Decontamination Group Research Articles

Prevention of acquired invasive fungal infection with decontamination regimen in mechanically ventilated ICU patients: a pre/post observational study

Background Invasive fungal infections acquired in the intensive care unit (AFI) are life-threating complications of critical illness. However, there is no consensus on antifungal prophylaxis in this setting. Multiple site decontamination is a well-studied prophylaxis against bacterial and fungal infections. Data on the effect of decontamination regimens on AFI are lacking. We hypothesised that multiple site decontamination could decrease the rate of AFI in mechanically ventilated patients. Methods We conducted a pre/post observational study in 2 ICUs, on adult patients who required mechanical ventilation for >24 h. During the study period, multiple-site decontamination was added to standard of care. It consists of amphotericin B four times daily in the oropharynx and the gastric tube along with topical antibiotics, chlorhexidine body wash and nasal mupirocin. Results In 870 patients, there were 27 AFI in 26 patients. Aspergillosis accounted for 20/143 of ventilator-associated pneumonia and candidemia for 7/75 of ICU-acquired bloodstream infections. There were 3/308 (1%) patients with AFI in the decontamination group and 23/562 (4%) in the standard-care group (p = 0.011). In a propensity-score matched analysis, there were 3/308 (1%) and 16/308 (5%) AFI in the decontamination group and the standard-care group respectively (p = 0.004) (3/308 vs 11/308 ventilator-associated pulmonary aspergillosis, respectively [p = 0.055] and 0/308 vs 6/308 candidemia, respectively [p = 0.037]). Conclusion Acquired fungal infection is a rare event, but accounts for a large proportion of ICU-acquired infections. Our study showed a preventive effect of decontamination against acquired fungal infection, especially candidemia. Take home message Acquired fungal infection (AFI) incidence is close to 4% in mechanically ventilated patients without antifungal prophylaxis (3% for pulmonary aspergillosis and 1% for candidemia). Aspergillosis accounts for 14% of ventilator-associated pneumonia and candidemia for 9% of acquired bloodstream infections. Immunocompromised patients, those infected with SARS-COV 2 or influenza virus, males and patients admitted during the fall season are at higher risk of AFI. Mechanically ventilated patients receiving multiple site decontamination (MSD) have a lower risk of AFI.

Comparative evaluation of shear bond strength of different bonding system with effect of saliva contamination and decontamination. - An in vitro study

Introduction: This study aims for the bond strength measurement of two new self etch bonding agent and effect of salivary contamination and decontamination on the bonding agent strength. Materials and Methods:Premolar teeth, 60, removed during orthodontic treatment were collected and the buccal surfaces of the tooth were made to a plane dentinal surface. The randomly divided samples were distributed into three subgroups for OptibondAll in one kerr (BSA) and three subgroup for Single Bond Universal 3M (BSB) of 10 each. For optibond all in one (BSA), BSA-I Is the control group (self-etch bonding agent applied to flat dentine), BSA-II Is the contamination group (self-etch bonding agent applied, followed by saliva application and then dried with air), BSA-III Is the decontamination group (application of self-etch bonding agent, followed by contamination of saliva, dried with air and then reapplication of self-etch bonding agent). For Single Bond Universal 3M(BSB), BSB-I - The control group (self-etch bonding agent applied to flat dentine), BSB-II -The contamination group (self-etch bonding agent applied, followed by saliva application and then dried with air), BSB-III -The decontamination group (application of self-etch bonding agent, followed by contamination of saliva, dried with air and then reapplication of self-etch bonding agent). Followed by the bonding procedure, a 5mm composite block with bulkfill (ivoclar vivadent) was built on the flat dentine surface. Instron universal testing machine (USA) with a 1 mm per minute cross head speed was used to test the bonding strength. Data Obtained were subjected to statistical analysis by one way ANOVA test, and tukey’s multipe comparison and unpaired t-test for the inter group comparison. Result: In the Kerr group (BSA), the shear bond strength of the contamination sub-group (BSA-II) decreased to 5.57 ± 1.77 MPa, as opposed to 13.87 ± 2.12 MPa of control group (BSA-I) and 14.85 ± 2.25 MPa of BSA-III group, which was

