Chlorhexidine Preparations Research Articles

Pre-procedural Topical Antisepsis in the Neonate: A Systematic Review Evaluating Risk Factors for Skin Injury.

Pre-procedural antisepsis is a critical component of hospital-acquired infection prevention in the neonatal intensive care unit (NICU). However, broadly utilized topical antiseptic agents pose an elevated risk of disruption to neonatal skin integrity, and evidence-based guidelines are lacking. This systematic review of the literature sought to assess and characterize the predisposing risk factors for and types of neonatal skin injury from topical antiseptic agents. A systematic search of Medline Ovid, Embase, Web of Science, CINAHL, and Cochrane Library was conducted, including academic literature providing data on neonatal skin injuries related to topical antisepsis in the NICU. A total of 19 articles (99 patients) met the inclusion criteria. Of the available data, most reported skin injuries were described in extremely preterm (98.1%) and very low birth weight (98.4%) infants. The majority of reported adverse cutaneous events were attributed to chlorhexidine preparations (74.8%), followed by octenidine (18.2%), povidone-iodine (6.1%), and isopropyl alcohol (2.0%). Erythema (40.1%), skin breakdown (23.4%), and chemical burns (17.5%) were the skin reactions reported most frequently, followed by skin irritation (8.3%), and skin necrosis (2.8%). Our findings indicate that both extremely preterm and very low birth weight infants are particularly susceptible to skin toxicities from pre-procedural antiseptic preparations. These data underscore the need for future research to support the development of guidelines which minimize iatrogenic cutaneous injuries in the neonatal population, specifically for the care of infants under 2 months of age, for whom current recommendations are lacking due to a paucity of data.

Activity of chlorhexidine formulations on oral microorganisms and periodontal ligament fibroblasts.

Given the importance of microorganisms in the pathogenesis of the two most prevalent oral diseases (i.e. caries and periodontitis), antiseptics are widely used. Among the antiseptics chlorhexidine (CHX) is still considered as gold standard. The purpose of this in-vitro-study was to determine the antimicrobial activity of new CHX digluconate containing formulations produced in Switzerland. Two test formulations, with 0.1% or 0.2% CHX (TestCHX0.1, TestCHX0.2) were compared with 0.1% and 0.2% CHX digluconate solutions (CHXph0.1, CHXph0.2) without additives and with a commercially available formulation containing 0.2% CHX digluconate (CHXcom0.2). The minimal inhibitory concentrations (MIC) of the CHX formulations were determined against bacteria associated with caries or periodontal disease. Then the anti-biofilm activities of CHX preparations were tested regarding inhibition of biofilm formation or against an existing biofilm. Further, the cytotoxicity of the CHX preparations against periodontal ligament (PDL) fibroblasts was measured. There were no or only minor differences of the MIC values between the CHX preparations. Except for 0.1% CHXph, all formulations blocked the formation of the biofilms. When analyzing the effect on an established “cariogenic” biofilm, the TestCHX0.2 was most active (- 3.5 log10 colony forming units (cfu); p<0.001 vs. control). The cfu counts of an established periodontal biofilm were most decreased by CHXcom0.2 (-3.9 log10), followed by TestCHX0.2 (-3.34 log10) and CHXph0.2 (-3.0 log10 cfu) (each p<0.001 vs. control). All CHX preparations reduced the viability of the PDL fibroblasts. Taken together, the Swiss made test mouth rinses have an equal or better antibacterial and anti-biofilm activity as the respective CHX solutions and can be recommended.

Досвід використання препаратів хлоргексидину в акушерстві та гінекології

The objective: generalization of the experience of using chlorhexidine drugs in obstetric and gynecological practice. Materials and methods. The efficacy of using Depantol and Hexicon for non-specific colpitis in patients of adolescent, reproductive age, pregnant women, women in perimenopause, as well as in patients after cervical, vaginal and perineal operations was evaluated and generalized. The surveyed groups contained 30 to 50 patients. The diagnosis of nonspecific vaginitis was verified by clinical and laboratory examination. Criteria for recovery were complete clinical and bacterial sanation. The effectiveness of therapy was evaluated immediately after treatment and after 1 and 3 months. The data were compared with the appropriate control groups or with the condition prior to treatment. Results. High efficiency of chlorhexidine preparations in the treatment of nonspecific colpitis in patients of different age categories and conditions was noted. The experience of using Depantol and Gecikon in obstetrics and gynecology is generalized, priorities are determined in the application of these drugs. Conclusion. Preparations of chlorhexidine Geksikon and Depantol are highly effective against the main pathogens of inflammatory nonspecific vulvovaginitis. They do not interfere with the functional activity of lactobacilli, which helps maintain a normal vaginal biocenosis. The drug Geksikon with success can be recommended both for the treatment of gynecological patients of reproductive age, and pregnant women. The use of Depantol, due to the regenerative activity of the dexpanthenol component, is a priority in the treatment of infectious processes in adolescence, perimenopausal age and in patients after operations on the cervix, vagina and perineum. Key words: chlorhexidine preparations, obstetrics and gynecology, Depantol, Geksikon.

