povidone-iodine and Bacteremia

The aim of this study is to review the current evidence-based data regarding strategies for prevention of central venous catheter (CVC) infections at the time of catheter insertion and as a part of routine care.. We conducted a PubMed search from January 1990 to November 2010 using the following keywords: central venous catheter, clinical trials, pediatric, infection, prevention, antibiotic, chlorhexidine, dressing, antiseptic impregnated catheters, ethanol lock, impregnated cuff, insertion site infection, and Cochrane systematic review. Seven questions, selected by the American Pediatric Surgical Association Outcomes and Clinical Trials Committee, were addressed.. Thirty-six studies were selected for detailed review based on the strength of their study design and relevance to our 7 questions. These studies provide evidence that (1) chlorhexidine skin prep and chlorhexidine-impregnated dressing can decrease CVC colonization and bloodstream infection, (2) use of heparin and antibiotic-impregnated CVCs can decrease CVC colonization and bloodstream infection, and (3) ethanol and vancomycin lock therapy can reduce the incidence of catheter-associated bloodstream infections.. Grade A and B recommendations can be made based on available evidence in adult and limited pediatric studies for multiple components of proper CVC insertion practices and subsequent management. These strategies can minimize the risk of CVC infections in pediatric patients.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteremia; Bandages; Case-Control Studies; Catheter-Related Infections; Catheterization, Central Venous; Chlorhexidine; Coated Materials, Biocompatible; Disinfection; Equipment Contamination; Ethanol; Evidence-Based Medicine; Heparin; Humans; Meta-Analysis as Topic; Organ Specificity; Povidone-Iodine; Practice Guidelines as Topic; Randomized Controlled Trials as Topic

Central venous catheters (CVC) continue to play a prominent role in haemodialysis vascular access with 46% to 70% of patients commencing haemodialysis via a CVC. CVC access is associated with catheter-related infections, increased patient hospitalisations and death due to infection. A variety of interventions are used to prevent CVC infection.. To evaluate the benefits and harms of prophylactic topical antimicrobials, topical antiseptics, medicated and non-medicated dressings on infectious complications among haemodialysis patients with CVC.. We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles without language restriction.. We included randomised controlled trials (RCTs) and quasi-RCTs investigating any intervention that prevented infectious complications among haemodialysis patients with CVC. We excluded antimicrobial impregnated CVC or CVC using locking solutions with antimicrobial properties.. Two authors assessed study quality and extracted data. Dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI) and continuous outcomes as mean differences (MD).. Ten studies (786 patients) were included. Mupirocin ointment reduced the risk of catheter-related bacteraemia (RR 0.17, 95%CI 0.07 to 0.43) and had a significant effect on catheter-related infections caused by S. aureus. The risk of catheter-related bacteraemia was reduced by polysporin (RR 0.40, 95%CI 0.19 to 0.86) and povidone-iodine ointment (RR 0.10, 95%CI 0.01 to 0.72). Subgroup analysis suggested mupirocin (RR 0.12, 95%CI 0.01 to 2.13) and povidone-iodine ointment (RR 0.84, 95%CI 0.24 to 2.98) had no effect on all-cause mortality while polysporin ointment showed a significant reduction (RR 0.22, 95%CI 0.07 to 0.74). Mortality related to infection was not reduced by mupirocin, polysporin or povidone-iodine ointment. Topical honey did not reduce the risk of exit site infection (RR 0.45, 95%CI 0.10 to 2.11) or catheter-related bacteraemia (RR 0.80, 95%CI 0.37 to 1.73). Transparent polyurethane dressing compared to dry gauze dressing did not reduce the risk of CVC or exit site infection, or catheter-related bacteraemia.. Mupirocin ointment appears effective in reducing the risk of catheter-related bacteraemia. Insufficient reporting on mupirocin resistance was noted and needs to be considered in future studies. A lack of high quality data on the routine use of povidone-iodine ointment, polysporin ointment and topical honey warrant larger RCTs. Insufficient data were available to determine which dressing type (transparent polyurethane or dry gauze dressing) has the lowest risk of catheter-related infections.

Topics: Apitherapy; Bacitracin; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Drug Combinations; Gramicidin; Humans; Mupirocin; Polymyxin B; Povidone-Iodine; Randomized Controlled Trials as Topic; Renal Dialysis; Staphylococcal Infections

Patient care in hospitals often involves insertion of a non-tunneled central venous catheter for administering drugs, intravenous solutions, or total parenteral nutrition. Every change of dressing must be carried out in an appropriate fashion in order to reduce the risk of bacterial infection. We reviewed the existent literature in order to make a listof recommended disinfectants, type of dressings and intervals between dressing changes of a central venous catheter. A comparison was drawn between the guidelines of the Centers for Disease Control and Prevention (CDC) and the Robert Koch-Institut (RKI) issued in 2002 with those more recently published. Our search showed that chlorhexidine gluconate (from 0.5 to 2 percent), povidone-iodine (from 5 to 10 percent) or alcohol (70 percent) are the recommended disinfecting agents. The recommended dressing is gauze or transparent steam-permeable polyurethane dressings. Intervals between dressing changes varied between once a day and once in seven days, depending on the nature of the dressing applied.

Topics: 2-Propanol; Bacteremia; Bacterial Infections; Bandages; Catheterization, Central Venous; Chlorhexidine; Cross Infection; Disinfectants; Humans; Occlusive Dressings; Povidone-Iodine; Practice Guidelines as Topic

This review article addresses the effects of povidone-iodine (PVP-I) and its utility in the treatment of periodontal diseases. There are data to support the following statements: PVP-I is a potent antiseptic and, when used as a component in a rinse with H202, the rinse can decrease the level of gingivitis. With regards to patients with adult periodontitis, there is some evidence to indicate that PVP-I delivered via an ultrasonic device achieves better results in deep pockets than ultrasonic debridement when water is the irrigant. The benefits of PVP-I in the treatment of refractory periodontitis are unclear. Subgingival irrigation with PVP-I may reduce the incidence of bacteremia if it is employed as a pre-procedural intrasulcular irrigant; however, this technique is not recommended for high-risk patients. PVP-I is a safe antiseptic and does not appear to impede wound healing or induce resistant bacteria. It is an approved drug whose intraoral use is an unlabeled indication. In conclusion, the literature suggests that utilization of PVP-I is potentially beneficial in the management of some periodontal diseases. However, additional clinical trials are needed to verify this assessment, since it is based upon a limited number of studies.