Perioperative decontamination care bundle for prevention of nosocomial infection after cardiac surgery

Objective To observe the effect of the decontamination bundle of care for prevention of nosocomial infection after cardiac surgery. Methods Patients who underwent routine perioperative care from January 2012 to December 2013 for cardiac surgery were enrolled as the control group, while patients with bundle of care from May 2014 to April 2016 as the decontamination group. The care bundle included preoperative nasopharyngeal screening for methicillin-resistant Staphylococcus aureus (MRSA), perioperative systematic decontamination, isolation and antibiotic prophylaxis (mupirocin and glycopeptide) for MRSA carriers. The clinical data and nosocomial infection was collected and statistically analyzed. Results There were 712 cases in the control group and the incidence of nosocomial infection was 8.29% (59/712) including 4 MRSA cases. The decontamination group enrolled 791 cases with 5.56% (44/791) nosocomial infection including 2 MRSA cases. The bundles of care inhibited the nosocomial infection significantly (χ2=4.356, P<0.05), and there was a trend of decrease on MRSA infection. A total of 6 cases (0.76%) in the decontamination group were detected as MRSA colonization, but none of them got infected. Conclusions The care bundle of perioperative decontamination is useful to prevent nosocomial infection in cardiac surgery, especially to MRSA infection. Key words: Cardiac surgery; Bundles of care; Chlorhexidine; Nosocomial infection; Antibiotic prophylaxis

The influence of rifamycin decontamination on incorporation of autologous onlay bone grafts in rats: A histometric and immunohistochemical evaluation

ObjectiveAlthough it has been shown that rifamycin is an effective agent for bone graft decontamination, no information exists on the effects of rifamycin decontamination on bone graft incorporation. The aim of this study was to evaluate the influence of rifamycin decontamination on the incorporation of autologous onlay bone grafts quantitatively. DesignIn 30 rats, a standardized 5.0-mm-diameter bone graft was harvested from the right mandibular angle, contaminated with saliva, decontaminated with rifamycin solution, and augmented to the left as an onlay graft. Ten animals were sacrificed at 7, 14, and 21 days after surgery. In the control group (10 rats), the onlay grafts were neither contaminated nor decontaminated, and the rats were sacrificed at 21 days after surgery. Histological slides were prepared from each grafted site for both immunohistochemistry analysis (bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF) antibodies) and histometric analysis. Images obtained from the graft incorporation area with the light microscope were transferred to a PC, and they were evaluated using Clemex PE 3.5 image analysis software. ResultsThe grafts were fully incorporated in all specimens. The results showed that rifamycin decontamination has no detrimental effect on graft incorporation and the findings revealed a tendency for earlier revascularization and osteogenesis in the decontamination group. Data were analyzed using variance analysis and Tukey's test. ConclusionsRifamycin decontamination has no detrimental effect on autogenous graft incorporation, and it can be used for graft decontamination with confidence.

Methods of preventing bacterial sepsis and wound complications after liver transplantation.

