Cent Chlorhexidine Research Articles

Oral Care Effect on Intubated Patient with 0.2 per cent Chlorhexidine Gluconate and Tooth Brushing in Intensive Care Unit

Aims and Objectives: Ventilator-associated pneumonia is associated with increased morbidity and mortality. The aim of this pilot study was to determine the effectiveness of oral care with both tooth brushing and 0.2 per cent chlor-hexidine gluconate compared to 0.2 per cent chlorhexidine gluconate alone for the intubated patient in an intensive care unit (ICU). Materials and Methods: Patient screening was done over a period of two months. After taking informed consent, those ICU patients were divided into two groups. Only nine subjects were enrolled. During the study, the experimental group (N = 4) got oral care that consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate thrice a day. The control group got oral care with 0.2 per cent chlorhexidine gluconate alone thrice a day. The data were analysed by IBM statistical software SPPS, version 24. Results: Preliminary results suggest that the risk of ventilator-associated pneumonia in intubated patients can be reduced by maintaining thrice-daily oral care involving both tooth brushing and 0.2 per cent chlorhexidine gluconate. Conclusion: Thrice-daily oral care consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate might be a promise as a ventilator-associated pneumonia-reduction strategy in ICU. Furthermore, more studies are required for its application widely.

Perioperative Skin Preparation

Liaison: Anthony T Tokarski BS Leaders: David Blaha MD (US), Michael A. Mont MD (US), Parag Sancheti MS, DNB, MCh (International) Delegates: Lyssette Cardona MD, MPH, MHA, AAHIVS, FIDSA, Gilberto Lara Cotacio MD, Mark Froimson MD, Bhaveen Kapadia MD, James Kuderna MD, PhD, Juan Carlos Lopez MD, Wadih Y Matar MD, MSc, FRCSC, Joseph McCarthy MD, Rhidian Morgan-Jones MB BCh, FRCS, Michael Patzakis MD, Ran Schwarzkopf MD, Gholam Hossain Shahcheraghi MD, Xifu Shang MD, Petri Virolainen MD, PhD, Montri D. Wongworawat MD, Adolph Yates Jr, MD

Candida colonisation and the efficacy of chlorhexidine gluconate on soft silicone‐lined dentures of diabetic and non‐diabetic patients

The aim of this study was to evaluate Candida colonisation in the dentures with silicone soft liner in diabetic and non-diabetic patients and to assess the antifungal efficacy of chlorhexidine gluconate on Candida colonies. Thirty patients with resorbed ridges, fifteen each in the diabetic and non-diabetic group, were selected. The mandibular denture of each patient was lined with heat-polymerised silicone resilient liner. Patients were instructed to clean the dentures with soap water and brush. Samples from the fitting surface of mandibular dentures were collected at 15, 21 and 30 days. Subsequently, samples were collected at 15, 21 and 30 days, after cleaning the dentures with a detergent solution of 4% chlorhexidine gluconate, and incubated for the evaluation of Candida growth. These data were subjected to statistical analysis by Mann-Whitney U-test. Normal oral flora in diabetics and non-diabetics showed no difference (p > 0.05). The density of colonies increased after 21 and 30 days in diabetic patients (p < 0.05). Number of Candida colonies significantly reduced in both the groups after 21 and 30 days of cleaning the dentures with 4% chlorhexidine gluconate (p < 0.05). Dentures with silicone resilient liner exhibit increased Candida growth in diabetic patients. Four per cent chlorhexidine gluconate solution effectively disinfects these dentures.

Low‐cost periodontal therapy

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Application of 4% chlorhexidine solution for cord cleansing after birth reduces neonatal mortality and omphalitis

Commentary on: Arifeen SE, Mullany LC, Shah R, et al. The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial. Lancet 2012;379:1022–8.[OpenUrl][1][CrossRef][2][PubMed][3][Web of...

Comparison of two shampoos as sole treatment for canine bacterial overgrowth syndrome

Two antibacterial shampoos for the treatment of canine bacterial overgrowth syndrome (BOGS) were compared in a prospective controlled clinical trial. Forty dogs with clinical signs (pruritus, erythema and excoriations without...

Comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma

The clinical and antibacterial efficacy of two shampoos used as a sole antibacterial treatment in dogs with superficial pyoderma were investigated and compared. In a randomised, partially blinded study, a...