Topics: Anti-Infective Agents, Local; Bacteremia; Bacteria; Drug Labeling; Gingivitis; Humans; Mouthwashes; Periodontitis; Povidone-Iodine; Therapeutic Irrigation

Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in its occurrence.. Specimens were collected at the site of implantation for culture from the skin and the pocket before and after insertion in a consecutive series of patients who underwent elective permanent pacemaker implantation. Microorganisms isolated both at the time of insertion and of any potentially infective complication were compared by using conventional speciation and ribotyping. There were 103 patients (67 men and 36 women) whose age ranged from 16 to 93 years (mean+/-SD, 67+/-15). At the time of pacemaker implantation, a total of 267 isolates were identified. The majority (85%) were staphylococci. During a mean follow-up of 16.5 months (range, 1 to 24), infection occurred in four patients (3.9%). In two of them, an isolate of Staphylococcus schleiferi was recognized by molecular method as identical to the one previously found in the pacemaker pocket. In one patient, Staphylococcus aureus, an organism that was absent at the time of pacemaker insertion, was isolated. In another patient, a Staphylococcus epidermidis was identified both at the time of pacemaker insertion and when erosion occurred; however, their antibiotic resistance profiles were different.. This study strongly supports the hypothesis that pacemaker-related infections are mainly due to local contamination during implantation. S schleiferi appears to play an underestimated role in infectious colonization of implanted biomaterials and should be regarded as an important opportunistic pathogen.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Axilla; Bacteremia; Baths; Disinfection; Equipment Contamination; Female; France; Humans; Male; Middle Aged; Opportunistic Infections; Pacemaker, Artificial; Povidone-Iodine; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Thorax

Topics: Administration, Topical; Anti-Bacterial Agents; Bacteremia; Chlorhexidine; Dentistry, Operative; Endocarditis, Bacterial; Humans; Iodine; Povidone-Iodine; Premedication; Sodium Chloride

Sixty-nine consecutive pulmonary artery catheters (PACs) were prospectively studied in a medical-surgical intensive care unit. Fifteen (21.7 percent) and two (2.9 percent) of the PACs were associated with colonization and bacteremia, respectively. These data represent an incidence of 4.98 and 0.66 episodes per 100 catheterization-days, respectively. Coagulase-negative staphylococci were the most common isolates. The source of the colonizing microorganism was the skin in 56 percent of cases, hubs in 28 percent, and unknown in 16 percent. From multivariate analysis, only more than 5 days of catheterization was significantly associated with a greater risk of colonization. Antimicrobial use was associated with negative cultures. The most useful method to diagnose colonization was the examination of both tip and intradermal segments. In addition, we suggest associate hub cultures when catheter-related bacteremia is suspected. These data may be useful in improving efficacy in the diagnosis and prevention of PAC-related infection.

Topics: Bacteremia; Bacterial Infections; Bloodletting; Catheterization; Equipment Contamination; Female; Gram-Negative Bacteria; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Povidone-Iodine; Prospective Studies; Pulmonary Artery; Risk Factors; Skin; Spain; Staphylococcus; Time Factors

To perform a cost-effectiveness analysis of skin antiseptic solutions (chlorhexidine-alcohol (CHG) versus povidone iodine-alcohol solution (PVI)) for the prevention of intravascular-catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) in France based on an open-label, multicentre, randomised, controlled trial (CLEAN).. A 100-day time semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN database. This model includes eight health states and probabilistic sensitivity analyses on cost and effectiveness were performed. Costs of intensive care unit stay are based on a French multicentre study and the cost-effectiveness criterion is the cost per patient with catheter-related bloodstream infection avoided.. 2,349 patients (age≥18 years) were analyzed to compare the 1-time CHG group (CHG-T1, 588 patients), the 4-time CHG group (CHG-T4, 580 patients), the 1-time PVI group (PVI-T1, 587 patients), and the 4-time PVI group (PVI-T4, 594 patients).. 2% chlorhexidine-70% isopropyl alcohol (chlorhexidine-alcohol) compared to 5% povidone iodine-69% ethanol (povidone iodine-alcohol).. The mean cost per alive, discharged or dead patient was of €23,798 (95% confidence interval: €20,584; €34,331), €21,822 (€18,635; €29,701), €24,874 (€21,011; €31,678), and €24,201 (€20,507; €29,136) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. The mean number of patients with CRBSI per 1000 patients was of 3.49 (0.42; 12.57), 6.82 (1.86; 17.38), 26.04 (14.64; 42.58), and 23.05 (12.32; 39.09) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. In comparison to the 1-time PVI solution, the 1-time CHG solution avoids 22.55 CRBSI /1,000 patients, and saves €1,076 per patient. This saving is not statistically significant at a 0.05 level because of the overlap of 95% confidence intervals for mean costs per patient in each group. Conversely, the difference in effectiveness between the CHG-T1 solution and the PVI-T1 solution is statistically significant.. The CHG-T1 solution is more effective at the same cost than the PVI-T1 solution. CHG-T1, CHG-T4 and PVI-T4 solutions are statistically comparable for cost and effectiveness. This study is based on the data from the RCT from 11 French intensive care units registered with www.clinicaltrials.gov (NCT01629550).

Topics: 2-Propanol; Alcohols; Bacteremia; Catheter-Related Infections; Chlorhexidine; Cost-Benefit Analysis; Ethanol; Female; France; Fungemia; Humans; Intensive Care Units; Length of Stay; Male; Models, Economic; Povidone-Iodine; Treatment Outcome

