Topical Antiseptic Agents Research Articles

Boric acid- could it be a potential topical antiseptic agent?

Boric acid- could it be a potential topical antiseptic agent?

Dequalinium for bacterial vaginosis

Bacterial vaginosis is an infection characterised by overgrowth of anaerobic bacteria in the vagina with an accompanying loss of lactobacilli, and is thought to be the most common cause of...

MRSA decolonisation using polyhexanide 0.1 % with application where necessary of systemic antibiotics

SummaryBackground: Increasing infections and drug resistances lead to new treatment concepts in terms of MRSA decolonisation. An antibiotic-free decolonisation treatment with topical antiseptics is of great clinical interest. We investigated the effectiveness of MRSA decolonisation therapy using the topical antiseptic agent polyhexanide 0.1 %. If needed, a systemic antibiotic was added in case of hospitalisation, abscess formation, chronic wounds and others.Patients and methods: 63 patients were introduced to our outpatient clinic within a period of record of 15 months. 42 (66.7 %) of them were confirmed MRSA-positive and 27 (64.3 %) of these colonised patients were included to the protocol of decolonisation. Patients who followed the protocol of decolonisation (n=27) were investigated in terms of the site of MRSA-colonisation, parameters that minimize the effect of decolonisation, spa types as well as the effectiveness of the topical antiseptic agent polyhexanide 0.1 %.Results: 22 patients (81.5 %) were successfully decolonised within the group that followed the decolonisation protocol (n=27). Using polyhexanide 0.1 % as single treatment regime seven people (31.8 %) were successfully decolonised, whereas 15 patients (68.2 %) were in need of an additional systemic treatment with antibiotics in order to be decolonised. The implementation of one topical eradication cycle with polyhexanide 0.1 % was effective in case of an exclusive colonisation of the nose (n=3). At maximum, three decolonisation runs were necessary. Within six months of post-eradication investigations no relapses of MRSA were registered.Conclusions: One third of the decolonised patients were successfully treated with the topical antiseptic polyhexanide 0.1 %, whereas two thirds of the patients that followed the decolonisation protocol were in need of an additional systemic antibiotic.

The Role of Topical Antiseptic Agents Within Antimicrobial Stewardship Strategies for Prevention and Treatment of Surgical Site and Chronic Open Wound Infection.

Scope and Significance: The topical use of antiseptics for wound care has a role in an antimicrobial stewardship strategy. However, the details of this role need clarification. Further clinical research into the use of topical antiseptics in wound care would lower the risk of furthering antibiotic resistance and contribute to more effective antibiotic use. As part of this research, experimental and surveillance data are needed on the resistance and tolerance patterns associated with topical antiseptic use in wound infections. Objective: The development of antibiotic resistance presents global challenges in terms of patient harm and increased healthcare costs. The treatment of "at risk" and infected wounds contributes to this conundrum. Synergies between antibiotics and antiseptics and their appropriate combined use need exploration. Approach: A review of available evidence on the appropriateness of antiseptics as a fundamental component of antimicrobial stewardship strategies has been undertaken. Innovation: Opening up new ways of thinking and identifying gaps of knowledge will lead to optimizing justification of antimicrobial choices and combinations. This may lead to changes in practice in terms of solutions for the prevention and treatment of wound infection. Conclusion: Antiseptics are an integral part of antimicrobial stewardship strategies for the prevention and treatment of surgical site and chronic open wound infections.

Topical Antimicrobials and the Open Surgical Wound.

Topical antiseptic and antibiotic agents have been used for the prevention of surgical site infections since Joseph Lister's original research on this subject. Although these agents are used extensively in clinical practice, evidence to support the use of topical antimicrobial agents remains limited. The world literature on the use of antiseptic and antibiotic agents was evaluated to determine the current status of evidence to support the use of topical antimicrobial agents in the prevention of surgical site infections. Although several techniques of using topical antibiotic solutions, powders, antibiotic gauzes, and beads have some evidence for validation, there are equal numbers of reports that have failed to show benefit. There is little evidence to support the use of antiseptic solutions in the prevention of infections at the surgical site. Additional clinical trials are necessary to provide evidence to support any of the methods for using topical antimicrobial agents to present surgical site infections. Dilute antiseptic agents should be considered in future trials when antimicrobial activity can be identified without local toxicity.