Importance of Methicillin-Resistant Staphylococcus aureus Eradication in Carriers to Prevent Postoperative Methicillin-Resistant Staphylococcus aureus Surgical Site Infection

Although infrequent, postoperative methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection (SSI) is associated with significant morbidity and cost. Previous studies have identified the importance of MRSA screening to diminish the risk of postoperative MRSA SSI. The current study quantifies the importance of eradication of the MRSA carrier state to prevent MRSA SSI. Beginning February 2007, all admissions to an 800-bed tertiary care hospital were screened for MRSA by nasal swab using rapid polymerase chain reaction-based testing. Patients found to be nasal carriers of MRSA were treated with 2 per cent mupirocin nasal ointment and 4 per cent chlorhexidine soap before surgery. The subset of patients undergoing procedures that are part of the Surgical Care Improvement Project (SCIP) were followed for MRSA SSI (n = 8980). The results of preoperative MRSA screening and eradication of the carrier state were analyzed. Since the initiation of universal MRSA screening, 11 patients undergoing SCIP procedures have developed MRSA SSI (0.12%). Of these, six patients (55%) had negative preoperative screens. Of the five patients with positive preoperative screens, only one received treatment to eradicate the carrier state. In patients who develop MRSA SSI, failure to treat the carrier state before surgery results in MRSA SSI.

Factors affecting bacterial counts during preparation of the hands for aseptic surgery

This study was designed to compare the efficacy of four hand preparation techniques in removing bacteria from the hands preoperatively. The effect of bacteriological swabbing itself on bacterial counts was...

Meta-analysis of preoperative antiseptic bathing in the prevention of surgical site infection

Preoperative bathing with an antiseptic solution is widely used to prevent surgical site infection, but trial results are conflicting. Trials were identified by searches of Medline, Embase and the Cochrane controlled trials register. Studies were eligible if they compared an antiseptic solution used in preoperative bathing with a non-antiseptic washing agent or with no bathing and if they reported data on surgical site infection. Six trials with a total of 10 007 patients were included; all of them used 4 per cent chlorhexidine gluconate. Three trials with 7691 patients compared chlorhexidine with placebo. Bathing with chlorhexidine did not reduce surgical site infection rate; the relative risk (RR) was 0.91. Including only trials of high quality, the RR was 0.95. Three trials with 1443 patients compared bar soap with chlorhexidine; no differences in the surgical site infection rates were detected, and the RR was 1.02. Two trials of 1092 patients compared bathing with chlorhexidine with no washing. The surgical site wound infection rate in the two groups was similar, and the RR was 0.70. The evidence does not support preoperative bathing with chlorhexidine as a means of reducing surgical site wound infection.

Early biofilm formation and the effects of antimicrobial agents on orthodontic bonding materials in a parallel plate flow chamber

Decalcification is a commonly recognized complication of orthodontic treatment with fixed appliances. A technology, based on a parallel plate flow chamber, was developed to investigate early biofilm formation of a strain of Streptococcus sanguis on the surface of four orthodontic bonding materials: glass ionomer cement (Ketac Cem), resin-modified glass ionomer cement (Fuji Ortho LC), chemically-cured composite resin (Concise) and light-cured composite resin (Transbond XT). S. sanguis was used as it is one of the primary colonizers of dental hard surfaces. Artificial saliva was supplied as a source of nutrients for the biofilms. The effects of two commercially available mouthrinses (i.e. a fluoride containing rinse and chlorhexidine) were evaluated. Initial colonization of the bacterium was assessed after 6 hours of growth by the percentage surface coverage (PSC) of the biofilm on the disc surfaces. There were statistically significant differences in bacterial accumulation between different bonding materials (P < 0.05), Concise being the least colonized and Transbond XT being the most colonized by S. sanguis biofilms. All materials pre-treated with 0.05 per cent sodium fluoride mouthrinse showed more than 50 per cent reduction in biofilm formation. The 0.2 per cent chlorhexidine gluconate mouthrinse caused significant reduction of biofilm formation on all materials except Ketac Cem. This in vitro study showed that the use of a chemically-cured composite resin (Concise) reduced early S. sanguis biofilm formation. Also, fluoride had a greater effect in reducing the PSC by S. sanguis biofilms than chlorhexidine. Rinsing with 0.05 per cent sodium fluoride prior to placement of orthodontic appliances is effective in reducing early biofilm formation.

The effect of blood on disinfection of surgeons' hands.

Abstract The effect on skin flora of spreading 2 ml of blood over the hands after a 2-minute disinfectant handwash and then wearing rubber gloves for an hour was assessed by a trial in which 6 volunteers used each of six preparations, once with blood and once, as a control experiment, with water on their hands. Bacterial counts of handwashings and of glove washings showed significant interference by blood with the effectiveness of povidone iodine detergent solution (Disadine). With a 3 per cent hexachlorophane detergent cream (Disfex) significant interference by blood was shown in bacterial counts of glove washings and a nearly significant interference was shown in counts of handwashings. There was no evidence of any interference by blood with the effectiveness of a 4 per cent chlorhexidine detergent solution (Hibiscrub) or a 3 per cent hexachlorophane liquid soap containing 0.3 per cent chlorocresol (Ster-Zac).

Recolonization of mutans steptococci on teeth with orthodontic appliances after antimicrobial therapy

The aim of the present study was to compare the recolonization pattern of mutans streptococci on densely colonized teeth with and without fixed orthodontic appliances after treatment with a 40 per cent chlorhexidine (CHX) varnish (EC 40, Explore). Healthy subjects free of carious lesions requiring fixed orthodontic appliance treatment but with high bacterial mutans streptococci saliva counts were recruited (n = 10). For baseline registration, plaque from buccal sites was sampled and cultivated on Dentocult strips. Following professional tooth cleaning, CHX varnish was applied to all teeth for 8 minutes. Subsequently, orthodontic brackets and bands were inserted in either the upper or lower arch. Eight weeks after varnish application the degree of recolonization with mutans streptococci was reassessed on the buccal sites. Statistical analysis showed that recolonization with mutans streptococci was significantly higher (P < 0.05) on teeth with orthodontic appliances. The results indicate that the use of fixed orthodontic appliances creates artificial environments suitable for the proliferation of mutans streptococci after CHX varnish suppression.

Effects of 2% chlorhexidine and 5.25% sodium hypochlorite on gutta‐percha cones studied by atomic force microscopy

To compare the effects of 2% chlorhexidine (CHX) and 5.25% sodium hypochlorite (NaOCl) on gutta-percha (GP) cone structure using atomic force microscopy (AFM). Two standardized GP cones were sectioned 3 mm from the tip, attached to a glass base and immersed in 2% CHX or 5.25% NaOCl for 1, 5, 10, 20 and 30 min. Untreated GP cones were used as control. Topography and elasticity analyses were performed on 12 different regions located between 1 and 2 mm from the tip. Root mean square (RMS) parameters for contact mode imaging and force modulation microscopy variations were measured. The differences between RMS values were tested by anova with Fisher's protected LSD test for multiple comparisons. There was no deterioration in the topography and physical properties studied when 2% CHX was used in comparison with the control (P < 0.05). The RMS parameter for topography increased after 10 min of 5.25% NaOCl exposure in comparison with the control (P < 0.05). In addition, 5.25% NaOCl increased the elasticity of the GP cone after an immersion time of 1 min in comparison with the control (P < 0.05). Two per cent CHX did not change GP cone structure following up to 30 min exposure. Conversely, 5.25% NaOCl caused elastic changes after 1 min exposure.

A cleaning protocol for rotary nickel-titanium endodontic instruments.

The cleaning of endodontic and all dental instruments prior to sterilization is a prerequisite for their processing for re-use. This study aimed to develop a clinically practical cleaning protocol for rotary nickel-titanium (NiTi) endodontic files prior to sterilization. Cleaning experiments were conducted on six different types of files that had been used on human teeth. The experiments involved three components of mechanical and chemical removal of root canal debris from the files: the use of sponges soaked with chlorhexidine to remove gross debris, pre-soaking, and ultrasonication. After cleaning, the files were immersed in Van Gieson's solution and examined under magnification for stained debris. New unused files were also examined. Macroscopically, there were no instances of visible debris and all files appeared clean after all cleaning sequences. Microscopically, new files showed both stained and unstained debris, and several experimental cleaning regimens produced files that were free of stained debris. Combining elements of the most effective cleaning sequences resulted in a cleaning protocol that predictably produced clean files. The results do not support the recommendation for the single use of endodontic files based on inability to clean files between uses. Under experimental conditions the cleaning protocol developed rendered rotary NiTi files 100 per cent free of stained debris. The protocol comprises 10 vigorous strokes in a scouring sponge soaked in 0.2 per cent chlorhexidine solution, a 30 minute pre-soak in an enzymatic cleaning solution, 15 minutes ultrasonication in the same solution, and a 20 second rinse in running tap water. The protocol can be applied to all endodontic files.

Evaluation of the penetration strength, bactericidal efficacy and spectrum of action of several antimicrobial creams against isolated microorganisms in a burn centre

The antibacterial activity of eight antiseptic creams: 1 per cent silver sulphadiazine; 0.2 per cent nitrofurazone; 0.1, 0.5 and 1 per cent chlorhexidine; 2.2 per cent cerium nitrate; 10 per cent povidone iodine; and 1 per cent silver sulphadiazine with 2.2 per cent cerium nitrate were evaluated in vitro. The evaluation included the minimum inhibitory concentration (MIC) against 100 microorganisms isolated from burn patients, the chronology of the bacterial activity against Ps. aeruginosa and Staph. aureus and the penetration strength of the creams through a novel in vitro model contaminated with 17 microorganisms of different species isolated from burn patients. The results revealed that 0.5 per cent or 1 per cent chlorhexidine, 2.2 per cent cerium nitrate, and 1 per cent silver sulphadiazine with 2.2 per cent cerium nitrate were the creams which were effective at the highest dilutions. 0.5 per cent chlorhexidine and 10 per cent povidone iodine had the greater bactericidal activity. Finally, 0.2 per cent nitrofurazone showed greater penetration strength within the eschar model in comparison with the weaker penetration of 0.5 per cent and 1 per cent chlorhexidine and the absence of penetration by the rest of the antibacterial creams.

A new in vitro model to test the effectiveness of topical antimicrobial agents. Use of an artificial eschar

An in vitro method using a burn eschar ‘equivalent’ is described to compare the efficacy of several antimicrobial creams. Fragments of lyophilized pigskin were used as ‘germ carriers’ and after 24 h of treatment the effectiveness of the antimicrobial creams was tested through the evaluation of bacterial recovery both from the surface and from within the germ carriers'. The results showed a striking full skin thickness effectiveness of 0.5 per cent chlorhexidine, 10 per cent povidone iodine and 2 per cent cerium nitrate in comparison with the weak activity demonstrated by 1 per cent silver sulphadiazine cream.

Management of partial skin thickness burn wounds with Inadine dressings

In a prospective randomized trial, 213 consecutive patients with less than 10 per cent BSA partial thickness burns were treated as out-patients with either Bactigras (n= 102) (tulle gras dressing with 0.5 per cent Chlorhexidine Acetate B.P.) or Inadine (n = 111) (rayon dressing with 10 per cent povidone iodine ointment). Inadine caused less bleeding on dressing removal but not significantly less. Inadine treated patients required less analgesia, a reduced treatment time, a smaller number of hospital visits and less time off work/normal activities (P = 0.01). Inadine should be more widely used in the management of partial thickness burn wounds.

A Comparison of Bacterial Growth Inhibiting Effects of Six Commercially Available Mouthrinses

In this study the bacterial growth inhibiting effects of six commercially available mouthrinses (Hibident®, Prodent®, Merocet®, Listerine®, Veadent® and Mendol®) were determined. Hibident® was used as a positive control. Five strains were tested ( Streptococcus mutans C67, Streptococcus sanguis CH3, Veillonella alcalescens V1, Lactobacillus acidophilus JP and Actinomyces viscosus C74), as representatives of the supragingival human microflora. The Maximal Inhibiting Dilution (MID) was measured in batch cultures for each product and strain. With respect to the positive control, Hibident® (containing 0.2 per cent chlorhexidine), the most effective product was Meridol® (containing 125 ppm aminefluoride 297 and 125 ppm stannous fluoride) followed by Merocet® (containing 0.05 per cent cetylpyridinium chloride), Veadent® (containing 0.03 per cent sanguinarine), Listerine® (containing phenolic compounds) and Prodent® (containing 0.5 per cent sodium fluoride). Although all products have been separately reported to yield a plaque reduction in vivo , this study provides a firm basis for a comparison between products, as they were all evaluated in a similar way. Keywords: Mouthrinses; Bacterial growth; Maximal Inhibiting Dilution.

Bacteriological effect of cerium-flamazine cream in major burns

A controlled trial of the use of either 0·05 per cent chlorhexidine for bathing burn wounds or the topical application of a cream containing cerium nitrate and silver sulphadiazine showed that the cerium-flamazine cream significantly reduced the degree of Pseudomonas aeruginosa contamination of the burn wounds of patients with burns covering more than 15 per cent of the body surface area. The adherent eschar produced by treatment with cerium-flamazine provided a satisfactory wound cover until tangential excision could be carried out.