To assess the effect of concomitant subgingival rinsing with 10% PVP-iodine during subgingival instrumentation on the prevalence and magnitude of bacteraemia of oral origin.. Subgingival instrumentation was performed with water or PVP-iodine rinse in patients with periodontitis. Prior to instrumentation, subjects gargled for 1 min with the allocated liquid. Pockets were then rinsed for 1 min and subgingivally instrumented with liquid-cooled (water/PVP-iodine) ultrasonic scalers (1 min). Two minutes later, a blood sample from the arm vein was drawn using a lysis centrifugation blood culture system for quantitative microbiological analysis. Non-parametric statistical tests were performed to assess differences in the prevalence and extent of bacteraemia between groups.. Of the 19 samples in each group, oral-borne bacteraemia was detected in 10 of the control and 2 of the test samples. With an average of 3.0 [1; 5] colony forming units, significantly less bacteria and bacteraemia were found in the test group compared to the controls (12.2 [1; 46]) (p = 0.003). Anaerobic bacteria were not found in the test group.. Bacteraemia after subgingival instrumentation with concomitant PVP-iodine rinsing is reduced but not eliminated. Therefore, it might be recommended for patients at a high risk of endocarditis or infection of endoprostheses. However, preventive antibiotic treatment should not be omitted.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Bacteremia; Bacterial Load; Cross-Over Studies; Dental Scaling; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Mouth; Mouthwashes; Periodontal Attachment Loss; Periodontal Debridement; Periodontal Pocket; Periodontitis; Placebos; Povidone-Iodine; Ultrasonic Therapy

To evaluate the preventive effects of topical skin disinfection with chlorhexidine on bloodstream infection (BSI) associated with totally implantable venous port (Port-A).. Two consecutive cohorts of solid cancer patients were prospectively followed for the occurrence of Port-A associated BSI (PABSI). The first cohort used povidone-iodine as topical skin disinfection and the second cohort used chlorhexidine. The primary endpoint was the time to first PABSI. Propensity score analysis was applied. The preventive effects of chlorhexidine were analyzed by Cox proportional hazards models.. There were 396 patients (81,752 catheter-days) in the iodine cohort and 497 (99,977 catheter-days) in the chlorhexidine cohort. Gram-negative bacteria were the most common pathogens to cause first episode of PABSI (iodine cohort (I) vs chlorhexidine cohort (C) and 0.404 vs 0.450 per 1,000 catheter-day), followed by Gram-positive bacteria (I vs C and 0.269 vs 0.110 per 1,000 catheter-day), and fungi (I vs C and 0.098 vs 0.070 per 1,000 catheter-day). Three hundred forty-three patients were selected from each cohort by propensity score match analysis. Chlorhexidine use was associated with a significant improvement on time to first PABSI caused by Gram-positive bacteria (log-rank test, p=0.00175; HR=0.35, 95 % CI, 0.14-0.85, p=0.02). No significant preventive effects of chlorhexidine on time to first PABSI caused by Gram-negative bacteria or fungi was found.. Chlorhexidine topical skin disinfection may prevent PABSI caused by Gram-positive bacteria in patients with solid cancers. The nonsignificant effect on preventing overall PABSI may be attributed to the high incidence of Gram-negative bacteria related PABSI.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasms; Povidone-Iodine; Young Adult

Intravenous catheters have become one of the essential tools of modern medicine. Preventive measures taken while the catheter is being inserted or in place can provide a significant reduction in catheter-related infections and bacteremia/sepsis.This study aims to evaluate whether the patient's age and gender, the presence of malignancy and coexisting diseases, catheter duration, use of total parenteral nutrition solution, blood products, and antibiotics as well as antiseptics applied while attaching the central venous catheter (chlorhexidine and povidone-iodine) affect the development of catheter colonization and catheter-related bloodstream infections in patients with central venous catheters.. Our study includes 50 cases which were admitted to İzmir Atatürk Training and Research Hospital, I. Surgical Clinic, hospitalized due to various reasons between the dates of January‒December 2010 and required catheter use. Patients were randomly assigned to one of the two operating rooms, in one of which the insertion site was disinfected with Poviiodeks® (10 % povidone-iodine) while in the other, (latter) Savlosol® (15 % cetrimide, 1.5 % Chlorhexidine-gluconate, ethanol) was used.. Among many factors examined in our study, only the use of clorhexidine versus iodine povidon in skin antisepsis was found to be statistically significant in the reduction of CRBSI and CC (for CRBSI p=0.022 and for CC p=0.047).. Our study concludes that skin antisepsis is the only determining factor in the prevention of blood infection and colonization due to central venous catheter application and the use of clorhexidine vs. povidon is proven to be statistically significant (Tab. 1, Ref. 27).

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Chlorhexidine; Female; Humans; Male; Middle Aged; Povidone-Iodine; Young Adult

The aim of this pilot study was to evaluate the effects of mouthrinses containing 7.5% povidone iodine and 0.2% chlorhexidine on bacteraemia following impacted third molar surgery.. Thirty-four patients were enrolled in this study. Patients in the first group were asked to rinse their mouth with the mouthrinse containing 7.5% povidone iodine, patients in the second group were asked to rinse with the mouthrinse containing 0.2% chlorhexidine and patients in the third group were asked to rinse with 0.9% NaCl (sterile saline) solution. All rinses were used for one minute preoperatively. Peripheral venous blood samples were collected at baseline (preoperatively), 1 and 15 minutes after the completion of surgical tooth removal. Each blood sample was divided in two, placed in aerobic and anaerobic culture bottles and processed for microbiological examination.. Bactaeremia was detected in 33% of the povidone iodine group, 33% of the chlorhexidine group and 50% of the control group. Isolated bacteria were 58% anaerobes and predominantly 92%Streptococcus species. Incidence of bacteraemia was reduced with chlorhexidine and povidone iodine mouthrinses in third molar surgery, although the difference was not statistically significant (p > 0.05).. Bacteraemia was reduced with antibacterial mouthrinses in third molar surgery. The results of this study should be confirmed with further studies conducted on a larger patient population and with different antibacterial mouthrinses.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Bacteria, Anaerobic; Chlorhexidine; Female; Humans; Male; Middle Aged; Molar, Third; Mouthwashes; Pilot Projects; Povidone-Iodine; Preoperative Care; Streptococcus; Tooth Extraction; Tooth, Impacted; Young Adult