Bacterial sepsis and wound complications after liver transplantation increase mortality, morbidity, or hospital stay and are likely to increase overall transplant costs. All liver transplantation patients receive antibiotic prophylaxis. This is an update of our 2008 Cochrane systematic review on the same topic in which we identified seven randomised clinical trials.To assess the benefits and harms of different methods aimed at preventing bacterial sepsis and wound complications in people undergoing liver transplantation.We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded to February 2013.We included only randomised clinical trials irrespective of language or publication status. We excluded quasi-randomised and other observational studies for assessment of benefits, but not for harms.Two review authors collected the data independently. We calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) using fixed-effect and the random-effects models based on available-case analysis.We identified only seven trials for inclusion, including 614 participants. Only one trial was of low risk of bias risk. Overall, the quality of evidence was very low. There were five comparisons in the seven trials: selective bowel decontamination versus inactive control; selective bowel decontamination versus prebiotics with probiotics; selective bowel decontamination versus prebiotics; prebiotics with probiotics versus prebiotics; and granulocyte-colony stimulating factor (G-CSF) versus control. Four trials compared selective bowel decontamination versus placebo or no treatment. In one trial, participants were randomised to selective bowel decontamination, active lactobacillus with fibres (probiotic with prebiotic), or to inactivated lactobacillus with fibres (prebiotic). In one trial, active lactobacillus with fibres (probiotic with prebiotic) was compared with inactive lactobacillus with fibres (prebiotic). In the remaining trial, different doses of G-CSF and placebo were compared. There was no trial comparing different antibiotic prophylactic regimens in people undergoing liver transplantation. Most trials included adults undergoing elective liver transplantation. There was no significant difference in proportion of people who died or required retransplantation between the intervention and control groups in any of the five comparison groups. MORTALITY There were no differences between 190 participants (three trials); 5/87 (adjusted proportion: 6.2%) in selective bowel decontamination group versus 7/103 (6.8%) in inactive control group; RR 0.91 (95% CI 0.31 to 2.72); 63 participants (one trial); 0/32 (0%) in selective bowel decontamination group versus 0/31 (0%) in prebiotics with probiotics group; RR - not estimable; 64 participants (one trial); 0/32 (0%) in selective bowel decontamination group versus 0/32 (0%) in prebiotics group; RR - not estimable; 129 participants (two trials); 0/64 (0%) in prebiotics with probiotics group versus 0/65 (0%) in prebiotics group; RR - not estimable; and 194 participants (one trial); 22/124 (17.7%) in G-CSF group versus 10/70 (14.3%) in placebo group; RR 1.24 (95% 0.62 to 2.47). RETRANSPLANTATION There were no differences between 132 participants (two trials); 4/58 (adjusted proportion: 6.9%) in selective bowel decontamination group versus 6/74 (8.1%) in inactive control group; RR 0.85 (95% CI 0.26 to 2.85); 63 participants (one trial); 1/32 (3.1%) in selective bowel decontamination group versus 0/31 (0%) in prebiotics with probiotics group; RR 2.91 (0.12 to 68.81); 64 participants (one trial); 1/32 (3.1%) in selective bowel decontamination group versus 0/32 (0%) in prebiotics group; RR 3.00 (95% CI 0.13 to 71.00); 129 participants (two trials); 0/64 (0%) in prebiotics with probiotics group versus 1/65 (1.5%) in prebiotics group; RR 0.33 (95% CI 0.01 to 7.9); and 194 participants (one trial); 10/124 (7.1%) in G-CSF group versus 5/70 (7.1%) in placebo group; RR 1.13 (95% CI 0.4 to 3.17).There was no significant difference in the graft rejections, intensive therapy unit stay, or hospital stay between the intervention and control groups in any of the comparisons. Overall, 193/611 participants (31.6%) developed infective complications. The proportion of people who developed infective complications and the number of infective complication episodes were significantly higher in the selective bowel decontamination group than in the prebiotics with probiotics group (1 study; 63 participants; 15/32 (46.9%) in selective bowel decontamination group versus 4/31 (12.9%) in prebiotics with probiotics group; RR 3.63; 95% CI 1.36 to 9.74 and 23/32 participants (0.72 infective complications per participant) in selective bowel decontamination group versus 4/31 participants (0.13 infective complications per participant) in prebiotics with probiotics group; rate ratio 5.58; 95% CI 1.94 to 16.09). There was no significant difference between the proportion of participants who developed infection and the number of infection episodes between the intervention group and control group in any of the other comparisons.No trials reported quality of life and overall serious adverse events.Currently, there is no clear evidence for any intervention offering significant benefits in the reduction of bacterial infections and wound complications in liver transplantation. Selective bowel decontamination may even increase the rate of infections compared with prebiotics with probiotics. The confidence intervals were wide and further randomised clinical trials of low risk of bias are necessary.

Planning, implementation and evaluation of an emergency exercise at the Paul Scherrer Institute

Abstract Like all nuclear power plants in Switzerland, the Paul Scherrer Institute in Villigen (PSI), Switzerland, has the duty to conduct an emergency exercise every year. The two monitoring authorities ENSI (Swiss Federal Nuclear Safety Inspectorate) and the BAG (Federal Office of Public Health – FOPH) use this exercise for their yearly audit of the emergency organization. The emergency organization of the Paul Scherrer Institute consists of the emergency staff, the fire brigade, the first aid station, the traffic- and the security platoon and the radiation safety, the latter consisting of the decontamination group, the radio analytics group and the measurement group (for radioactivity dispersion calculations). The framework is set up by the ENSI beforehand, based on a fixed cycle. For the emergency exercise of 2009 a plane crashing into the interim storage facility of the federal government (BZL) at PSI was assumed. This contribution describes the approach of the planning process, the performance and the evaluation of the exercise.