Pre versus post application of a 0.12% chlorhexidine based oral hygiene protocol in an Egyptian pediatric intensive care unit: Practice and effects

BackgroundThe role of oral hygiene in the intensive care unit is indisputable. Several studies were carried out in different pediatric intensive care units using different oral hygiene regimes. Chlorhexidine preparations are widely used in oral care regimes. AimThis study was conducted in the pediatric intensive care unit of Children’s Hospital of Mansoura University, Egypt to unravel the effect of adoption of an oral hygiene protocol using 0.12% chlorhexidine solution on the outcome of mechanically ventilated patients. MethodsThe study comprised 50 patients admitted in the period from January 2013 to August 2016. The sample was analyzed as follow: intervention group (28 patients) and control group (22 patients). The intervention group received a 0.12% chlorhexidine based oral hygiene protocol while the control group received usual oral care without chlorhexidine. Mann-Whitney and Chi-square tests were used. ResultsDuration of mechanical ventilation and length of stay were significantly reduced in the intervention group (p =.003 and .007 respectively). Statistically insignificant difference in development of ventilation-associated pneumonia and mortality between both groups was shown (p = .068 and .208 respectively). ConclusionsAdoption of a 0.12% chlorhexidine based oral hygiene regime was associated with improved outcome in pediatric intensive care unit.

In vitro evaluation of antimicrobial efficacy of 2% chlorhexidine loaded electrospun nanofibers

IntroductionPersistent endodontic infection might be due to retention of microorganisms in dentinal tubules of root canal. C. albicans and E. faecalis are commonly found micro organisms in root canals of previously treated teeth. These micro organisms have shown to be resistant to most of the anti microbial agents used during root canal treatment but were found to be sensitive to Chlorhexidine (CHX). AimThis invitro study was conducted to evaluate the efficacy of 2% Chlorhexidine loaded eletrospun nanofibres and compare them with Chlorhexidine solution and gel in a pour plate or traditional streak agar diffusion model. MethodologyStandard holes in the cultivated Sabroaud's Dextrose and Muller Hinton agar plates were filled with one of the CHX preparations i.e 2% Chlorhexidine gluconate solution, 2% CHX gel, 2% CHX loaded electrospun nanofibre. The zones of microbial inhibition were measured after 24 and 72 hours of incubation at 37°C. Values obtained were subjected to statistical analysis. ResultsCHX Nanofibre showed values of zone of inhibition higher than solution (p≤0.05) and similar to that of gel. ConclusionCHX NF and gel had similar antimicrobial efficacy and CHX solution was least effective.

Use of Chlorhexidine Preparations in Total Joint Arthroplasty.

Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.