To determine the efficacy of rectum sterilization before TRUS guided prostate biopsy in order to decrease bacteremia rate and sepsis complication.. From August 2008 to March 2009, 100 volunteers who had an indication for prostate biopsy were recruited into the present study in a randomized controlled trial. The present study was approved by the Ethics Committee on Human Experimentation of Ramathibodi Hospital Faculty of Medicine, Mahidol University. The volunteers received unison enema one day before and Ciprofloxacin 500 mg 0.5-1 hr before the procedure. These 100 volunteers were divided into two groups; 50 were randomly assigned in the group of rectum cleaning with 10% povidone-iodine, whereas the other 50 volunteers were placed in the control group. Twelve cores of TRUS guided prostate biopsy were performed After the procedure, peripheral blood samples were taken for cultures for aerobic and anaerobic bacteria. A clinical follow-up at 48-72 hrs after the procedure was done via telephone.. Hemocultures were positive for 9 cases in the rectum cleaning group and 2 cases in the control group (p = 0.025). Three volunteers (one in the rectum cleaning group and two in the control group) had a postoperative fever but it spontaneously resolved. Two volunteers in the control group came back to the hospital because of urinary tract infections and rectal bleeding. None of the volunteers had clinical sepsis or went to other hospitals.. Sterilization of the rectum before TRUS guided prostate biopsy was found to reduce postoperative bacteremia and might reduce clinical infections.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteremia; Biopsy; Ciprofloxacin; Enema; Humans; Male; Middle Aged; Postoperative Complications; Povidone-Iodine; Prostate; Prostatectomy; Rectum; Sterilization; Thailand

To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).. Prospective, randomized controlled trial.. Intensive care unit in a teaching hospital.. Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.. A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1% vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.. The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.

Topics: Adult; Aged; Anti-Infective Agents, Local; Antisepsis; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Cross Infection; Equipment Contamination; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Hospitals, Teaching; Humans; Incidence; Intensive Care Units; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Sepsis; Treatment Outcome

To investigate rinsing with povidone-iodine on bacteraemia caused by ultrasonic scaling.. Sixty patients with gingivitis undertook a randomized, placebo-controlled trial in which 30 rinsed with 0.9% saline and 30 with 7.5% povidone-iodine for 2 min. before ultrasonic scaling of FDI teeth 31-35. Blood samples before and after 30 s and 2 min. of scaling were cultured by lysocentrifugation.. Oral bacteraemia occurred in 33.3% of the saline group and 10% of the povidone-iodine group. Regression analysis showed that rinsing with povidone-iodine was approximately 80% more effective than rinsing with saline in reducing the occurrence of bacteraemia, with a statistically significant odds ratio (OR) of 0.189 (95% confidence intervals, OR=0.043-0.827). There were 24 oral bacterial isolates in the saline group and 3 in the povidone-iodine group. Viridans streptococci comprised 11 of the isolates in the saline group and none in the povidone-iodine group. Bacteraemia magnitude was 0.1 colony-forming units/ml in the povidone-iodine subjects and 0.1-0.7 CFU/ml in the saline group.. Rinsing with 7.5% povidone-iodine reduced the incidence and magnitude of bacteraemia and eliminated viridans streptococci from such bacteraemia. Povidone-iodine rinsing may be helpful for ultrasonic scaling of gingivitis patients at risk of infective endocarditis.

Topics: Adult; Anti-Infective Agents, Local; Bacteremia; Dental Plaque Index; Dental Prophylaxis; Dental Scaling; Female; Gingivitis; Humans; Male; Middle Aged; Mouthwashes; Povidone-Iodine; Statistics, Nonparametric; Treatment Outcome

A meta-analysis and cost-effectiveness analysis of randomized controlled trials comparing chlorhexidine gluconate with povidone-iodine solutions for venous catheter site care found that the use of chlorhexidine gluconate significantly reduced the risk for catheter-related bloodstream infections and that it was cost-effective. The objective of the study was to implement locally formulated chlorhexidine gluconate for central venous catheter (CVC) site care in intensive care units (ICUs) at Siriraj Hospital.. The study was conducted in 312 subjects who needed CVC insertions in 3 ICUs from January to July 2006. One hundred twenty subjects received 2% chlorhexidine gluconate in 70% alcohol, whereas 192 subjects received 10% povidone-iodine as the antiseptic solution for CVC site care. The patients were assessed for CVC-related infections and for any adverse effects of 2% chlorhexidine gluconate in 70% alcohol.. The incidence of CRBSIs in the indwelling CVC subjects who received 2% chlorhexidine gluconate in 70% alcohol was less than those who received 10% povidone-iodine during the same period, 3.2 versus 5.6 episodes per 1000 CVC days, respectively (P= .06; OR, 3.26; 95% CI: 0.97-10.92). No adverse effects related to using 2% chlorhexidine gluconate in 70% alcohol were observed.. The locally formulated 2% chlorhexidine gluconate in 70% alcohol was safe, effective, and efficient for CVC site care in ICUs at Siriraj Hospital.

Topics: Academic Medical Centers; Anti-Infective Agents, Local; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Cross Infection; Female; Humans; Infection Control; Intensive Care Units; Male; Povidone-Iodine; Practice Guidelines as Topic; Prospective Studies; Thailand

Povidone-iodine ointment and gauze covered by transparent dressings were compared with transparent dressings alone in historical controls (both changed twice weekly) in neurosurgical patients needing catheter placement for prolonged periods. Colonization and bloodstream infection were both reduced with the new method (P < .01 and P = .062, respectively).

Topics: Aged; Bacteremia; Bandages; Catheterization, Central Venous; Colony Count, Microbial; Critical Care; Cross Infection; Equipment Contamination; Humans; Middle Aged; Neurosurgery; Ointments; Povidone-Iodine; Risk Factors; Survival Analysis; Treatment Outcome

Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI).. A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting. Six level III neonatal intensive care units. Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours.. Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source.. Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the antimicrobial dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5-0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5-2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8-1.5) did not differ between the 2 groups. Localized contact dermatitis from the antimicrobial dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing

Topics: Administration, Cutaneous; Administration, Topical; Bacteremia; Bacterial Infections; Bandages; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Disinfection; Equipment Contamination; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Povidone-Iodine; Treatment Outcome