Effects of saliva contamination and decontamination procedures on shear bond strength of self-etch dentine bonding systems: An in vitro study

Objective:This study aims to evaluate the effect of saliva contamination on the shear bond strength of two self-etch dentine bonding systems and also investigate the effect of decontamination procedure on the recovery of bond strength.Materials and Methods:Sixty premolars extracted for orthodontic reason were obtained and the buccal surfaces of teeth were reduced to create a flat dentine surface. The samples were randomly divided into three sub-groups for AdheSE (ASE) (Ivoclar – Vivadent, Schaan, Liechtenstein) and three sub-groups for Adper Prompt Self-Etch Adhesive (ADP) (3M ESPE, St Paul, MN, USA) of 10 each. For AdheSE (ASE); ASE-I was the control group (primer applied to fresh dentine surface), ASE-II was the contamination group (primer applied, followed by saliva contamination and then air dried) and ASE-III was the decontamination group (primer applied, followed by saliva contamination, air dried and then primer reapplied). For Adper Prompt (ADP); ADP-I was the control group (self-etch adhesive applied to fresh dentine surface), ADP-II was the contamination group (self-etch adhesive applied, followed by saliva contamination and then air dried) and ADP-III was the decontamination group (self-etch adhesive applied, followed by saliva contamination, air dried and then self-etch adhesive reapplied). Followed by the bonding procedure, a 5 mm composite resin block with Filtek P-60 (3M ESPE, St Paul, MN, USA) was built on the substrate. Shear bond strength (SBS) was tested with Instron Universal testing machine (Instron Corporation, Canton, MA, USA) with a cross head speed of 1 mm per minute. Data obtained was subjected to one way ANOVA test, while the inter group comparison was made using Tukey’s multiple comparison and Unpaired t-test.Results:In AdhSE group (ASE), the sub-group ASE-II (contamination group) [5.4 ± 2.2 MPa] showed lower SBS than ASE-I [11.8 ± 2.6 MPa] and ASE-III [8.9 ± 3.3 MPa], which was statistically significant. There was no significant difference in the bond strength between the ASE-I (control group) and ASE-III (decontamination group). In Adper Prompt group (ADP), there was a severe decrease of bond strength in ADP-II (contamination group) [4.6 ± 1.1 MPa] when compared to ADP-I (control group) [7.4 ± 1.4 MPa] and ADP-III (decontamination subgroup) [14.1 ± 2.2 MPa] which was statistically significant. The bond strength of ADP-III wherein Adper Prompt bonding agent was reapplied after salivary contamination was found to be statistically significant than ADP-I and ADP-II.Conclusion:Saliva contamination reduces the dentine bond strength of both the self-etch systems; AdheSE and Adper Prompt. Re-application of the primer for the AdheSE and re-application of the adhesive for the Adper Prompt after air drying the saliva off can recover the dentine bond strength. In the Adper Prompt group, the added application of adhesives to decontaminate saliva not only recovered the bond strength but also improved it significantly.

Gingival and plaque decontamination: Can we take a bite out of VAP?

Expanded AbstractCitationFourrier F, Dubois D, Pronnier P, Herbecq P, Leroy O, Desmettre T, Pottier-Cau E, Boutigny H, Di Pompeo C, Durocher A, Roussel-Delvallez M: Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med 2005, 33:1728–1735 [1].BackgroundPoor oral hygiene and colonization of dental plaque is likely to play an important role in the development of ventilator-associated pneumonia (VAP) in many critically ill patients. Preliminary observations have suggested that dental plaque antiseptic decontamination (PAD) may reduce the frequency of VAP and ICU acquired bacteremia.MethodsDesign and settingProspective, multi-center, double-blind, placebo-controlled trial in six French ICUs.ObjectiveTo document the effect of gingival and dental plaque antiseptic decontamination on the rate of nosocomial bacteremias and respiratory infections acquired in the ICU.Patients and intervention228 non-edentulous patients requiring endotracheal intubation and mechanical ventilation with an anticipated ICU length of stay > 5 days were randomized to receive 0.2% chlorhexidine gel or placebo applied to dental and gingival surfaces three times daily for the duration of their ICU stay until day 28.OutcomesThe primary end point was the composite incidence of bacteremia, bronchitis and VAP acquired in the ICU. Secondary endpoints included ICU mortality, length of stay and medical and nursing care loads. Changes in bacterial colonization were evaluated in a subset of randomized patients.ResultsAll baseline characteristics were similar between the treated and the placebo groups. The trial was stopped based on an interim analysis showing statistical futility. The incidence of nosocomial infections was 17.5% (13.2 per 1000 ICU days) in the placebo group and 18.4% (13.3 per 1000 ICU days) in the plaque antiseptic decontamination group (p = NS). No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days, mortality, length of stay, and care loads. On day 10, the number of positive dental plaque cultures was significantly lower in the treated group (29% vs. 66%; p < 0.05). Highly resistant Pseudomonas, Acinetobacter, and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination. No side effect was reported.ConclusionGingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients. However, its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria.

Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: A double-blind placebo-controlled multicenter study*

To document the effect of gingival and dental plaque antiseptic decontamination on the rate of nosocomial bacteremias and respiratory infections acquired in the intensive care unit (ICU). Prospective, multicenter, double-blind, placebo-controlled efficacy study. Six ICUs: three in university hospitals and three in general hospitals. A total of 228 nonedentulous patients requiring endotracheal intubation and mechanical ventilation, with an anticipated length of stay > or =5 days. Antiseptic decontamination of gingival and dental plaque with a 0.2% chlorhexidine gel or a placebo gel, three times a day, during the entire ICU stay. Demographic and clinical characteristics, organ function data (Logistic Organ Dysfunction score), severity of condition (Simplified Acute Physiologic Score), and dental plaque status were assessed at baseline and until 28 days. Bacteriologic sampling of dental plaque and saliva was done every 5 days, and blood, tracheal aspirate, and bronchoalveolar lavage cultures were performed when appropriate. The primary efficacy end point was the incidence of bacteremia, bronchitis, and ventilator-associated pneumonia, expressed as a percentage and per 1000 ICU days. All baseline characteristics were similar between the treated and the placebo groups. The incidence of nosocomial infections was 17.5% (13.2 per 1000 ICU days) in the placebo group and 18.4% (13.3 per 1000 ICU days) in the plaque antiseptic decontamination group (not significant). No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days, mortality, length of stay, and care loads (secondary end points). On day 10, the number of positive dental plaque cultures was significantly lower in the treated group (29% vs. 66%; p < .05). Highly resistant Pseudomonas, Acinetobacter, and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination. No side effect was reported. Gingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients. However, its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria.

Pilot Trial of Selective Decontamination for Prevention of Bacterial Infection in an Intensive Care Unit

Selective decontamination of the oropharynx and gastrointestinal tract with nonabsorbable antimicrobials and sucralfate, a stress ulcer prophylactic that maintains the normal gastric acid bacterial barrier, were compared for prevention of pneumonia in a cardiac surgery intensive care unit. Over 8 months, 51 patients received selective decontamination and 56 received sucralfate. The selective decontamination regimen included polymyxin, gentamicin, and nystatin given as an oral paste and as a solution; patients also received standard antacid or histamine2 blocker stress ulcer prophylaxis. Patients in the selective decontamination group had significantly less colonization of the oropharynx and stomach by gram-negative bacilli (12% vs. 55%, P less than .001), significantly fewer infections due to gram-negative bacilli (6% vs. 20%, P = .02), and fewer infections overall (12% vs. 27%, P = .04). There was one episode of pneumonia in the selective decontamination group and five in the sucralfate group. Mortality and length of stay did not differ between the groups, but those receiving selective decontamination had less than one-third as many days of systemic antibiotic therapy with no increase in colonization or infection with resistant gram-negative bacilli. Thus, selective decontamination appeared to reduce both extrapulmonary and pulmonary infections.