Antimicrobial Formulation and Delivery in the Prevention of Surgical Site Infection.

A number of adjunct antimicrobial measures have been studied in an attempt to reduce surgical site infection (SSI) rates. In addition to parenteral antibiotic prophylaxis, these measures include oral antibiotics in bowel preparation for colorectal surgery, antiseptic/antimicrobial irrigation, antimicrobial sutures, local antibiotics, skin incision antibacterial sealants, and antimicrobial dressings. It is the purpose of this review to study the evidence behind each of these measures and to evaluate relevant data for recommendations in each area. A systematic review of the literature through PubMed was performed. Need for adequate dosing and re-dosing of intravenous peri-operative antibiotics, duration of antibiotic usage past wound closure, and the use of antibiotic bowel preparation in colorectal surgery are well defined in the published literature. However, data on local antimicrobial measures remain controversial. Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable.

Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review.

Infants in the neonatal intensive care unit are highly susceptible to healthcare associated infections (HAI), with a substantial impact on mortality, morbidity and healthcare costs. Effective skin disinfection with topical antiseptic agents is an important intervention in the prevention or reduction of HAI. A wide array of antiseptic preparations in varying concentrations and combinations has been used in neonatal units worldwide. In this article we have reviewed the current evidence of a preferred antiseptic of choice over other agents for topical skin disinfection in neonates. Chlorhexidine (CHG) appears to be a promising antiseptic agent; however there exists a significant concern regarding the safety of all agents used including CHG especially in preterm and very low birth weight infants. There is substantial evidence to support the use of CHG for umbilical cord cleansing and some evidence to support the use of topical emollients in reducing the mortality in infants born in developing countries. Well-designed large multicentre randomized clinical trials are urgently needed to guide us on the most appropriate and safe antiseptic to use in neonates undergoing intensive care, especially preterm infants.

Antiseptic Body Washes for Reducing the Transmission of Methicillin-Resistant Staphylococcus aureus: A Cluster Crossover Study.

Background. Limiting the spread of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities where the organism is highly endemic is a challenge. The use of topical antiseptic agents may help interrupt the transmission of MRSA and reduce the risk of clinical infection. Octenidine dihydrochloride is a topical antiseptic that exhibits in vitro efficacy against a wide variety of bacteria, including S aureus. Methods. We conducted a prospective cluster crossover study to compare the use of daily octenidine body washes with soap and water in patients identified by active surveillance cultures to be MRSA-colonized, to prevent the acquisition of MRSA in patients with negative screening swabs. Five adult medical and surgical wards and 2 intensive care units were selected. The study involved an initial 6-month phase using octenidine or soap washes followed by a crossover in each ward to the alternative product. The primary and secondary outcomes were the rates of new MRSA acquisitions and MRSA clinical infections, respectively. Results. A total of 10 936 patients admitted for ≥48 hours was included in the analysis. There was a small reduction in MRSA acquisition in the intervention group compared with controls (3.0% vs 3.3%), but this reduction was not significant (odds ratio, 0.89; 95% confidence interval, .72-1.11; P = .31). There were also no significant differences in clinical MRSA infection or incidence of MRSA bacteremia. Conclusions. This study suggests that the targeted use of routine antiseptic washes may not in itself be adequate to reduce the transmission of MRSA in an endemic hospital setting.

Chlorhexidine skin or cord care for prevention of mortality and infections in neonates.

Affordable, feasible and efficacious interventions to reduce neonatal infections and improve neonatal survival are needed. Chlorhexidine, a broad spectrum topical antiseptic agent, is active against aerobic and anaerobic organisms and reduces neonatal bacterial colonisation and may reduce infection. To evaluate the efficacy of neonatal skin or cord care with chlorhexidine versus routine care or no treatment for prevention of infections in late preterm or term newborn infants in hospital and community settings. We searched CENTRAL, latest issue of The Cochrane Library, MEDLINE (1966 to November 2013), EMBASE (1980 to November 2013), and CINAHL (1982 to November 2013). Ongoing trials were detected by searching the following databases: www.clinicaltrials.gov and www.controlled-trials.com. Cluster and individual patient randomised controlled trials of chlorhexidine use (for skin care, or cord care, or both) in term or late preterm neonates in hospital and community settings were eligible for inclusion. Three authors independently screened and selected studies for inclusion. Two review authors independently extracted data, and assessed study risk of bias. The quality of evidence for each outcome was assessed using GRADE. We calculated pooled risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs), and presented results using GRADE 'Summary of findings' tables. We included 12 trials in this review. There were seven hospital-based and five community-based studies. In four studies maternal vaginal wash with chlorhexidine was done in addition to neonatal skin and cord care. Newborn skin or cord cleansing with chlorhexidine compared to usual care in hospitalsLow-quality evidence from one trial showed that chlorhexidine cord cleansing compared to dry cord care may lead to no difference in neonatal mortality (RR 0.11, 95% CI 0.01 to 2.04). Moderate-quality evidence from two trials showed that chlorhexidine cord cleansing compared to dry cord care probably reduces the risk of omphalitis/infections (RR 0.48, 95% CI 0.28 to 0.84).Low-quality evidence from two trials showed that chlorhexidine skin cleansing compared to dry cord care may lead to no difference in omphalitis/infections (RR 0.88, 95% CI 0.56 to 1.39). None of the studies in this comparison reported effects of the treatments on neonatal mortality. Newborn skin or cord cleansing with chlorhexidine compared to usual care in the communityHigh-quality evidence from three trials showed that chlorhexidine cord cleansing compared to dry cord care reduces neonatal mortality (RR 0.81, 95% CI 0.71 to 0.92) and omphalitis/infections (RR 0.48, 95% CI 0.40 to 0.57).High-quality evidence from one trial showed no difference between chlorhexidine skin cleansing and usual skin care on neonatal mortality (RR 1.03, 95% CI 0.87 to 1.23). None of the studies in this comparison reported effects of the treatments on omphalitis/infections. Maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention (sterile saline solution) in hospitalsModerate-quality evidence from one trial showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on neonatal mortality (RR 0.98, 95% CI 0.67 to 1.42). High-quality evidence from two trials showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on the risk of infections (RR 0.93, 95% CI 0.82 to 1.16).Findings from one trial showed that maternal vaginal cleansing in addition to total body cleansing results in increased risk of hypothermia (RR 1.33, 95% CI 1.19 to 1.49). Maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention (sterile saline solution) in the communityLow-quality evidence from one trial showed no difference between maternal vaginal chlorhexidine in addition to total body cleansing and no intervention on neonatal mortality (RR 0.20, 95% CI 0.01 to 4.03). Moderate-quality evidence from one trial showed that maternal vaginal chlorhexidine in addition to total body cleansing compared to no intervention probably reduces the risk of neonatal infections (RR 0.69, 95% CI 0.49 to 0.95). These studies did not report effect on omphalitis. There is some uncertainty as to the effect of chlorhexidine applied to the umbilical cords of newborns in hospital settings on neonatal mortality. The quality of evidence for the effects on infection are moderate for cord application and low for application to skin. There is high-quality evidence that chlorhexidine skin or cord care in the community setting results in a 50% reduction in the incidence of omphalitis and a 12% reduction in neonatal mortality. Maternal vaginal chlorhexidine compared to usual care probably leads to no difference in neonatal mortality in hospital settings. Maternal vaginal chlorhexidine compared to usual care results in no difference in the risk of infections in hospital settings. The uncertainty over the effect of maternal vaginal chlorhexidine on mortality outcomes reflects small sample sizes and low event rates in the community settings.

English

One of the serious and growing challenges for infection control programs worldwide is hospital acquired infections. Klebsiella pneumoniae is considered the second most common cause of hospital-acquired Gram-negative blood stream infections. Chlorhexidine is a topical antiseptic agent, widely used in different applications in hospitals. Healthcare associated infection rates were lower after chlorhexidine-containing detergent hand washing when compared with using plain soap or an alcohol-based hand rinse. Intensive exposure of hospital pathogens to biocides may result in the emergence of resistance not just to the biocides but also to antibiotics. We aimed to investigate the susceptibility of multi-drug resistant K. pneumoniae isolates to chlorhexidine and to correlate chlorhexidine susceptibility and its association with both the efflux pump genes (cepA, qacDE, qacE), and resistance to later-generation anti-Gram negative antibiotics. Fifty-six strains of K. pneumoniae were isolated from blood specimens in intensive care units, Suez Canal University Hospital, Ismailia, Egypt. Antibiotic sensitivity profiles were determined by disc diffusion method. Minimal inhibitory concentration (MICs) of 1% chlorhexidine was assessed by the agar dilution method. The effect of efflux pumps was determined by repeating the susceptibility in the presence of the efflux pump inhibitor carbonyl cyanide m-chlorophenyl hydrazone (CCCP) (10 mg/L). Polymerase chain reaction (PCR) was used for identifying efflux pump genes. The MICs of chlorhexidine ranged from 4 - 256 mg/L. Most isolates carried the cepA gene. The MICs of chlorhexidine was significantly reduced on addition of CCCP. Carriage of efflux pump gene cepA affect chlorhexidine susceptibility in ICU related K. pneumoniae infections.   Key words: Klebsiella pneumoniae, chlorhexidine, efflux pump, ICU.

Topical continuous use of Lippia sidoides Cham. essential oil induces cutaneous inflammatory response, but does not delay wound healing process

Ethnopharmacological relevanceThe essential oil of Lippia sidoides (EOLS) has been used in Brazilian folk medicine as a topical antiseptic agent in skin for treatment of wounds and superficial infections of the body. The aim of this study was to investigate the effects of EOLS on intact and damaged skin, including its action on expression of mediators, COX-2 and VEGF, involved in healing full-thickness cutaneous lesions in vivo. Material and methodsEOLS was analyzed chemically and used at different concentrations to dose-response experiments in skin mice. Skin irritation tests by one-dosage and multiple-dosages and irritation to damaged skin were assessed by macroscopy, morphometry and histological and immunohistochemical analyses. To evaluate the effects of EOLS on wound healing, excision wounds were surgically created on the dorsum of rats, and the ointments at 6% and 12% were applied daily to the wound area. Cutaneous lesions were assessed by planimetric (wound contraction) and macroscopic parameters. ResultsSkin irritation tests showed that topical application of EOLS promoted cutaneous inflammation in varying degrees, which was demonstrated by increase of skin thickness and formation of cutaneous edema and erythema. Topical administration of EOLS in high concentrations presented an irritant response to skin, but this irritation is lighter when low concentrations this oil were used. Histological evaluation supported the outcome of these models, which revealed accentuated presence of inflammatory cells infiltration. In wound healing process, the lesions treated with EOLS showed intense edema and exsudation up to day 5, but there were not significant differences in the wound contraction on days 14 and 21. No immunohistochemical staining was verified to COX-2 and VEGF mediators in skin treated with EOLS 12%. ConclusionThe continuous application of EOLS in adequate concentrations on cutaneous wounds increases inflammatory response without delay the lesions closure. The association of these results with antimicrobial action previously related to EOLS allows its indication as an alternative therapeutic modality for topical treatment of infected cutaneous wound. Nevertheless, further studies need to be performed to determine the mechanism of action and support its application in clinical practice.

Topische Therapie von Infektionen, Hauttumoren und Hyperkeratosen

In this review substances for the topical treatment of skin infections, skin tumors and hyperkeratotic disorders are presented. Substances with specific actions as topical antimycotic, antibiotic, antiseptic, antiviral and antiparasitic agents as well as diclofenac in hyaluronic acid, 5-fluoruracil, imiquimod, ingenol mebutate, bexarotene, mechlorethamine, BCNU, alitretinoin, silicone gel, salicylic acid and urea are discussed with respect to their mode of action, indication and side effects.