Chlorhexidine-Alcohol Versus Povidone-Iodine for Surgical-Site Antisepsis

Conclusion: For clean-contaminated surgery, cleansing of the patient's skin with chlorhexidine-alcohol reduces surgical-site infections compared with cleansing with povidone-iodine. Summary: There are 27 million operative procedures performed annually in the United States (Infect Control Hosp Epidemiol 1999;20:250-78). Surgical-site infections occur in 300,000-500,000 patients in the United States each year (J Am Coll Surg 2008;206:814-9; JAMA 2005;294:2035-42). There are recommendations by the Centers for Disease Control and Prevention (CDC) to use 2% chlorhexidine preparations for preoperative cleansing of sites for insertion of vascular catheters, but no CDC recommendations have been put forth regarding antiseptics to prevent surgical-site infection in surgical procedures. This study compared the efficacy of povidone-iodine and chlorhexidine-alcohol in preventing surgical-site infections in patients with clean-contaminated operations in six university-affiliated hospitals. Patients were randomly assigned to preoperative skin preparation with chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. Surgical-site infection ≤30 days was the primary outcome. Secondary outcomes included individual types of surgical-site infection. There were 849 patients (440 in the povidone-iodine group and 409 in the chlorhexidine-alcohol group) that qualified for intention to treat analysis. Surgical-site infection rates were lower in the chlorhexidine-alcohol group than the povidone-iodine group (9.5% vs 16.1%; relative risk, 0.59; 95% confidence interval, 0.41-0.85; P = .004). With regard to secondary end points, chlorhexidine-alcohol was more protective against surgical-site infections than povidone-iodine for superficial incisional infections (4.2% vs 8.6%, P = .008) and deep incisional infections (1% vs 3%, P = .05). The difference in protection against organ-space infections was 4.4% vs 4.5%. There were 813 patients who remained in the study for 30 days and were subject to a per protocol analysis. Overall results remain similar. No differences were noted in adverse events in the two study groups. Comment: In the accompanying editorial to this article, Dr Richard Wenzel makes the observation that human beings have approximately 1013 total cells, with a total number of colonizing microbes per human being of 1014. Basically, bacteria have a 10:1 numerical advantage! The study indicates that all infections at a specific anatomic site can be reduced with a relatively inexpensive process. By substituting chlorhexidine-alcohol for povidone-iodine, all we need to treat are 17 surgical patients with clean-contaminated wounds to prevent 1 surgical-site infection. Of course, vascular surgical procedures fall primarily into the clean-wound category rather than clean-contaminated, as studied here. Nevertheless, the weight of the available literature with respect to chlorhexidine-alcohol vs povidone-iodine for surgical-site antisepsis clearly indicates that chlorhexidine-alcohol is the preferred agent.

The Synergistic Antimicrobial Effect by Mechanical Agitation and Two Chlorhexidine Preparations on Biofilm Bacteria

Introduction Irrigation of the root canal with antibacterial solutions is considered an essential part of root canal treatment in endodontics. The purpose of this study was to investigate whether mechanical agitation (ultrasonic or sonic) improves the effectiveness of chlorhexidine against biofilm bacteria in vitro. Methods Collagen-coated hydroxyapatite (CHA) disks were exposed to dispersed subgingival plaque for 3 weeks at 37°C. The multispecies biofilms established were subjected for 1 and 3 minutes to CHX-Plus (Vista Dental Products, Racine, WI) and 2% chlorhexidine (CHX), with or without mechanical agitation. After treatment, the amount of dead bacteria in biofilms was analyzed by viability staining and confocal laser scanning microscopy (CLSM). The morphology of biofilms, with or without mechanical agitation, was also examined by CLSM. Results The structure of the biofilm did not show any obvious change when the solutions surrounding the biofilm were exposed to continuous ultrasonic or sonic agitation. The combined use of mechanical agitation and chlorhexidine had a more pronounced antimicrobial effect against the biofilms than either one alone. Sonic activation (EndoActivator; Advanced Endodontics, Santa Barbara, CA) showed the highest levels of bactericidal activity with CHX-Plus after both exposure times. The proportion of killed bacteria also depended on the type of irrigant ( p < 0.001) and the time of exposure ( p < 0.001). Conclusions The low-intensity ultrasonic or sonic agitation that does not disrupt biofilm or disperse the biofilm bacteria improves the action of disinfectants against biofilm bacteria.

Evaluation of the Effect of Two Chlorhexidine Preparations on Biofilm Bacteria In Vitro: A Three-Dimensional Quantitative Analysis

Introduction Microorganisms are essential in the development of periradicular diseases and are the major causative factors associated with endodontic treatment failures. Microbial biofilms are communities of bacteria that attach to surfaces and form heterogeneous three-dimensional structures. The purpose of this study was to develop a biofilm model that closely mimicked in vivo biofilm and to determine its susceptibility to endodontic antimicrobial irrigants by three-dimensional quantitative analysis. Methods Collagen-coated hydroxyapatite (C-HA) and uncoated hydroxyapatite (HA) disks were inoculated with dispersed subgingival plaque for 3 weeks. Thick biofilms rich in spirochetes were formed on both substrates. Biofilms were subjected to 1-, 3-, and 10-minute exposures to CHX-Plus (Vista Dental Products, Racine, WI) and 2% chlorhexidine (CHX). After treatment, the volume ratio of dead bacteria to all bacteria in biofilms, indicated by the ratio of red and (red + green) fluorescence, was analyzed by confocal laser scanning microscopy for each medicament. Results The proportion of killed bacteria was depended on the type of irrigant and the time of exposure in both C-HA and HA biofilm models (p = 0.00). CHX-Plus showed higher levels of bactericidal activity at all exposure times than 2% CHX (p < 0.001). The C-HA biofilm was thicker than the HA biofilm. Less bacteria were killed in C-HA biofilm than in the HA model. Conclusions This multispecies biofilm model and quantitative analysis methodology may be useful for the evaluation of the antimicrobial effectiveness of endodontic disinfecting agents.

