intranasal povidone-iodine solution in the clinical setting; however, it also appears to be a promising antiseptic regimen for preoperative decontamination in patients planned to undergo surgery. Povidone-iodine is a commonly used medical antiseptic agent that is used by surgeons to promote wound healing and prevent postoperative bacterial infections. Chlorhexidine gluconate is both an antiseptic and a disinfectant, which is used to clean the skin and surgical instruments. Our review of the literature on studies on the effectiveness of intranasal povidone-iodine in the reduction of intranasal bacterial colonization and the prevention of SSI identified only 5 controlled clinical studies. One study, however, showed increased effectiveness in preventing SSI when topical intranasal povidone-iodine was combined with the use of chlorhexidine gluconate washcloths. Further large-scale controlled clinical studies are needed before proper guidelines can be made.
Collapse
Affiliation(s)
- Vidmi Taolam Martin
- Department of Orthopedic and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Mohamed Abdullahi Abdi
- Department of Orthopedic and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Jie Li
- Department of Orthopedic and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Dongtai Li
- Department of Orthopedic and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Zhaozhen Wang
- Department of Orthopedic and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Xianliao Zhang
- Department of Orthopedic and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Welera Haissou Elodie
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Bo Yu
- Department of Orthopedic and Traumatology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| |
Collapse
|
3
|
Chorney SR, Rizzi MD, Dedhia K. Considerations for povidone-iodine antisepsis in pediatric nasal and pharyngeal surgery during the COVID-19 pandemic. Am J Otolaryngol 2020; 41:102737. [PMID: 32979667 PMCID: PMC7501061 DOI: 10.1016/j.amjoto.2020.102737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgeons resuming elective procedures during the COVID-19 pandemic should consider strategies to mitigate risk of exposure. For otolaryngologists performing surgery on children, unique vulnerability to SARS-CoV-2 results from a regular interface with the upper respiratory tract mucosa. A growing interest in perioperative application of povidone‑iodine (PVP-I) to the nasopharynx and oropharynx has emerged. The purpose of this review is to provide an evidence-based assessment of PVP-I in pediatric oral, nasal and pharyngeal surgery. METHODS A contemporary literature review with algorithmic approach to the potential use of PVP-I in pediatric mucosal surgery. RESULTS Several formulations of PVP-I have shown rapid in vitro virucidal activity against SARS-CoV-2. Antisepsis using 1.0% PVP-I mouthwash and 0.45% PVP-I throat spray can occur after 30 seconds of contact time. To date, in vivo effectiveness of PVP-I against SARS-CoV-2 has yet to be established and possible risks of its direct use on upper aerodigestive mucosa of children must be weighed. CONCLUSION Further research is required prior to strongly recommending PVP-I use in preparation for nasal, oral or pharyngeal surgery in children.
Collapse
Affiliation(s)
- Stephen R Chorney
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75207, USA; Children's Medical Center Dallas, Dallas, TX, 75235, USA.
| | - Mark D Rizzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Kavita Dedhia
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
4
|
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]
|
5
|
Kanagalingam J, Amtha R. Povidone-iodine in dental and oral health: a narrative review. J Int Oral Health 2020. [DOI: 10.4103/jioh.jioh_89_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Topical chlorhexidine, povidone-iodine and erythromycin in the repair of traumatic ulcers on the rat tongue: Clinical, histological and microbiological evaluation. Arch Oral Biol 2018; 87:218-225. [PMID: 29316457 DOI: 10.1016/j.archoralbio.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study investigated the effect of topical application of 0.12% chlorhexidine, 10% povidone-iodine and 50% erythromycin on the optimization of healing process of traumatic ulcers made on ventral tongue of rats. DESIGN Forty-Eight Wistar rats were randomly divided into four groups: control, chlorhexidine (Chx), povidone-iodine (PvI) and erythromycin (Er). An ulcer of 5 mm in diameter was made on the ventral tongue of the animals. After 24 h, a microbiological sample was taken and daily application of the substances started. Six animals each group were euthanized at 4 days and the others at 8 days postoperative, totaling three and seven days of treatment. Prior to euthanasia, a new microbiological collection was performed. RESULTS The experimental groups showed less area of residual ulcer. A significant difference was seen between the PvI and Chx in relation to the control after three days of treatment (p < 0.05). Although the experimental groups displayed greater newly formed epithelial area, there was no significant difference compared to the control (p > 0.05). Er exhibed the lowest inflammation scores after seven days of treatment (p < 0.05). PvI showed reduction of microorganisms at both times and under aerobic (p < 0.01 at 3 days and p < 0.001 at 7 days) and microaerophilic (p < 0.05) conditions. Er significantly reduced the count of microorganisms in aerobic condition when compared to control group (p < 0.05 at 3 days and p < 0.01 at 7 days). CONCLUSIONS All drugs promoted reduction of the microorganisms at the site of the injury, which may have a direct effect on the tissue repair process.