Sodium hypochlorite-induced acute kidney injury

Sodium hypochlorite (bleach) is commonly used as an irrigant during dental procedures as well as a topical antiseptic agent. Although it is generally safe when applied topically, reports of accidental injection of sodium hypochlorite into tissue have been reported. Local necrosis, pain and nerve damage have been described as a result of exposure, but sodium hypo-chlorite has never been implicated as a cause of an acute kidney injury (AKI). In this report, we describe the first case of accidental sodium hypochlorite injection into the infraorbital tissue during a dental procedure that precipitated the AKI. We speculate that oxidative species induced by sodium hypochlorite caused AKI secondary to the renal tubular injury, causing mild acute tubular necrosis.

An audit on the documentation of the interpretation of chest radiographs following thoracic surgery

s / International Journal of Surgery 11 (2013) 589e685 614 ABSTRACTS Conclusions: Whilst discharge documentation has improved, significant deviation from local guidelines remains and is principally due to use of antiplatelet therapy after mitral repair. 0941: AN AUDIT ON THE DOCUMENTATION OF THE INTERPRETATION OF CHEST RADIOGRAPHS FOLLOWING THORACIC SURGERY Daron Nazari , Kapil Sugand , Martin Yates , Ian Hunt . 1 St George's University of London, London, UK; 2 Imperial College London, London, UK. Aims: All patients undergoing thoracic surgery at our institution undergo post-operative and post-drain removal chest radiographs (CXR). General Medical Council (GMC) Good Medical Practice guidelines state that the interpretation of all investigations should be documented by the requesting physician. The aim of this audit was to assess compliance with GMC standards. Methods: A prospective audit was carried out of all patients who underwent thoracic surgery between 1st November and 7th December 2012. Quality of documentation within the patient record was assessed by a single investigator for both the post-operative and the post-drain removal CXR's. For each CXR, basic demographics (date, patient details and physician identification) and the presence or absence of post-operative pulmonary complications were assessed. Results: During the period of study 63 patients underwent thoracic surgery. 49(78%) patients had documentation of post-operative and 46(73%) post-drain removal CXRs. However, more detailed clinical information was included in only 9(14%) and 12(19%) of records respectively. Conclusions: There is a suboptimal level of documentation of routine CXRs post-thoracic surgery. Improvement, therefore, is crucial in recording the presence or absence of radiographic post-operative complications in patient records. A pro forma for CXR documentation has been introduced and re-audit is currently in progress. 0982: THE EUROSCORE II IS A BETTER PREDICTOR OF MORTALITY THAN LOGISTIC EUROSCORE FOR PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION Ashok Kar, Daniel Moffat, Simon Kennon, Anne Malecki, Wael Awad. London Chest Hospital, London, UK. Objectives: Patient selection for transcatheter aortic valve implantation (TAVI) is critical because of proven efficacy for conventional aortic valve surgery (AVR). Currently available risk scoring systems are known to be inadequate; logistic Euroscore (LES) over predicts mortality for AVR. This study compared predictive ability of the new EuroSCORE II (ES2) with LES in patients undergoing TAVI. Methods: All patients undergoing TAVI (January 2009 September 2012) were identified from our registers. LES and ES2 scores were calculated and predicted mortalities for the 2 scoring systems compared with that observed. Results: 124 patients underwent TAVI: 3 cases were excluded due to insufficient data. Mean age of patients (n1⁄4121) was 81.9 years (75 e 91). Mean predicted LES was 21.6 12.6 compared to 7.7 6.2 for ES2; paired student t-test showed ES2 to be significantly lower (p 60kg. This may contribute to longer hospital admissions and more patients being discharged in AF. Other cardiac units should be encouraged to audit local practice and initiate change to guidelines. 1225: PRE-OPERATIVE TOPICAL ANTISEPTICS AND POST-OPERATIVE INFECTION RATES IN CARDIOTHORACIC SURGERY: META-ANALYSES OF PROSPECTIVE STUDIES Sudeep Das De. University of Cambridge, Cambridge, UK. Aim: To investigate the role of routine pre-operative topical antiseptic agents in cardiothoracic surgery. Background: Staphylococcus aureus is a major cause of post-operative infection after open-heart surgery, with the patient's endogenous flora as the principal source. However the routine use of pre-operative topical antiseptics in all cardiothoracic patients has not been established. In a meta-analysis, we quantitatively assessed the associations reported in prospective studies of routine use of preoperative topical antiseptics. Methods and Results: Studies were identified by computer-assisted searches of the published literature and scanning of relevant reference lists. The following was abstracted: size and type of cohort, mean age, mean duration of follow-up, and the relative risk ratio of developing a post-operative infection when using topical antiseptic agents. There were 5 studies reporting the use of pre-operative chlorhexidine and 4 studies on topical mupirocin. The combined relative risk ratio of developing a postoperative infection when using topical chlorhexidine versus the control armwas 0.47 (CI 0.39-0.63, p<0.05). The combined relative risk ratio when using topical mupirocin of developing an infection was 0.43 (CI 0.32-0.72, p<0.05). Conclusion: Published prospective studies provide good evidence to support the routine use of preoperative topical antiseptic agents.