Chlorhexidine varnish may be useful adjunct to routine periodontal therapy?

PubMed, Embase and the Cochrane Library were searched for relevant studies. Only controlled human trials of chlorhexidine varnish using clinical outcomes were included: other chlorhexidine preparations (mouth rinses/ gels) were excluded, as were studies with concomitant preventive measures, eg, fluoride varnishes. Details of data extraction methods are not provided and a qualitative summary is presented. Ten studies were identified. Comparisons were difficult because of considerable variation in the study parameters, such as varnishes with different chlorhexidine concentrations, different ages of participants, number of applications and clinical indices employed. Eight of the 10 studies found improvements in clinical parameters. The application of chlorhexidine varnish seems to have beneficial effects in people who have chronic gingivitis, improving their plaque accumulation and bleeding levels and reducing their gingival index. It is possible to maintain this beneficial effect for prolonged periods of time, although this requires re-applications of the varnish.

In vitro antibacterial effect of calcium hydroxide combined with chlorhexidine or iodine potassium iodide on Enterococcus faecalis.

Several studies have shown a higher success rate of root canal therapy when the canal is free from bacteria at the time of obturation. Treatment strategies that are designed to eliminate this microflora should include agents that can effectively disinfect the root canal. Enterococcus faecalis is often associated with persistent endodontic infections. While in vivo studies have indicated calcium hydroxide to be the most effective all-purpose intracanal medicament, iodine potassium iodide (IKI) and chlorhexidine (CHX) may be able to kill calcium hydroxide-resistant bacteria. Supplementing the antibacterial activity of calcium hydroxide with IPI or CHX preparations was studied in bovine dentine blocks. While calcium hydroxide was unable to kill E. faecalis in the dentine, calcium hydroxide combined with IKI or CHX effectively disinfected the dentine. The addition of CHX or IKI did not affect the alkalinity of the calcium hydroxide suspensions. It may be assumed that combinations also have the potential to be used as long-term medication. Cytotoxicity tests using the neutral red method indicated that the combinations were no more toxic than their pure components.

Dissolution of pulp tissue by aqueous solution of chlorhexidine digluconate and chlorhexidine digluconate gel.

To evaluate the activity of various root canal irrigants on bovine pulp tissue. The irrigants tested were: 0.5, 1.0 and 2.5% sodium hypochlorite; 2% aqueous solution of chlorhexidine digluconate; 2% chlorhexidine digluconate gel (Natrosol); and distilled water as control. Bovine pulp fragments were weighed and placed in contact with 20 mL of each tested substance in a centrifuge at 150 r.p.m. until total dissolution. Dissolution speed was calculated by dividing pulp weight by dissolution time. Statistical analysis was performed using the Kruskal-Wallis test. Distilled water and both solutions of chlorhexidine did not dissolve the pulp tissue within 6 h. Mean dissolution speeds for 0.5, 1.0 and 2.5% sodium hypochlorite solutions were 0.31, 0.43 and 0.55 mg min(-1), respectively. The solvent ability of chlorhexidine solutions was similar to that of distilled water. The results for sodium hypochlorite solutions, chlorhexidine solutions and distilled water were statistically different (P>0.01). Both chlorhexidine preparations and distilled water were not able to dissolve pulp tissue. All sodium hypochlorite solutions were efficient in dissolving pulp tissue; the dissolution speed varied with the concentration of the solution.

Comparison of the Efficacy of Three Different Chlorhexidine Preparations in Decreasing the Levels of Mutans Streptococci in Saliva and Interdental Plaque