Collapse
|
7
|
Augustin M, Goepel L, Jacobi A, Bosse B, Mueller S, Hopp M. Efficacy and tolerability of liposomal polyvinylpyrrolidone-iodine hydrogel for the localized treatment of chronic infective, inflammatory, dermatoses: an uncontrolled pilot study. Clin Cosmet Investig Dermatol 2017; 10:373-384. [PMID: 28989281 PMCID: PMC5624600 DOI: 10.2147/ccid.s141887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infection is common in many chronic, inflammatory skin conditions but is often difficult to treat, in part due to growing bacterial resistance to antibiotics. Liposomal polyvinyl-pyrrolidone (PVP)-iodine hydrogel has a unique mode of action, combining the antiseptic and anti-inflammatory actions of PVP-iodine with the drug delivery and moisturizing properties of liposomes. We investigated the utility of liposomal PVP-iodine to treat infective dermatoses. In this prospective, single-arm (uncontrolled), open-label Phase II pilot study, patients with acne vulgaris (n=30), atopic dermatitis (n=20), impetigo contagiosa (n=10), and rosacea (n=10) received PVP-iodine (3%) hydrogel for ≤4 weeks. Global Clinical Severity score improved for all dermatoses (range: 0.5 for acne vulgaris [p<0.001] to 1.0 for impetigo contagiosa [p=0.011]). Improvements in pain, quality of life, (Freiburg Life Quality Assessment), and Eczema Area and Severity Index scores were also seen. Treatment was well tolerated; most frequent adverse events were burning (14%) or itching (9%) sensations. Thus, liposomal PVP-iodine hydrogel has potential utility as an effective treatment for inflammatory skin conditions associated with bacterial colonization.
Collapse
Affiliation(s)
| | - Lisa Goepel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg
| | - Arnd Jacobi
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg
| | - Bjoern Bosse
- Mundipharma Research GmbH & Co.KG, Limburg (Lahn), Germany
| | - Stefan Mueller
- Mundipharma Research GmbH & Co.KG, Limburg (Lahn), Germany
| | - Michael Hopp
- Mundipharma Research GmbH & Co.KG, Limburg (Lahn), Germany
| |
Collapse
|
8
|
|
9
|
Kanagalingam J, Feliciano R, Hah JH, Labib H, Le TA, Lin JC. Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections. Int J Clin Pract 2015; 69:1247-56. [PMID: 26249761 PMCID: PMC6767541 DOI: 10.1111/ijcp.12707] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 07/23/2015] [Indexed: 12/14/2022] Open
Abstract
AIMS To better inform medical practitioners on the role of antiseptics in oropharyngeal health and disease, this article focuses on povidone-iodine (PVP-I), an established and widely-available antiseptic agent. METHODOLOGY Review of the anti-infective profile, efficacy and safety of PVP-I in managing common upper respiratory tract infections such as the common cold, influenza and tonsillo-pharyngitis, as well as oral complications resulting from cancer treatment (oral mucositis), and dental conditions (periodontitis, caries). RESULTS Antiseptics with broad-spectrum anti-infective activity and low resistance potential offer an attractive option in both infection control and prevention. While there is some evidence of benefit of antiseptics in a variety of clinical settings that include dental and oral hygiene, dermatology, oncology, and pulmonology, there appears to be discordance between the evidence-base and practice. This is especially apparent in the management and prevention of oropharyngeal infections, for which the use of antiseptics varies considerably between clinical practices, and is in marked contrast to their dermal application, where they are extensively used as both a prophylaxis and a treatment of skin and wound infections, thus minimising the use of antibiotics. CONCLUSION The link between oral and oropharyngeal health status and susceptibility to infection has long been recognised. The high rates of antibiotic misuse and subsequent development of bacterial resistance (e.g. increasing vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA)) in large parts of the world, especially across Asia Pacific, highlight the need for identifying alternative antimicrobials that would minimise the use of these medications. This, together with recent large-scale outbreaks of, for example, avian and swine influenza virus, further underline the importance of an increasing armamentarium for infection prevention and control.
Collapse
Affiliation(s)
- J Kanagalingam
- Lee Kong Chian School of Medicine, NTU-Imperial College, Singapore
| | - R Feliciano
- Department of Otolaryngology, St Luke's Medical Center, Global City, Philippines
| | - J H Hah
- Department of Otolaryngology-Head and Neck Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - H Labib
- Dr. Hussein Labib Dental Clinic, Dubai, United Arab Emirates
| | - T A Le
- Department of Oncology, Cho Ray hospital, Ho Chi Minh City, Vietnam
| | - J-C Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
10
|
Jain R, Thomas MS, Yadav A. Resurrecting an unsalvageable lower incisor with a mono-block approach. J Conserv Dent 2015; 18:423-6. [PMID: 26430310 PMCID: PMC4578191 DOI: 10.4103/0972-0707.164061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Contemporary techniques, as well as the availability of bioactive and adhesive materials in endodontics, have helped revivifying teeth that were deemed hopeless. These newer materials and techniques would enable the clinician: (a) to predictably stop microbial activity (b) to achieve a total corono-apical fluid tight seal and (c) to strengthen mutilated teeth by obtaining intra-radicular reinforcement through mono-block effect. This case report demonstrates the successful treatment of a mutilated anterior tooth with the use of bioactive and adhesive materials to obtain a total seal and mono-block effect. This article also shows the use of a simple method in the placement of root filling cement into the root canal.
Collapse
Affiliation(s)
- Rachit Jain
- Department of Conservative Dentistry and Endodontics, Geetanjali Dental and Research Institute, Udaipur, Rajasthan, India
| | - Manuel S Thomas
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| | - Amit Yadav
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| |
Collapse
|
11
|
Abstract
Central giant cell granuloma (CGCG) is an intraosseous lesion consisting of fibrous cellular tissue that contains multiple foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of woven bone. An 8-year-old boy presented himself complaining of a painless swelling in the left maxilla that had started 1 year. Computed tomography (CT) scan confirmed a poorly defined multilocular radiolucent lesion in the left maxilla crossing the midline. The patient underwent enucleation through an intraoral approach of the lesion. The biopsy revealed multinucleated giant cells in a fibrous stroma. A CT was taken approximately 1 year postoperatively. There was no clinical or radiographic evidence of recurrence. Therefore, surgical treatment of CGCG can be performed, trying to preserve the surrounding anatomic structures, which can be maintained in case the lesion does not show an aggressive clinical behavior, avoiding large surgical defects which are undesirable in children.
Collapse
|