A multicenter prospective, randomized, controlled trial, with 0.5% tincture of chlorhexidene versus 10% povidone-iodine as cutaneous antisepsis for central venous catheter (CVC) insertion, was conducted for patients in intensive care units. Of 374 patients, 242 had a CVC inserted for >3 days and were used for the primary analysis. Outcomes included catheter-related bacteremia, significant catheter colonization (> or = 15 colony-forming units [cfu]), exit-site infection, serial quantitative exit-site culture (every 72 h), and molecular subtyping of all isolates. Patients in both study groups were comparable with respect to age, sex, underlying disease, length of hospitalization, reason for line insertion, and baseline APACHE II score. Documented catheter-related bacteremia rates were 4.6 cases per 1000 catheter-days in the chlorhexidine group (n=125) and 4.1 cases per 1000 catheter-days in the povidone-iodine group (n=117; not significant [NS]). Significant catheter-tip colonization occurred in 24 (27%) of 88 patients in the povidone-iodine group and in 31 (34%) of 92 patients in the chlorhexidine group (NS). A mean exit-site colony count of 5.9 x 10(5) cfu/mL per 25 cm(2) of the surface area of skin in the povidone-iodine group versus 3.1 x 10(5) cfu/mL per 25 cm(2) in the chlorhexidine group (NS) was found. There was a trend toward fewer exit-site infections in the chlorhexidine group (0 of 125 patients) versus those in the povidone-iodine group (4 of 117 patients; P=.053). Results of an intention-to-treat analysis were unchanged from the primary analysis. No difference was demonstrable between 0.5% tincture of chlorhexidine and 10% povidone-iodine when used for cutaneous antisepsis for CVC insertion in patients in the intensive care unit.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacteremia; Catheterization, Central Venous; Chlorhexidine; Critical Care; Female; Humans; Male; Middle Aged; Povidone-Iodine; Prospective Studies

It is well known that the occurrence of bacteremia after dental procedures can place certain patients at risk for bacterial endocarditis. The authors compared the efficacy of two antiseptic agents in the prevention of post-treatment bacteremia in 120 dental patients. Before treatment, dentists irrigated the gingival sulcus of each patient with 10 percent povidone-iodine, 0.2 percent chlorhexidine or sterile water. The authors report lower levels of bacteremia among patients treated with the povidone-iodine solution.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacteremia; Chlorhexidine; Dental Care; Endocarditis, Bacterial; Female; Gingiva; Humans; Male; Middle Aged; Povidone-Iodine; Single-Blind Method; Streptococcal Infections; Therapeutic Irrigation

The purpose of the study was to compare the efficacy of 10% povidone-iodine with that of 0.5% chlorhexidine gluconate in 70% isopropyl alcohol for the prevention of peripheral intravenous catheter colonization in neonates. This was a multicenter, nonrandomized prospective study in a tertiary neonatal intensive care setting in which povidone-iodine and chlorhexidine gluconate were each used as antiseptic skin preparations over sequential 6-month periods. During the first 6 months of the study when povidone-iodine was in use 9.3% (38 of 408) of catheters were colonized. During the second 6 months of the study when chlorhexidine gluconate was in use, catheter colonization occurred in 4.7% (20 of 418, P = 0.01). Catheter-related bacteremia occurred during only 0.2% (2 of 826) of all catheterizations. Heavy skin colonization before catheter insertion (relative risk, 3.6; 95% confidence interval, 1.9, 7.0), catheterization > or = 72 hours (relative risk. 2.0; 95% confidence interval, 1.01, 3.8) and gestational age < or = 32 weeks (relative risk, 1.8; 95% confidence interval, 1.02, 3.3) increased colonization risk. Ampicillin infusion (relative risk, 0.4; 95% confidence interval, 0.2, 0.7) and 0.5% chlorhexidine gluconate cutaneous antisepsis (relative risk, 0.4; 95% confidence interval, 0.2, 0.8) were factors associated with decreased colonization risk. We conclude that 0.5% chlorhexidine gluconate in 70% isopropyl alcohol appears to be more efficacious than 10% povidone-iodine for the prevention of peripheral intravenous catheter colonization in neonates.

Topics: Analysis of Variance; Anti-Infective Agents, Local; Antisepsis; Bacteremia; Bacteria; Catheterization, Peripheral; Chlorhexidine; Colony Count, Microbial; Equipment Contamination; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Logistic Models; Male; Povidone-Iodine; Prospective Studies; Risk Factors; Treatment Outcome

Catheter related sepsis, especially with staphylococci, is one of the most important complications of haemodialysis or peritoneal dialysis. In a prospective, randomized, open study of 129 haemodialysis patients, exit site infection and bacteraemia were significantly greater in the untreated group (18.2% each) than the group treated with povidone-iodine (PVP-I) ointment (4.8% each), P < 0.02. In nasal carriers of S. aureus, PVP-I resulted in 100% risk reduction of bacteraemia and exit site infection (P < 0.05) and 70% risk reduction of catheter tip infections (P < 0.05). Preliminary results of an on-going randomized study in patients on intermittent peritoneal dialysis suggest, in the 69 patients so far studied, a reduced S. aureus infection rate in patients who received PVP-I ointment at the catheter exit site (2.9%) compared with the untreated group (8.8%) despite a higher nasal carriage rate in the PVP-I group. Statistical significance has not been demonstrated for these interim results and the study is continuing.

Topics: Bacteremia; Bacterial Infections; Catheters, Indwelling; Equipment Contamination; Humans; Peritoneal Dialysis; Povidone-Iodine; Prospective Studies; Renal Dialysis; Staphylococcal Infections

We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, prospective observational study of 249 consecutive patients aged ≥ 20 years proceeded in the ED of a university hospital in Japan during 6 months. Pairs of blood samples were collected for aerobic and anaerobic culture from all patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. We found 50 (20.1%) patients with potentially contaminated blood cultures. Fifty-six (22.5%) patients were true bacteremia and 143 (57.4%) patients were true negatives. Multivariate analysis associated more frequent contamination when puncture sites were disinfected with povidone-iodine than with alcohol/chlorhexidine (adjusted risk difference, 12.9%; 95% confidence interval [CI] 8.8-16.9; P < 0.001). Sites of blood collection were also associated with contamination. Femoral and central venous with other sites were associated with contamination more frequently than venous sites (adjusted risk difference), 13.1% (95% CI 8.2-17.9; P < 0.001]) vs. 17.3% (95% CI 3.6-31.0; P = 0.013). Rates of contaminated blood cultures were significantly higher when blood was collected from femoral sites and when povidone-iodine was the topical antiseptic.

Topics: Aged; Aged, 80 and over; Bacteremia; Blood Culture; Blood Specimen Collection; Chlorhexidine; Diabetes Complications; Diabetes Mellitus; Disinfectants; Emergency Service, Hospital; Ethanol; False Positive Reactions; Female; Femoral Vein; Hospitals, University; Humans; Hypertension; Japan; Male; Middle Aged; Neoplasms; Povidone-Iodine; Prospective Studies

The usefulness of povidone-iodine as an alternative to antimicrobial agents, for endophthalmitis, has recently been documented. We report a case of endogenous endophthalmitis successfully treated with intravitreal injection of povidone-iodine.. An 88-year-old woman underwent small bowel bypass surgery for postoperative ileus following rectal cancer resection. She developed a fever during total parenteral nutrition and was diagnosed with gram-positive cocci bacteremia of central venous catheter origin. The patient was referred to our department with chief complaints of ocular pain, hyperemia and decreased vision in the right eye, which had manifested during the febrile period. The initial examination revealed the visual acuity in her right eye to be finger counting and that in her left eye 0.2. The right eye showed a severe inflammatory reaction in the anterior chamber, fibrin deposition, and hypopyon. The fundus was difficult to visualize. Endogenous endophthalmitis due to bacteria was diagnosed. Surgical treatment was judged to be difficult based on the patient's poor general condition and mental status, and intravitreal injection of 0.1 ml of 1.25% povidone-iodine was performed on the same day. The inflammation rapidly diminished, and the hypopyon had disappeared 4 days after treatment. The fundus became visible 7 days after treatment and there was no recurrence of endophthalmitis findings. The visual acuity in her right eye recovered to that in the left eye (0.2).. Intravitreal injection of povidone-iodine is potentially useful and effective as an alternative treatment of antibiotics for endogenous endophthalmitis patients, especially in whom surgical therapy is difficult.

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Bacteremia; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Visual Acuity

Central venous (CV) catheters are required for chemotherapy but they may become a source of life-threatening infections of the bloodstream. The most effective way to disinfect the port of a CV catheter has not been established.. We report the data obtained between April 2008 and March 2010 using 83% ethanol (period I) and between April 2010 and March 2014 using 10% povidone-iodine (period II) to sterilize the access port. The participants received chemotherapy or autologous/allogeneic stem cell transplantation at the present institution.. No significant difference was observed in patient characteristics between the two periods, such as disease, median age, or the period of neutropenia. The incidence of positive blood culture during periods I and II was 18.5% (31/168) and 11.4% (40/350; P = 0.041), respectively. The incidence of catheter-associated bloodstream infection on blood culture during periods I and II was 11.9% (20/168) and 6.3% (22/350; P = 0.043), respectively. Bacillus cereus infection was not detected during period II.. The incidence of infection caused by CV catheters was significantly reduced using povidone-iodine; therefore, we recommend this procedure as part of the routine in chemotherapy.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Bacteremia; Blood Culture; Catheter-Related Infections; Catheterization, Central Venous; Child; Child, Preschool; Ethanol; Febrile Neutropenia; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Povidone-Iodine; Retrospective Studies; Sterilization; Young Adult

In Japan, blood cultures for children are performed by pediatric residents, and povidone-iodine (PI) is the recommended solution for skin preparation. Given that PI needs to be applied for 1.5-2 min before venipuncture, skin preparation may be suboptimal if this is not followed. In this study, we investigated the blood culture contamination rate after skin preparation with only 70% isopropyl alcohol (IPA) or IPA plus PI.. We performed a retrospective study of patients aged ≤6 years who provided blood cultures in the emergency department or pediatric ward. Patients with indwelling central venous catheter were excluded. We evaluated the impact of changing the method of skin preparation, comparing the traditional method using IPA plus PI between 2008 and 2010 (IPA + PI group) with the simplified method using only IPA between 2015 and 2017 (IPA group).. A total of 5,365 blood culture samples were eligible for this study. Of these, 171 (3.2%) had an organism identified in blood culture. Of the blood culture-positive samples, 68 (1.3%) were true positive and 103 (1.9%) were contaminated. Thirty-eight (1.6%) of 2,407 cultures in the IPA group were contaminated, whereas 65 (2.2%) of 2,958 cultures in the IPA + PI group were contaminated (OR, 0.72; 95%CI: 0.48-1.07; P = 0.1). Coagulase-negative Staphylococcus grew significantly less in the IPA group (1.7% vs 1.0%, P = 0.02).. A single application of 70% IPA may be the optimal skin preparation method for obtaining peripheral blood cultures from children in Japan.

Topics: 2-Propanol; Anti-Infective Agents, Local; Antisepsis; Bacteremia; Blood Culture; Child; Child, Preschool; Cross-Sectional Studies; False Positive Reactions; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Infant; Infant, Newborn; Male; Phlebotomy; Povidone-Iodine; Retrospective Studies; Specimen Handling

To determine if a povidone iodine rectal preparation (PIRP) reduces rates of bacteriuria and bacteremia following transrectal ultrasound guided prostate needle biopsy (TRUS PNB).. Men undergoing TRUS PNB were prospectively enrolled in a study comparing the impact of PIRP versus standard of care (two pills of ciprofloxacin 500 mg). Urine, blood, and rectal cultures were obtained 30 minutes post-procedure with colony forming units (CFUs) determined after 48 hours. Patients were called 7 and 30 days post-procedure to evaluate for infections.. A total of 150 men were accrued into this study including 95 receiving PIRP and 55 the standard of care. Two-thirds of patients were undergoing an initial biopsy, 19% used antibiotics within the previous 6 months, and median number of biopsy cores was 14. There were no differences between the two cohorts with respect to baseline or biopsy characteristics. In the PIRP cohort, rectal cultures before and after PIRP administration noted a 97.2% reduction in microorganism colonies (2.4 x 10 5 CFU/mL versus 6.7 x 10³CFU/mL, p < 0.001). Mean urine bacterial counts following TRUS PNB were 1 CFU/mL for PIRP versus 7 CFU/mL for standard cohort (p < 0.001). Mean serum bacterial counts following TRUS PNB were 0 CFU/mL for PIRP versus 3 CFU/mL for standard of care (p = 0.01). One patient in the PIRP cohort (1.1%) developed post-biopsy sepsis while 3 (5.5%) in the standard cohort had an infectious complication (1 UTI, 2 sepsis).. A PIRP regimen reduced bacteruria and bacteremia following TRUS PNB.