The aim of the present study was to evaluate and compare the effects of three different chlorhexidine (CHX)-containing preparations on mutans streptococci (MS) levels in interdental plaque and whole saliva. Ninety-three healthy schoolchildren (8–10 years old) with high scores of salivary MS were selected by a screening procedure and randomised into three equally sized groups. MS were enumerated at all mesial interdental sites of the first permanent molars with aid of a modified chairside technique. The patients were then treated three times within 2 weeks with either a 1% CHX/thymol-containing varnish (group A) or a 1% CHX gel (group B), or they were subjected to daily supervised toothbrushing with a 0.4% CHX dentifrice for 1 month (group C). Follow-up samples of saliva and plaque from the interdental sites were collected 1 and 3 months after termination of treatment. A statistically significant reduction of MS levels in saliva and interdental plaque was found in all groups after 1 month. The CHX-containing dentifrice (group C) was the most effective method in reducing MS levels in saliva, and a significantly stronger (p < 0.05) suppression was found after 1 and 3 months when compared with the gel and the varnish forms. The gel (group B) tended to be slightly more effective than the varnish (group A). In the interdental plaque, the reduction of MS was less marked than in the saliva, and the three groups exhibited MS reductions of similar magnitude (20%) and duration, persisting up to 3 months. However, a high proportion (approximately 50%) of all interdental sites were relatively unaffected by the treatments. In conclusion, our results suggest that the interdental MS colonisation was difficult to combat, irrespective of CHX preparation and method, while the salivary levels were more easily affected. Daily tooth-brushing with a CHX-containing dentifrice was more effective in reducing MS in saliva compared with the gel or varnish applications.

Current Treatment Recommendations for Topical Burn Therapy

Infections in burn patients continue to be the primary source of morbidity and mortality. Topical antimicrobial therapy remains the single most important component of wound care in hospitalised burn patients. The goal of prophylactic topical antimicrobial therapy is to control microbial colonisation and prevent burn wound infection. In selected clinical circumstances topical agents may be used to treat incipient or early burn wound infections. At the present time silver sulfadiazine is the most frequently used topical prophylactic agent; it is relatively inexpensive, easy to apply, well tolerated by patients, and has good activity against most burn pathogens. In patients with large burns the addition of cerium nitrate to silver sulfadiazine may improve bacterial control. Mafenide acetate has superior eschar-penetrating characteristics, making it the agent of choice for early treatment of burn wound sepsis. However, the duration and area of mafenide application must be limited because of systemic toxicity associated with prolonged or extensive use. Other agents, such as nitrofurazone or chlorhexidine preparations, may be useful in isolated clinical situations. The undesirable side effects of silver nitrate solution limit its use by most clinicians at the present time.

Surgical hand disinfection: effect of sequential use of two chlorhexidine preparations

The antimicrobial efficacy of three ‘two-phase’ surgical hand disinfection procedures was compared, in a volunteer study, to 60% n-propanol, applied for 5 min, which is the reference hand-disinfection procedure used in Austria and West Germany (FRG). The procedures involved sequential use of unmedicated soap or a disinfectant-detergent containing 4% chlorhexidine gluconate (CHX; ‘Hibiscrub’) followed by a handrub preparation containing 70% w w isopropanol plus 0·5% CHX (‘Hibisol’). The immediate and sustained effects (3 h) of washing with unmedicated soap (3 min) followed by rubbing on ‘Hibisol’ (4 min) were significantly smaller (log 10 reductions of 1·72 and 1·12) than with each of the other procedures. Use of ‘Hibiscrub’ (3 min) and ‘Hibisol’ (4 min) produced log 10 reductions of 2·50 and 1·71, equalling those of the reference procedure with n-propanol (2·49 and 1·78). When ‘Hibisol’ was used for 5 min rather than 4 min, a considerable, though not significant, increase in effect was achieved (log 10 reductions of 2·90 and 2·07). Replacement of unmedicated soap by ‘Hibiscrub’ could significantly improve the effectiveness of the hand disinfection procedure commonly used by surgeons in German-speaking countries; namely to wash hands first with soap and then disinfect them with an alcoholic preparation. It may also be of additional advantage as this adds another ‘layer’ of CHX when ‘Hibisol’ rather than alcohol alone is used.

Hygienic hand disinfection tests in three laboratories

A comparative study was made in three laboratories of a test for hygienic hand disinfection. Staphylococcus aureus was applied to the finger-tips of a total of 74 volunteers (49 female and 25 male) and the effect of washing with three chlorhexidine preparations and one non-medicated soap was assessed after one and five applications. Fingertip inoculation is convenient and is a realistic representation of the in-use situation. Although significant differences were obtained between log 10 reductions in test organisms using the same formulation in different centres, and different periods in the same centre, the maximum differences after a single application of a preparation were small, e.g. between centres 0·39 and between periods in the same centre 0·55, and after multiple applications the maximum difference between centres was 0·42 and between periods in the same centre it was 0·51. The differences between preparations were similar in all centres. This test compares well with other similar tests and products can be placed in rank order of effectiveness. It is concluded that this test, if carried out under the controlled conditions described, is sufficiently reproducible between laboratories and repeatable within laboratories to be used as a standard test.

