povidone-iodine and Kidney-Failure--Chronic

In this study, we discuss a mechanism of development of access-related Staphylococcus aureus infections in patients on buttonhole (BH) method and logically construct a measure to prevent such infections on the basis of the mechanism.. S. aureus can colonize a BH track. Once S. aureus colonizes a BH track, access-related infections may develop when the equilibrium is upset between the factors of host resistance and a level of bacterial growth in a BH track. Thus, the logically constructed measure to prevent access-related infections are as follows: (1) decolonization of S. aureus from a BH track by applying mupirocin ointment to a BH entry site when a patient has been proven to be a carrier of S. aureus in the track, (2) prevention of bacterial invasion of the BH track by a new method to remove a scab completely, and (3) control of bacterial growth in the BH track by disinfecting the site with diluted povidone-iodine solution (0.1% povidone-iodine solution) before access vessel cannulation.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Catheter-Related Infections; Catheterization, Peripheral; Catheters, Indwelling; Female; Humans; Kidney Failure, Chronic; Male; Mupirocin; Povidone-Iodine; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Exit-site infection (ESI), tunnel infection and associated peritonitis are major causes of morbidity and catheter loss in chronic peritoneal dialysis patients. Meticulous exit-site care is vital in preventing ESI. Avoiding trauma to the exit-site and daily cleaning of the exit-site with a dedicated antimicrobial soap is essential for the longevity of the peritoneal dialysis catheter. Antibiotics cream and disinfectant agents including povidone-iodine, chlorhexidine, electrolytic chloroxidizing solutions (Amuchina 10% - ExSept Plus, Amuchina 5% - ExSept) are useful to keep the resident micro-organisms inhibited. ESI rates in peritoneal dialysis patients treated with Amuchina 10% (ExSept Plus) and Amuchina 5% (ExSept) for the exit-site care are similar or lower compared to povidone-iodine or chlorhexidine. Electrolytic chloroxidizing (Amuchina 10% - ExSept Plus and Amuchina 5% - ExSept) solutions for exit-site care are effective for prevention and treatment of ESI.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Catheters, Indwelling; Chlorhexidine; Equipment Contamination; Humans; Hypochlorous Acid; Infection Control; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Skin Care; Soaps; Sodium Chloride

Subclavian catheter (SCC) related infections are a major cause of morbidity in hemodialysis patients, the vast majority due to staphylococci species. Povidone-iodine (PI) has proven anti-staphylococcal activity. Therefore, a randomized controlled trial of topical PI ointment was undertaken to evaluate the impact of this prophylactic intervention on the incidence of SCC related infections in hemodialysis patients. The role of S. aureus nasal carrier state in the acquisition of infection was also evaluated. Patients requiring SCC for temporary hemodialysis access were randomized to receive the treatment (T; N = 63) or sterile gauze dressings alone (C; N = 66). Catheter duration ranged from 2 to 210 days in both groups, with a mean of 38.6 days in T and 36.2 days in C (NS). Exit site (ES) infections were significantly less in T (5%) versus C (18%) (P less than 0.02); tip colonization (TC) was 17% in T versus 36% in C (P less than 0.01), while the incidence of septicemia (S) was also significantly less in T (2%) versus C (17%; P less than 0.01). S. aureus nasal carriers were at a threefold higher risk of SCC related septicemia (0.009/day) than noncarriers (0.003/day; P less than 0.05). The beneficial effect of PI ointment was most evident in this high risk group of S. aureus carriers: ES = 0% T versus 24% C, TC = 12% T versus 42% C, S = 0% T versus 29% C, P less than 0.05. There were no adverse effects of the treatment. The routine application of topical PI ointment to temporary hemodialysis catheter exit sites is effective in reducing SCC related infections.

Topics: Acute Kidney Injury; Administration, Topical; Catheterization, Central Venous; Humans; Kidney Failure, Chronic; Middle Aged; Povidone-Iodine; Renal Dialysis; Sepsis; Staphylococcal Infections; Subclavian Vein

Scab removal is a time-consuming process and often injures the skin at a buttonhole entry site. Incomplete removal of scabs may cause access-related infection.. In a new procedure, buttonhole entry sites were treated with a moist healing step after hemodialysis, and then a formed scab was wiped off with a microfiber towel during bathing on the night prior to hemodialysis, which was performed on the following day. In the moist healing step, the entry site was disinfected with a diluted povidone-iodine solution (0.1% povidone-iodine solution).. When the buttonhole entry sites of the patients were treated with the new procedure, the scabs had already been removed at the buttonhole entry sites, and the sites were covered with a thin transparent membrane. Histological examination showed the thin membrane was stratum corneum, in which nuclei are still seen in keratinocytes.. By treating the buttonhole entry sites of patients with the wound moist healing method and then rubbing the sites with a microfiber towel during bathing, scabs can be removed without injuring the skin at the sites in advance.

Topics: Aged; Anti-Infective Agents, Local; Arteriovenous Shunt, Surgical; Baths; Catheterization, Peripheral; Female; Humans; Keratinocytes; Kidney Failure, Chronic; Male; Middle Aged; Povidone-Iodine; Renal Dialysis; Skin; Wound Healing

Topics: Adult; Humans; Instillation, Drug; Kidney; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Living Donors; Male; Middle Aged; Nephrectomy; Povidone-Iodine; Time Factors; Treatment Outcome; Urinary Catheterization

Topics: Chylothorax; Female; Humans; Infant, Newborn; Kidney Failure, Chronic; Lung Diseases; Lymphangiectasis; Pleurodesis; Povidone-Iodine

In this study, we performed exit-site care using one of three methods (A: cleanse the exit site with povidone-iodine daily and apply gauze dressing; B: cleanse the exit site with povidone-iodine once a week, cover the site with a small gauze, and seal it completely with dressing film; C: the same as in B, above, except once every two weeks). The results show that there was a higher rate of positive bacterial growth in method A (17/24, 71%), and we concluded that the sterility of the exit site was not maintained 24 hours after cleansing. In methods B and C, in which the exit site was kept sealed, we did not detect bacterial growth in almost any of the cases (B = 0/44, C = 1/7). Although the patients took a bath and did not perform any care of the exit site for one to two weeks, the results show that the exit site was protected from bacterial invasion. We believe that this method could reduce exit-site infection while requiring no daily care.

Topics: Aged; Bacterial Infections; Bacteriological Techniques; Catheters, Indwelling; Colony Count, Microbial; Female; Humans; Kidney Failure, Chronic; Male; Occlusive Dressings; Peritoneal Dialysis, Continuous Ambulatory; Povidone-Iodine; Surgical Wound Infection

Fifteen episodes of infection due to Pseudomonas aeruginosa, including peritonitis and catheter site infections, occurred in nine patients receiving continuous ambulatory peritoneal dialysis over a 27-month period. Eight episodes were associated with catheter loss. Occurrence of P aeruginosa infection was significantly associated with use of povidone-iodine solution to cleanse the catheter site. There was no association with use of povidone-iodine solution to disinfect tubing connections, use of other skin care products or exposure to other environmental sources of P aeruginosa. Cultures of available povidone-iodine products were negative. Local irritation and alteration in skin flora caused by antiseptic solution or low-level contamination of povidone-iodine solution are potential mechanisms of infection.

Topics: Catheters, Indwelling; Follow-Up Studies; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Povidone; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections