Aqueous Chlorhexidine Research Articles

Antiseptic efficacy and plasma chlorhexidine levels following two different methods of application of 1% aqueous chlorhexidine gluconate for skin disinfection in preterm newborns: a randomized controlled trial

Antiseptic efficacy and plasma chlorhexidine levels following two different methods of application of 1% aqueous chlorhexidine gluconate for skin disinfection in preterm newborns: a randomized controlled trial

The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation

Respiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associated infections.Aim of the study. To evaluate clinical effectiveness of the original oral care protocol in ICU patients on invasive mechanical ventilation (IMV).Materials and Methods. A multicenter, open-label, randomized, prospective, controlled study was conducted in 55 surgical ICU patients on long-term mechanical ventilation. Oral care for patients in the study group (group 1, N=30) included brushing with disposable toothbrushes and rinsing with an aqueous solution of 0.05% chlorhexidine digluconate three times daily. In the control group (group 2, N=25), patients' oral care was performed twice a day using sterile cotton swabs soaked in 0.05% aqueous chlorhexidine digluconate solution. The results were statistically processed using IBM SPSS Statistics 21. The relative risk (RR) of events was calculated with a 95% confidence interval (95% CI). The 95% CIs for event density parameters such as incidence rate (IR) and incidence rate ratio (IRR) were calculated using the exact Poisson test.Results. The incidence of ventilator-associated pneumonia (VAP) was 13.6 cases [95% CI: 4.4; 31.7] per 1,000 ventilation days in group 1 and 23.6 cases [95% CI: 7.7; 55] per 1,000 ventilation days in group 2. The incidence of VAP was 1.74 times lower [95% CI: 0.4, 7.54] in group 1 vs. group 2 (P=0.398). The identity of oral and tracheal flora on day 7 was 20% in group 1 and 50% in group 2, RR=0.4, 95% CI: 0.165–0.973, P=0.037. Serum C-reactive protein levels were significantly lower in group 1 on day 7 of ventilation compared to group 2 (P=0.04).Conclusion. The original oral care protocol, based on toothbrushing 3 times daily with a set of disposable toothbrushes and 0.05% aqueous solution of chlorhexidine digluconate, is associated with a tendency to lower VAP incidence per 1000 days of ventilation, significantly lower similarity between oral and tracheal flora, and lower serum C-reactive protein levels on day 7 of IMV. Further research on various aspects of oral care in ICU patients is needed, especially in the absence of complete clinical guidelines and clearly effective strategies for the prevention of ventilator-associated infections.

Temporal decreases in pathogen colonization and infection among hospitalized neonates following routine skin antisepsis with chlorhexidine gluconate: Botswana 2022 – 2023

Background: Multidrug-resistant Gram-negative bacteria are a major cause of sepsis among hospitalized neonates globally. Aqueous chlorhexidine gluconate (CHG) skin antisepsis has been shown to be safe for use in infants; however, its sustained effectiveness in preventing Gram-negative pathogen colonization, bloodstream infection (BSI), and mortality is unclear. Methods: We conducted a period prevalence survey, with 26 sampling events over 12 months (18 October 2022 – 31 October 2023) at a 33-bed neonatal unit in a tertiary public hospital in Botswana where ESBL-producing Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii are leading causes of BSI. Perirectal and periumbilical skin swabs were collected every two weeks from all inpatients. Swabs were inoculated onto chromogenic media selective and differential for extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) and Acinetobacter spp. (CHROMagar™ ESBL, Acinetobacter). Colonization status was determined based on culture growth and colony morphology. Contemporaneous data on all-cause mortality and BSI were abstracted from routine surveillance records. Pre- and post-CHG prevalences were compared using a simple Chi-square test. During the surveillance period, an outbreak of K. pneumoniae linked to contaminated multi-use vials was detected, thus BSIs and deaths during the outbreak period (2 February–6 April, 2023) were excluded. In February 2023, the hospital infection prevention and control (IPC) team introduced twice-weekly whole-body cleansing with commercially available 2% aqueous CHG, performed by caregivers and healthcare workers on neonates >24 hours old and weighing ≥1 kg until discharge. Results: There were significant decreases in ESBL-E and Acinetobacter skin and perirectal colonization following the CHG intervention (Table 1; Figure 1). After the CHG intervention, the incidence of Acinetobacter BSIs declined significantly and there was a trend toward a decline in other BSIs and mortality. No adverse events associated with CHG were reported. Conclusions: Twice-weekly CHG application was temporally associated with significant reductions in neonatal ESBL-E and Actinetobacter skin and perirectal colonization and Acinetobacter BSI. This analysis was limited by a short pre-intervention surveillance period and thus may have been influenced by confounders such as seasonality, and intensified IPC efforts following the outbreak. Analysis of the routine CHG use in other settings and over longer surveillance periods are needed to better understand its effectiveness as an IPC strategy in settings where neonatal sepsis incidence is high. Table 1. Colonization prevalence, BSI incidence, and mortality surrounding introduction of CHG skin cleansing in a neonatal unit, 18 October 2022 – 31 October 2023.

Comparing the in vitro efficacy of chlorhexidine and povidone-iodine in the prevention of post-surgical endophthalmitis

BackgroundIntravitreal injections are a common ophthalmologic procedure. While infections following these injections are rare, they can lead to endophthalmitis, with potentially serious consequences. Various methods have been proposed to prevent endophthalmitis, including the use of antisepsis and antibiotics in patient preparation.PurposeTo evaluate the antiseptic efficacy of aqueous chlorhexidine (CHX) and povidone-iodine (PI) when used alone and in combination with lidocaine gel (LG) in vitro.MethodsTwo independent experimental trials were conducted. The first trial determined the minimum inhibitory concentrations (MICs) and the minimum bactericidal concentrations (MBCs) of CHX and PI against six bacterial strains. The second trial evaluated the bactericidal efficacy of the antiseptic agents (CHX 0.1% and PI 5%) and their combination with LG against the same bacterial strains.ResultsCHX was more effective than PI in reducing the number of colonies forming units (cfus) of the tested bacteria. The order in which the antiseptic and LG were administered affected their effectiveness, with CHX administered before LG resulting in greater reduction of bacterial growth.ConclusionsCHX 0.1% is more effective than PI 5% as an antiseptic agent. Application of CHX and PI prior to the use of lidocaine gel results in a more effective reduction of microorganisms.

Effects of Phyllanthus niruri antiseptic skin cream on surgical wounds in Felis catus after ovariosalpingohysterectomy

Studies highlight the cost-effectiveness and lower adverse effects of herbal remedies than allopathic medicines, making them attractive amidst growing microbial resistance concerns. This investigation explored the in vitro antiseptic properties of Phyllanthus niruri alcoholic extract (EA) against Escherichia coli, Staphylococcus aureus, Streptococcus spp., and Candida albicans. Various in vitro methods were employed, including disk diffusion, Minimum Inhibitory Concentration (MIC), and Bactericidal/Fungicidal Concentration (MBC/MFC). A skin cream formulation using P. niruri was developed, undergoing in vivo trials on ten feline subjects post-ovariosalpingohysterectomy (OSH). Felines were treated with P. niruri skin cream (100mg/ml), with 0.1% aqueous chlorhexidine as the positive control. Skin assessments included hyperemia, crust, edema, and exudation. Inhibition was observed in vitro at various EA concentrations, and cytotoxicity analysis showed no harm. The P. niruri skin cream at 100mg/ml exhibited consistent outcomes, with a minor deviation from the fifth day onwards, without compromising therapeutic efficacy (Tukey test, p < 0.05). The formulation demonstrated stable physical-chemical properties with no adverse feline reactions. These findings suggest the skin cream's in vivo antimicrobial potential as a future antiseptic alternative.

Rates of endophthalmitis before and after transition from povidone-iodine to aqueous chlorhexidine asepsis for intravitreal injection

ObjectiveTo assess the rate of post-intravitreal injection endophthalmitis between 2 asepsis groups: aqueous chlorhexidine 0.1% and povidone-iodine 5%. DesignRetrospective, observational cohort study. ParticipantsPatients with infectious endophthalmitis post intravitreal injection (n = 58) at a single centre from July 2009 to July 2022. MethodsRetrospective chart review of all patients receiving intravitreal injections (216 593 injections) at a single centre over 14 years. Patients from July 2009 to February 2017 received povidone-iodine 5%, and patients from March 2017 to July 2022 received aqueous chlorhexidine 0.1%. Assessed characteristics of endophthalmitis cases included demographics, visual function, intervention type, and microbiological results. ResultsThe rate of endophthalmitis was comparable for povidone-iodine (1.4:5000) and aqueous chlorhexidine (1.3:5000) (p = 0.77). Vitreous cultures were negative for 55% of patients. Visual acuity (VA) outcomes did not differ between asepsis groups nor between culture positive/negative groups. Patients having vitrectomy (PPV) had worse final vision (p = 0.08) but there was no VA difference between early and late PPV. ConclusionsAqueous chlorhexidine 0.1% is a viable and safe alternative to povidone-iodine 5% for post-intravitreal injection endophthalmitis prophylaxis and may reduce ocular surface adverse events and discomfort.

Characterization of injuries and dressings of left ventricular assist device drivelines

Aim: To Identify and characterize driveline-related injuries among patients with HeartMate II® or HeartMate 3® and assess the dressings used during hospital stay. Method: Observational, cross-sectional study conducted between 2015 and 2023 at a large hospital in São Paulo, Brazil. Results: The sample consisted of 18 patients, with driveline injuries identified in 66.7%, categorized into stages one (83.3%), two (8.3%), and four (8.3%). Of these, 66.6% were diagnosed with driveline infection according to the Utah classification: stages two (50%), three (37.5%), and four (12.5%). A correlation was found between the occurrence of injuries and longer support time (p=0.035) and the presence of a diagnosis of driveline infections (p=0.013). The solutions most frequently used were Chloraprep™ (27.8%), Aqueous Chlorhexidine 0.5% (22.2%), and Saline 0.9% (22.2%), while the dressings were IV3000™ (72.2 %), Excilon™ (44.4%), and Biatain®Ag (33.3%). Conclusion: Driveline dressings are not standardized, indicating the need for new protocols and guidelines based on studies of high methodological quality and presenting robust evidence of the best solutions and dressings to prevent complications and promote better outcomes.

Avaliação da clorexidina 0,12% em pacientes de unidade de terapia intensiva: ensaio clínico randomizado

ABSTRACT Objective: To evaluate the antimicrobial effect of 0.12% aqueous chlorhexidine solution on the oral microbiota of patients on mechanical ventilation in Intensive Care Units (ICUs) at 6, 8 and 12 hours after oral hygiene. Methods: This is a randomized clinical trial in which 30 patients admitted to the ICUs of a philanthropic hospital based in Aracaju-SE, selected by spontaneous demand over a period of 2 months according to inclusion criteria, were randomized and equally distributed into three groups. Oral hygiene followed the disinfection protocol adopted by the hospital, the same recommended by the Brazilian Association of Intensive Medical Care (AMIB). Saliva samples were collected before the application of 0.12% chlorhexidine, shortly after application of the solution, and then after 6 hours (TEST 1 Group), 8 hours (TEST 2 Group) and 12 hours (CONTROL Group), according to each group. Results: The material was sent to a clinical analysis laboratory for microbiological evaluation using the bacterioscopy technique, also called Gram stain. The results were tabulated in spreadsheets and analyzed using the Friedman test between groups and Kruskal Wallis test between groups. Conclusion: The study showed no statistical difference between groups and between groups.

Endophthalmitis after Anti-VEGF Intravitreal Injections with Aqueous Chlorhexidine versus Povidone–Iodine as Ocular Antiseptics

To compare the rates and outcomes of endophthalmitis after intravitreal injections (IVIs) for patients pretreated with 5% povidone-iodine (PI) and 0.05% chlorhexidine (CHX). A retrospective, single-center, comparative cohort study. A total of 8686 patients were included in the study, and a total of 67 695 anti-VEGF injections were performed from January 1, 2019, to November 30,2021. A private retina practice of 13 retina specialists in Colorado. Using electronic health records, patients with preinjection preparation with PI or CHX were compiled retrospectively. Use of prefilled versus nonprefilled syringes was also tabulated. Patients with postinjection endophthalmitis (PIE) were identified among the 2 groups. Postinjection endophthalmitis is defined as an inflammation of the eye from infectious agents after an IVI. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was determined at the time of causative anti-VEGF injection, endophthalmitis presentation, and 3-month follow-up. A total of 67 695 IVIs were administered by 13 retina specialists during the study period. A total of 13 of 32 802 (0.0396%; 1 in 2523 injections) cases of presumed endophthalmitis occurred in the PI group, and 9 of 34 893 (0.0258%; 1 in 3877 injections) cases in the CHX group (P= 0.395). For the PI group, there were 2 culture-positive endophthalmitis cases (0.0061%, 1 in 16 401), compared with 2 cases in the CHX group (0.00573%, 1 in 17 447) (P= 1.000). No significant difference was observed in the average logMAR VA of PI and CHX at causative injection (P= 0.3851), endophthalmitis encounter (P= 0.7718), and 3-month follow-up (P= 0.6152). A significant reduction in presumed endophthalmitis (P= 0.0445) and culture-positive cases (P= 0.0130) was present for prefilled IVI compared with nonprefilled injections. No significant difference in the rate of endophthalmitis or visual outcomes were found in the CHX group compared with the PI group. Prefilled syringes were associated with a significant reduction in endophthalmitis rate. Further multicenter studies are needed to validate the efficacy and safety of CHX compared with PI for IVI preparation. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Frequency of isolation of nosocomial pneumonia pathogens from the respiratory tract of cardiac surgery hospital patients who are under extended artificial lung ventilation and efficiency of oral cavity sanitation with chlorhexidine solution

Objective. To assess the frequency and degree of bacterial contamination of the respiratory tract in patients of cardiac surgery hospital, who are on prolonged mechanical ventilation, and to evaluate the efficiency of sanitation of the oral cavity with a solution of chlorhexidine. Materials and methods. A comparative analysis of the oral and tracheobronchial tract microbiota in operated patients of cardiac surgery hospital undergoing prolonged (4872 hours) artificial lung ventilation (ALV) was carried out. Microbiological assessment of the effectiveness of the oral cavity sanation with 0.1 % aqueous chlorhexidine solution is given. Results. The oral and tracheobronchial microbiota of cardiac surgery patients undergoing prolonged ALV are represented by gram-positive (S. epidermidis) and gram-negative (K. pneumoniae, P. aeruginosa, A. baumannii) microorganisms as well as Candida fungi. It was found out that the indices of the frequency and intensity of microbial isolation from the samples of the lower parts of the respiratory tract content were comparable with those of the oral cavity. The exception was S. epidermidis, the number of which in the lower airways compared to the upper ones was low. There was a statistically significant decrease in the intensity of microbial contamination of the oral cavity in patients on ALV after the sanation procedure with an aqueous chlorhexidine solution. Conclusions. Frequency and intensity indices of opportunistic microorganisms (K. pneumoniae, P. aeruginosa, A. inaumannii, Candida fungi) isolation from the oral cavity and lower respiratory tract in patients of cardiac surgical hospital under prolonged ALV have no statistically significant differences. The exception is S. epidermidis, whose numbers in the lower airways are low compared to the upper ones. The microbiological effectiveness of 0.1 % aqueous chlorhexidine solution in the process of sanitation of the oral cavity in patients on prolonged ALV has been established.

Chlorhexidine digluconate exerts bactericidal activity vs Gram positive Staphylococci with bioelectrocatalytic compatibility: High level disinfection for implantable biofuel cells

Implanted devices destined for contact with sterile body tissues, vasculature or fluids should be free of any microbial contamination that could lead to disease transmission. The disinfection and sterilisation of implantable biofuel cells is a challenging and largely overlooked subject due to the incompatibility of fragile biocatalytic components with classical treatments. Here we report the development of a convenient “soft” chemical treatment based on immersion of enzymatic bioelectrodes and biofuel cells in dilute aqueous chlorhexidine digluconate (CHx). We show that immersion treatment in a 0.5 % solution of CHx for 5 min is sufficient to remove 10-6 log colony forming units of Staphylococcus hominis after 26 h while shorter treatments are less effective. Treatments with 0.2 % CHx solutions were ineffective. Bioelectrocatalytic half-cell voltammetry revealed no loss in activity at the bioanode after the bactericidal treatment, while the cathode was less tolerant. A maximum power output loss of ca. 10 % for the glucose/O2 biofuel cell was observed following the 5 min CHx treatment, while the dialysis bag had a significant negative impact on the power output. Finally, we report a proof-of-concept in vivo operation for 4 days of a CHx-treated biofuel cell with a 3D printed holder and additional porous surgical tissue interface. Further assessments are necessary to rigorously validate sterilisation, biocompatibility and tissue response performance.

The effect of chlorhexidine, povidone‐iodine and betadine antiseptic eye drops on cultured human conjunctival goblet cell survival

AbstractPurpose: To compare the effect of ocular antiseptic treatment in terms of 0.05% aqueous chlorhexidine, 5% povidone‐iodine (PI) and 5% betadine on cell viability and mucin secretion of primary cultured human goblet cells.Methods: Cell viability of primary cultured human goblet cells was analysed using lactate dehydrogenase (LDH) and tetrazolium dye (MTT) colorimetric assays. Expression of mucin was visualized by immunohistochemical staining of MUC5AC.Results: According to the LDH assay, PI and betadine significantly reduced goblet cell survival compared to controls (mean cell survival 23% ± 6 and 23% ± 7, respectively) (p < 0.05), whereas chlorhexidine (mean cell survival 78 ± 17) did not significantly affect goblet cell viability. Similar results were obtained from the MTT assay, where PI and betadine caused a significant loss of goblet cells (mean cell survival 26% ± 12 and 26% ± 13, respectively) (p < 0.05), and chlorhexidine caused a non‐significant loss of goblet cells compared to controls (mean cell survival 79% ± 8).Conclusions: PI and betadine, the most used antiseptic treatments prior to ocular surgery, are significantly more cytotoxic on conjunctival goblet cells compared to chlorhexidine.

Disinfection Strategies for Carbapenem-Resistant Klebsiella pneumoniae in a Healthcare Facility.

Disinfectant resistance is evolving into a serious problem due to the long-term and extensive use of disinfectants, which brings great challenges to hospital infection control. As a notorious multidrug-resistant bacterium, carbapenem-resistant Klebsiella pneumoniae (CRKP) is one of the most common and difficult pathogens of nosocomial infection. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) tests of seven kinds of disinfectants (0.1% benzalkonium bromide, 4% aqueous chlorhexidine, 75% alcohol, entoiodine II, 2% glutaraldehyde, 2000 mg/L chlorine-containing disinfectants, and 3% hydrogen peroxide) were detected by the broth dilution method. Three efflux pump genes (oqxA, oqxB, and qacE∆1-sul1) were detected by PCR. The mean MIC value of aqueous chlorhexidine from the intensive care unit (ICU) (0.0034%) was significantly higher than that from non-ICUs (0.0019%) (p < 0.05). The positive rates of three efflux pump genes oqxA, oqxB and qacE∆1-sul1 were 60.9% (39/64), 17.2% (11/64) and 71.9% (46/64) in the detected CRKP isolates, respectively. This study discovered that CRKP strains demonstrated extensive resistance to clinical disinfectants and suggest that it is necessary to perform corresponding increases in the concentration of aqueous chlorhexidine and chlorine-containing disinfectants on the basis of current standards in the healthcare industry.

АНАЛИЗ ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ ЛЕЧЕБНО-ПРОФИЛАКТИЧЕСКИХ СРЕДСТВ У ПАЦИЕНТОВ С ЛАБОРАТОРНО ПОДТВЕРЖДЕННЫМ ДИАГНОЗОМ SARS-COV-2

To date, there is a limited amount of literature that describes the use of oral therapeutic and prophylactic drugs in patients with a confirmed diagnosis of SARS-CoV-2. Therefore, this topic is relevant. Thus, the purpose of this study was to study the effectiveness of the use of therapeutic and prophylactic agents in patients with a laboratory-confirmed diagnosis of mild to moderate SARS-CoV-2, with or without concomitant oral co-infection.&#x0D; The data of the conducted study will constitute an important stage in the algorithm of specialized therapy.&#x0D; Materials and methods. A comparative analysis of the use of therapeutic and prophylactic agents for the oral cavity in patients with a confirmed diagnosis of SARS-CoV-2 was carried out. The conclusions are based on the results of a clinical study that compared the effectiveness of the use of therapeutic and prophylactic agents in 90 patients aged 20 to 87 years with mild to moderate Sars-CoV-2 with oral co-infection and 15 patients aged from 20 to 87 years of age with mild to moderate Sars-CoV-2 without coinfection.&#x0D; Results. During the study, the following results were obtained. The most effective drug was a solution of aqueous chlorhexidine 0.5%, but there was a side effect in the form of xerostomia. The Miramistin solution also had high efficiency, and the lowest efficiency was observed when using the Rotokan solution.&#x0D; Conclusions. The data of the conducted study will constitute an important stage in the algorithm of specialized therapy.

Chlorhexidine and other alternatives for povidone-iodine in ophthalmic surgery: review of comparative studies.

Povidone-iodine (PVI) is a universally accepted antiseptic agent used in ophthalmic surgery. Insufficient antisepsis in patients with self-reported allergies to iodine has led to devastating complications. The aim of this study was to review the current evidence for alternatives to PVI in ocular surgery. Aqueous chlorhexidine has been used as a primary antiseptic agent in Sweden for several years and has proven efficiency and safety; in a study of a large series of intravitreal injections in Australia, the endophthalmitis rates were similar to those after the use of PVI. The evidence related to using other disinfectants such as picloxydine, hypochlorous acid solution, and polyhexanide is scarce. Single studies have shown lower patient discomfort after conjunctival lavage with chlorhexidine or hypochlorous acid than with PVI. No evidence was found to suggest changing from PVI to other antiseptic agents. Disinfectant solutions other than PVI or chlorhexidine will require further investigations to show their utility in ocular surgery.

2% aqueous vs alcohol-based chlorhexidine for skin antisepsis in VLBW neonates undergoing peripheral venipuncture: a non-inferiority trial.

To compare 2% aqueous chlorhexidine gluconate (AQC) vs. 2% chlorhexidine gluconate in 70% isopropyl alcohol (ALC) for pre-venipuncture skin antisepsis in very-low-birth-weight neonates (VLBW, birth-weight <1500 grams). Double-blind, non-inferiority trial randomized 199 VLBW neonates, age 2-28 days, to receive pre-venipuncture skin preparation using single application of swabstick impregnated with AQC (n = 99) or ALC (n = 100). Skin clearance rate (percentage post-cleansing skin swabs with <15 bacterial colony forming units) with a 10% non-inferiority margin for AQC was primary outcome. Absolute and relative CFU reduction and adverse skin reactions were compared. AQC's clearance was non-inferior to ALC (91% vs. 88%; 95% CI -6.6%, +12.4%). Median (interquartile range) absolute [61 (16, 110) vs. 63 (18, 100); p = 0.65] and relative [100% (97%, 100%) vs. 100% (99.7%, 100%); p = 0.20] CFU reductions were similar. Neither group experienced any adverse reactions. AQC may provide non-inferior skin disinfection to ALC in VLBW neonates. ClinicalTrials.gov NCT01270776.

The behaviour of aluminium ions in artificial saliva and the impact of the chlorhexidine digluconate on its removal – A diffusion model

Diffusion coefficients for aluminum chloride in artificial saliva or chlorhexidine digluconate solutions (pure and commercially, frequently used as a mouthwash), at tracer concentrations (D0T) at 298.15 K and at different pH, as well as ternary diffusion for aqueous AlCl3 and chlorhexidine digluconate solutions, were measured by using the Taylor dispersion technique.Notable coupled diffusion of AlCl3 and chlorhexidine digluconate is observed by obtaining of the negative values of the cross-diffusion coefficients, D21. These results show the occurrence of complex structures formed between Al3+ and gluconate anions. Support for these facts are given by molecular dynamics simulations (MDS).

Antimicrobial effect of Red Roselle (Hibiscus Sabdariffa) against different types of oral bacteria.

This study aimed to compare the antimicrobial effect of an aqueous extract Red Roselle calyx (RE), Chlorhexidine (CH), Amoxicillin-clavulanic acid (ACA), Tetracycline (Tet), and Metronidazole (Met)on Streptococcus mutans (S. mutans), Staphylococcus aureus (S. aureus) and Enterococcus faecalis (E. faecalis) bacteria. The bacterial inhibition zones (BIZ)of the RE (25, 50, 75, 100) mg/ml and CH solutions (0.2%, 2%) were determined using the agar well diffusion method. Additionally, the susceptibility of the tested bacteria against (30 μg) of standard antibiotics of ACA, Tet, and Met was examined. The bacterial minimum inhibitory concentration (MIC) was measured using the Broth Micro dilution method (BMDM). All tests were carried out in triplicates, and water was considered the negative control. For S. mutans, the RE at 50 mg/ml or above concentrations displayed higher BIZ than 0.2% CH. 100 mg/ml of RE recorded a greater BIZ than the 2% CH. The greater BIZ against S. mutans was recorded by Tet. A comparable effect was found with 0.2% CH (75, 100) mg/ml of the RE against S. aureus. Greater BIZ for S. aureus and E. faecalis were reported for 100 mg/ml RE compared to the Tet and Met RE at 100 mg/ml inhibited the E. faecalis growth in a zone size comparable to the CH (0.2%, 2%).The RE with 50,100 mg/ml concentrations showed comparable antimicrobial effect to 0.2%, 2% concentrations of CH, respectively. As an herbal substitute for commercial disinfectants, the RE can be considered an effective final endodontic irrigant and dental mouthwash.

Intraluminal endoscopy in diagnosis and treatment of fluid collections in acute pancreatitis

To improve treatment outcomes in patients with acute pancreatitis through a differentiated approach to transluminal drainage. There were 1074 patients with acute pancreatitis between January 2018 and December 2021 at the Sklifosovsky Research Institute for Emergency Care. EUS was used as a final diagnostic method to determine localization, dimensions, shape and contours of fluid collections. We also assessed content, presence or absence of a capsule and connection with pancreatic ductal system, possibility of intraluminal drainage under EUS control. A plastic stent with rounded ends was installed if homogeneous hypo- and anechoic cavity with clear even contours was detected. The same measure was applied in case of aspiration of serous or serous-hemorrhagic fluid. The indication for installation of covered self-expanding endoprosthesis was inhomogeneous anechoic fluid collection with hyperechoic inclusions (sequesters) and cloudy purulent content. Patients with necrotic forms underwent insertion of a cystonasal drainage tube 7Fr for sanitation of the cavity with 0.05% aqueous chlorhexidine solution. Endoscopic sequestrectomy was performed every 24-48 hours. Stent was removed in 6 (for encapsulated peripancreatic fluid collections) or 1 month (for other types of fluid collections) after discharge. According to the EUS data, endoscopic TLD was performed in 63 (46%) out of 136 patients with fluid collections. Among 63 patients with TLD, connection with pancreatic ductal system was found in 5 (7.9%) patients. These ones underwent pancreaticoduodenal stenting. Twenty-two patients underwent elective sequestrectomy after stenting of necrotic types of fluid collections with fully covered self-expanding stents. Additional percutaneous drainage was required in 11 (45.8%) of 24 patients. Complicated postoperative period was observed in 4 (6.3%) patients with acute necrotic fluid collections (bleeding from the area of pancreatogenic destruction). Four (6.3%) patients died. Autopsy revealed resolution of purulent-inflammatory process in all patients. Intraluminal surgery is possible not only for homogeneous delimited fluid collections, but also for advanced lesions including infected destructions. This approach allows us to consider endoscopic intraluminal drainage as the final minimally invasive method of surgical treatment of pancreatic necrosis. Its effectiveness is up to 45.8%.

Skincare practices in extremely premature infants: A survey of tertiary neonatal intensive care units from Australia and New Zealand

To investigate skincare practices in the first 2 weeks of life in extremely premature infants across tertiary neonatal intensive care units (NICUs). A web-based secure survey invite was emailed to the medical directors of tertiary NICUs. The survey included questions on various aspects of skincare practices in the first 2 weeks of life in extremely premature infants (born before 28 weeks gestation). The person most familiar with local skincare practices was asked to complete the survey and only one response per unit was requested. We performed a descriptive analysis. We received responses from 30 out of 32 NICUs (response rate 93%). Twenty-five NICUs (89%) reported offering resuscitation and intensive care to infants born at ≥23 weeks gestation. All NICUs reported occurrences of skin breakdown, including medical adhesive-related skin injury (30%), abrasion/friction-associated skin injury (46%), perineal skin breakdown (55%), pressure site injury (47%) and diaper dermatitis (60%). A high level of consensus (≥75%) was observed for certain practices, such as the use of polyethylene occlusive plastic wraps at birth and aqueous chlorhexidine solution for sterile procedures, but a low level of consensus (<25%) was observed for many other practices, including the skin risk assessment tool used. Skin injuries in extremely premature infants are common and skincare practices vary considerably amongst NICUs. Clinical practice improvement projects and further clinical research will help improve consistency amongst NICUs. Further research is needed to assist the development of evidence-based guidelines and benchmarking for skincare practices in these vulnerable infants.