Topics: Administration, Topical; Anti-Infective Agents, Local; Bacteremia; Bacteriuria; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Povidone-Iodine; Prospective Studies; Prostate; Prostatic Neoplasms; Rectum

To make a field comparison of the effectiveness, ease of use, and cost of a chlorhexidine antiseptic solution (CBA) and an alcohol-based povidone-iodine solution (PVP-IA) for the prevention of central venous catheter (CVC)-related infections in an intensive care unit, with the aim of identifying the superior antisepsis agent.. We measured the CVC colonization and infection incidence for PVP-IA (Betadine alcoolique(®)) and for CBA (Biseptine(®)) during two successive 1-year periods of routine surveillance (REA RAISIN network). A questionnaire on the ease of CBA use was administered. Consumption data were obtained from the hospital pharmacy.. The study included 806 CVC (CBA period: 371). Upon switching from PVP-IA to CBA, we recorded a significant reduction in colonization incidence/100 catheter days (1.12 vs. 1.55, p=0.041), nonsignificant differences concerning CVC-related infection incidence/100 catheter days (0.28 vs. 0.26, p=0.426), and a nonsignificant reduction in CVC-related bacteremia/100 catheter days (0.14 vs. 0.30, p=0.052). PVP-IA users were at significantly higher risk of CVC colonization or infection based on a multivariate Cox model analysis (relative risk [95% CI]: 1.48 [1.01-2.15], p=0.043). The main drawbacks of CBA use were its low cleansing activity and its colorless solution. No cost advantage was found.. Our field study revealed no major clinical advantage of CBA use in CVC infection and no cost advantage in addition to limited ease of use.

Topics: Anti-Infective Agents, Local; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Chlorhexidine; Colony Count, Microbial; Cross Infection; Drug Costs; Equipment Contamination; Female; Humans; Intensive Care Units; Male; Povidone-Iodine; Prohibitins; Proportional Hazards Models; Prospective Studies

The aim of this retrospective study was to investigate whether the application of a chlorhexidine-impregnated dressing (Biopatch) at the exit site of tunneled-cuffed hemodialysis catheters has any effect on the incidence and etiology of catheter-related bacteremia (CRB). This study was carried out over a 5-year period in a single center, where, in the first 2(1/2) years, the exit sites were cleansed with betadine at every hemodialysis session and then covered with a transparent dressing (pre-Biopatch Era). During the next 2(1/2) years, Biopatch was applied to the exit site once a week after cleansing with betadine, and then covered with a transparent dressing (Biopatch Era). The application of Biopatch significantly decreased the incidence of exit site infections (ESI) (P<0.05). However, there was no difference in the incidence of CRBs or their microbiological distribution. The improved ESI rate had no effect on the overall catheter survival time. The antimicrobial sensitivities of the Gram-positive microorganisms were statistically different for the 2 different types of infections (P<0.05). In conclusion, even though Biopatch is effective in decreasing the incidence of ESI, it has no effect on the incidence of CRB, the etiology of CRB, or the overall catheter survival time. The distinct difference between the antimicrobial sensitivities of the ESI and CRB suggests that they are not a spectrum of the same pathogenesis. These preliminary data support the intraluminal pathogenesis of CRB, rather than the exit site as a possible entry point for the extraluminal route.

Topics: Adolescent; Bacteremia; Bandages; Catheter-Related Infections; Child; Chlorhexidine; Female; Humans; Male; Povidone-Iodine; Renal Dialysis; Retrospective Studies

To test the effects of several biocides [N-propanol, a commercially available propanol/ethanol/chlorhexidine mixture, polyvinylpyrolidone (povidone-iodine) and hydrogen peroxide] on established biofilms of Staphylococcus epidermidis isolated from patients with cardiac implant infections and catheter-related bacteraemia.. Biofilms were grown in microtitre plates for 24 h, dyed and stained with Crystal Violet. The mean optical density (OD) and the OD ratio (ODr=OD of the treated biofilm/OD of the untreated biofilm) were used for quantification. Biofilms were incubated with 60% (v/v) N-propanol, the mixture of propanol/ethanol/chlorhexidine, hydrogen peroxide at three concentrations (0.5%, 3% and 5%, v/v) and povidone-iodine for 1, 5, 15, 30 and 60 min. Unstained biofilms were sonicated and plated on Columbia agar for time-kill curves. S. epidermidis skin isolates from healthy volunteers were used as controls.. Biofilm ODs of the clinical S. epidermidis isolates and the isolates from the healthy volunteers were significantly different (1.17+/-0.512 versus 0.559+/-0.095, respectively; mean+/-SD) (P<0.01). No viable S. epidermidis was detected in biofilms treated with the alcohols, N-propanol or the propanol/ethanol/chlorhexidine mixture. Incubation with povidone-iodine and hydrogen peroxide 3% and 5% led to a log reduction of the viable cells of >5 after incubation for 5 min, however, up to 10(3) viable cells were detected in four isolates after 30 min of incubation with povidone-iodine.. S. epidermidis obtained from infected implants forms thicker biofilms than that of healthy volunteers. Hydrogen peroxide, at a concentration of 3% and 5%, and alcohols rapidly eradicate S. epidermidis biofilms, whereas povidone-iodine is less effective.

Topics: 1-Propanol; Alcohols; Anti-Infective Agents, Local; Bacteremia; Biofilms; Chlorhexidine; Disinfectants; Ethanol; Humans; Hydrogen Peroxide; Povidone-Iodine; Prosthesis-Related Infections; Staphylococcus epidermidis

The central venous catheter (CVC) is a necessary, yet inherently risky, modern medical device. We aimed to carry out a systems-based intervention designed to facilitate the use of maximal sterile barrier precautions and the use of chlorhexidine for skin antisepsis during insertion of CVC.. All patients in whom a CVC was inserted at a medical-surgical intensive care unit at a university-affiliated public hospital were included in a before-after trial. The standard CVC kit in routine use before the intervention included a small sterile drape (24" by 36") and 10% povidone-iodine for skin antisepsis. We special ordered a customized kit that, instead, included a large sterile drape (41" by 55") and 2% chlorhexidine gluconate in 70% isopropyl alcohol. Both the standard kit in use before the intervention and the customized kit included identical CVCs. Baseline data included the quarterly CVC-associated bloodstream infection (BSI) rates during the 15 months before the intervention. Comparison data included the quarterly CVC-associated BSI rates during the 15 months after we instituted exclusive use of the customized kit.. The mean quarterly CVC-associated BSI rate decreased from a baseline of 11.3 per 1000 CVC-days before the intervention to 3.7 per 1000 CVC-days after the intervention (P < .01). Assuming direct costs of at least 10,000 dollars per CVC-associated BSI, we calculated resultant annualized savings to the hospital of approximately 350,000 dollars.. Infection control interventions that rely on voluntary changes in human behavior, despite the best intentions of us all, are often unsuccessful. We have demonstrated that a systems-based intervention led to a sustained decrease in the CVC-associated BSI rate, thereby resulting in improved patient safety and decreased cost of care.