Management of non‐healable or maintenance wounds with topical povidone iodine

Although complete healing may appear to be the logical goal for most patients and clinicians, some wounds do not have the potential to heal due to a number of factors such as inadequate vasculature, coexisting medical conditions and medications that prohibit the healing process. Local management of wounds that are considered to have poor potential for healing remains elusive. The purpose of this article is to review the evidence that supports the use of topical antiseptic agents in non-healable wounds. Retrospective chart audit was conducted to evaluate the use of povidone iodine in the management of wounds that were deemed to have poor healing potential.

Reduced susceptibility to chlorhexidine in staphylococci: is it increasing and does it matter?

Antiseptic agents are increasingly used for hand hygiene and skin decolonization as key tools for the prevention of healthcare-associated infections. Chlorhexidine, a divalent, cationic biguanide, has a broad spectrum of activity and is one of the most frequently used topical antiseptic agents. Notably, there are an increasing number of prevalence studies that report reduced levels of susceptibility to chlorhexidine. In contrast to bacterial resistance to antibiotics, using parameters such as the MIC to define resistance to antiseptics, including chlorhexidine, is not straightforward. A range of methods have been used for the detection of reduced susceptibility to chlorhexidine, but, importantly, there is no standardized method and no consensus on the definition of chlorhexidine 'resistance'. In this review we have assessed the methods available for the detection of reduced susceptibility to chlorhexidine and the prevalence of coresistance to other antimicrobial agents. We have focused on the development of reduced susceptibility to chlorhexidine and the presence of efflux-mediated resistance genes in staphylococci, and have reviewed the clinical significance of this phenomenon. Lastly, we have identified unanswered questions to further our understanding of this emergent threat. We anticipate that clinical use of chlorhexidine will continue to increase, and it will be important to be alert to the possibility that this may lead to the emergence of new clones with reduced susceptibility. Indiscriminate chlorhexidine use in the absence of efficacy data should be discouraged.

Cerium nitrate treatment prevents progressive tissue necrosis in the zone of stasis following burn

Cerium nitrate (CN) was used as a topical antiseptic agent for the treatment of burn wounds and found to reduce the number of anticipated death in burn. This decreased burn related mortality cannot be explained by the control of wound infection alone. In the studies performed to elucidate the unexplained effects of CN treatment, it was shown that CN treatment reduced the alarm cytokine levels, decreased leukocyte activation, reduced macromolecular leakage and finally burn edema formation. We hypothesized that CN treatment prevents the conversion of the zone of stasis to progressive tissue necrosis by decreasing leukocyte activation and reducing macromolecular leakage and burn edema.This was investigated on a well-described burn comb model in the rats. Fifty-four rats were randomly divided into control and CN treatment groups. Each rat in CN treatment group received 0.04M CN bathing 30min after burn whereas rats in control group received 0.09% saline bathing. Viability of zone of stasis is assessed with 99mTc-sestamibi scintigraphy. Nine rats in each group were scintigraphically evaluated at the 3rd and 7th day after burn and remaining 9 rats had macroscopic and histological examination at the 21st day after burn to confirm the scintigraphic results.In CN treatment groups, the scintigraphic uptake ratios were higher both at post burn day 3rd and 7th when compared to that of control groups. This was statistically significant (p≤0.05). In the CN treatment group, the results of the average percentage of the re-epithelialization in the zone of stasis were higher than that of control groups. The difference between the groups was also statistically significant (p≤0.05).These results were accepted that CN treatment prevents progressive tissue necrosis in the zone of stasis. This study further elucidates the unexplained effects of CN treatment on burn.

Contact dermatitis presenting as non-healing wound: case report

Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies.

Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units

IntroductionGiven the high morbidity and mortality attributable to ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, prevention plays a key role in the management of patients undergoing mechanical ventilation. One of the candidate preventive interventions is the selective decontamination of the digestive or respiratory tract (SDRD) by topical antiseptic or antimicrobial agents. We performed a meta-analysis to investigate the effect of topical digestive or respiratory tract decontamination with antiseptics or antibiotics in the prevention of VAP, of mortality and of all ICU-acquired infections in mechanically ventilated ICU patients.MethodsA meta-analysis of randomised controlled trials was performed. The U.S. National Library of Medicine's MEDLINE database, Embase, and Cochrane Library computerized bibliographic databases, and reference lists of selected studies were used. Selection criteria for inclusion were: randomised controlled trials (RCTs); primary studies; examining the reduction of VAP and/or mortality and/or all ICU-acquired infections in ICU patients by prophylactic use of one or more of following topical treatments: 1) oropharyngeal decontamination using antiseptics or antibiotics, 2) gastrointestinal tract decontamination using antibiotics, 3) oropharyngeal plus gastrointestinal tract decontamination using antibiotics and 4) respiratory tract decontamination using antibiotics; reported enough data to estimate the odds ratio (OR) or risk ratio (RR) and their variance; English language; published through June 2010.ResultsA total of 28 articles met all inclusion criteria and were included in the meta-analysis. The overall estimate of efficacy of topical SDRD in the prevention of VAP was 27% (95% CI of efficacy = 16% to 37%) for antiseptics and 36% (95% CI of efficacy = 18% to 50%) for antibiotics, whereas in none of the meta-analyses conducted on mortality was a significant effect found. The effect of topical SDRD in the prevention of all ICU-acquired infections was statistically significant (efficacy = 29%; 95% CI of efficacy = 14% to 41%) for antibiotics whereas the use of antiseptics did not show a significant beneficial effect.ConclusionsTopical SDRD using antiseptics or antimicrobial agents is effective in reducing the frequency of VAP in ICU. Unlike antiseptics, the use of topical antibiotics seems to be effective also in preventing all ICU-acquired infections, while the effectiveness on mortality of these two approaches needs to be investigated in further research.

Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone–iodine in clean-contaminated surgery

Surgical-site infection increases morbidity, mortality and financial burden. The preferred topical antiseptic agent (chlorhexidine or povidone-iodine) for preoperative skin cleansing is unclear. A meta-analysis of clinical trials was conducted to determine whether preoperative antisepsis with chlorhexidine or povidone-iodine reduced surgical-site infection in clean-contaminated surgery. The systematic review identified six eligible studies, containing 5031 patients. Chlorhexidine reduced postoperative surgical-site infection compared with povidone-iodine (pooled odds ratio 0.68, 95 per cent confidence interval 0.50 to 0.94; P = 0.019) . Chlorhexidine should be used preferentially for preoperative antisepsis in clean-contaminated surgery.