Hygienic hand disinfection: a comparative study with chlorhexidine detergents and soap

The efficacy of two chlorhexidine hand-wash detergents and liquid soap was compared in a laboratory trial using artificial contamination of fingers with Micrococcus and Serratia. Agents were assessed for both a rapid and sustained effect after a single contact, and for a cumulative persistent effect after multiple contact over four days. Disinfectant activities were compared by statistical analysis of log reduction factors and log count time gradients (decimal reduction times). The latter analysis attempted to accommodate significant subject variation in response to both agent and organism. All handwashing methods significantly reduced contamination levels. Both chlorhexidine formulations were significantly better than soap in their activity against Micrococcus, but were not more effective than soap in removing contamination with Serratia. Both chlorhexidine preparations showed significant skin persistence and were generally acceptable to subjects after prolonged use. Some effect of the formulation of the hand-wash on chlorhexidine activity was demonstrated.

Hand disinfection: a comparison of various agents in laboratory and ward studies

The efficacy of 14 hand washing or disinfectant preparations was compared in laboratory tests on staff volunteers. The test organism, Escherichia coli, was applied to the fingertips and log reductions (LR) were measured following treatment with the test agent and control preparations (70% isopropanol and non-medicated bar soap). Alcoholic preparations, particularly n-propanol and isopropanol were the most effective showing LRs of 3·1–3·8. Chlorhexidine (LR 2·9) and povidone-iodine detergent preparations were significantly more effective than non-medicated soap (LR 2·1), but triclosan products were not. In addition the residual effect of several of these formulations was assessed after 10 applications by comparing the survival of E. coli on the fingertips over a 32-min period. This number of handwashes compares favourably with those recorded during an 8 h nursing shift. Chlorhexidine-detergent consistently showed the best residual activity. Alcoholic formulations showed little or no residual effect. The survival studies show that on the whole gram-positive organisms ( Staphylococcus aureus and Candida albicans) survive better on the skin than Gram-negative bacilli (GNB). However, it would seem that GNB which are considered to be residents ( Acinetobacter calcoaceticus and Enterobacter spp.) survive much better than many other GNB ( Pseudomonas aeruginosa, E. coli and Proteus vulgaris). The Klebsiella species varied in survival times. Random sampling of ward staff hands showed that contamination with S. aureus and GNB was greater in dermatological and general wards than in an isolation unit, where handwashing or disinfection was carried out after every patient contact. No cross-infection occurred in the isolation ward during periods of study in which 70% alcohol, chlorhexidine-detergent and non-medicated soap were used.

Evaluation of the skin disinfecting activity and cumulative effect of chlorhexidine and triclosan handwash preparations on hands artificially contaminated with Serratia marcescens.

The initial and cumulative efficacy of two antiseptic handwash preparations in eliminating Serratia marcescens from hands was evaluated on volunteers. Two antiseptics with persistent skin antibacterial activity, 4% chlorhexidine gluconate in detergent and 1.5% triclosan in natural soap, were studied in a new protocol designed according to Food and Drug Administration guidelines. After a single handwash, both preparations exhibited a degerming action statistically superior to the mechanical elimination of the marker organism that was achieved by the nonmedicated controls. Following a further nine hand recontamination sequence with 10(9) colony-forming units (cfu)/mL S marcescens (mean predisinfection baseline, log10 6.6), the efficacy of chlorhexidine and triclosan was significantly augmented: the mean log10 reduction factors were 4.15 and 3.78, respectively. In the absence of internationally accepted testing standards for antiseptic handwash products, the significance of protocol variables is discussed. The advantages to preventative microbiology of antiseptics with persistent skin antibacterial activity are highlighted.

A comparison of triclosan and chlorhexidine preparations with 60 per cent isopropyl alcohol for hygienic hand disinfection

Four detergent preparations containing triclosan; two alcoholic products, containing triclosan and chlorhexidine respectively, and a detergent preparation containing chlorhexidine were compared with 60 per cent isopropyl alcohol following a single hand wash using Escherichia coli as the test organism. In vitro tests indicated that all had a high activity against hospital pathogens. The triclosan-containing preparations exhibited a significant residual activity. Experiments in volunteers showed that 0·5 per cent alcoholic triclosan was significantly more effective than all other preparations tested. All the detergent preparations had an effect similar to that of 60 per cent isopropyl alcohol. None of the seven products evaluated was significantly less bactericidal than 60 per cent isopropyl alcohol.