Topics: Bacteremia; Catheterization, Central Venous; Chlorhexidine; Cross Infection; Disinfectants; Health Care Costs; Hospitals, University; Humans; Infection Control; Povidone-Iodine; Statistics as Topic; Surgery Department, Hospital

Topics: Bacteremia; Decontamination; Humans; Nose; Povidone-Iodine; Premedication; Preoperative Care; Radionuclide Imaging; Rhinoplasty; Surgical Wound Infection

Despite efforts to have hemodialysis patients begin renal replacement therapy with a mature arteriovenous shunt, many patients begin dialysis with a cuffed tunneled catheter as their access. An increasing number of differently designed tunneled hemodialysis catheters have become available in the last decade. The primary aim of this study is to compare catheter survival for Hickman (Bard, Salt Lake City, UT) and Opti-flow (Bard) catheters. The 16-month experience with 182 catheters, totaling 13,861 catheter-days, is reported. The probability of Hickman catheter failure at 30, 60, and 90 days was 29%, 49%, and 67%. The probability of Opti-flow catheter failure was significantly less at 10%, 24%, and 38% for the same times, respectively (P: < 0.05 for all time points). The difference in catheter failure rates was caused by a greater malfunction rate of Hickman catheters; the two catheters had similar infection rates. We conclude that survival of Opti-flow catheters was significantly better than that of Hickman catheters from 30 to 90 days, which is a clinically relevant period when patients are waiting for maturation of a permanent access or replacement of a failed access. Since the conclusion of our study, we documented 10 episodes of Opti-flow catheter malfunction within 4 months secondary to hairline fracture of the arterial hub. The Opti-flow catheter was recalled and is now available with retooled hubs.

Topics: Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Disinfectants; Equipment Contamination; Equipment Failure; Female; Humans; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Renal Dialysis

To validate a standardized optimal national procedure for donor arm disinfection.. A direct swabbing and plating technique was used to enumerate bacteria present on the arm pre- and postdisinfection. Twelve donor arm disinfection techniques were evaluated.. The Medi-Flex Adapted method, consisting of a two-stage process with an initial application of isopropyl alcohol followed by tincture of iodine, produced the best arm disinfection. A percentage reduction in bacterial counts of 99.79% (logarithmic reduction of 2.67) was obtained. Postdisinfection, 70% of donors had bacterial counts of zero, and 98% had counts of 10 or less.. The Medi-Flex disinfection method offers the English National Blood Service a validated, optimal 'best practice' disinfection technique and should contribute significantly to the reduction in risk of transmission of bacteria by transfusion.

Topics: 2-Propanol; Administration, Cutaneous; Arm; Bacteremia; Bacteria; Bacteriological Techniques; Blood Donors; Chlorhexidine; Disinfectants; Disinfection; Humans; Hydrogen Peroxide; Infection Control; Phlebotomy; Povidone-Iodine; Skin; Transfusion Reaction

The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). There was a significant correlation between log total bacterial count by biopsy with total white cell count and age (P = 0.028), and a significant negative correlation between total bacterial count by swab with per cent TBSA (P = 0.006). There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.

Topics: Age Factors; Alginates; Anti-Infective Agents, Local; Bacteremia; Bacteria; Bandages; Biopsy; Body Surface Area; Burns; Cerium; Chlorhexidine; Colony Count, Microbial; Follow-Up Studies; Forecasting; Graft Survival; Humans; Leukocyte Count; Linear Models; Povidone-Iodine; Pseudomonas Infections; Silver Sulfadiazine; Skin Transplantation; Staphylococcal Infections; Treatment Failure; Treatment Outcome; Wound Infection

In 1989 we investigated the first instance of Pseudomonas cepacia infections due to intrinsic contamination of a povidone-iodine product. Six patients in a Texas pediatric facility had P. cepacia infection or pseudoinfection (three, peritonitis; one, pseudoperitonitis; and two, pseudobacteremia). Epidemiological studies showed one risk factor for infection of peritoneal fluid with P. cepacia: performance of peritoneal dialysis in the dialysis unit with use of one lot of povidone-iodine later found to be intrinsically contaminated (4/5 vs. 0/16, P = .001). Blood cultures yielded P. cepacia after nurses wiped the tops of blood culture bottles with the povidone-iodine solution before inoculation. P. cepacia was cultured from three povidone-iodine containers used at the hospital and from four containers of the same lot obtained from other health-care facilities in Texas and California. Isolates from patients and the povidone-iodine had similar antibiograms, identical plasmid profiles, and identical DNA banding patterns on the basis of results of ribonucleotide typing. This investigation demonstrates that intrinsic contamination of povidone-iodine solution with P. cepacia can result in infections in addition to colonization and/or pseudoinfection.

Topics: Bacteremia; Burkholderia cepacia; Child, Preschool; Cohort Studies; Cross Infection; Disease Outbreaks; Drug Contamination; Humans; Infant; Intensive Care Units, Pediatric; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Pseudomonas Infections; Retrospective Studies; Risk Factors; Texas

The effect of local irrigation of the gingival sulcus, which is considered an important source of bacteremia following dental procedures, with three different antiseptic solutions including hydrogen peroxide, chlorhexidine and povidone iodine, on the frequency of bacteremia after tooth extraction was determined, and the efficacies of the three antiseptics were compared. Although all the antiseptic solutions reduced the frequency of bacteremia to various degrees, povidone iodine was the most effective, and seemed to be the best choice since the decrease was statistically significant. Local administration of antiseptic solutions is therefore recommended as an adjuvant to systemic antibiotic prophylaxis.

Topics: Adult; Anti-Infective Agents, Local; Bacteremia; Bacteria; Chlorhexidine; Female; Gingiva; Humans; Hydrogen Peroxide; Male; Oral Hygiene Index; Povidone-Iodine; Therapeutic Irrigation; Tooth Extraction