povidone-iodine and Pneumonia--Bacterial

Aerobic and facultatively anaerobic gram-negative bacilli (AGNB) are opportunistic pathogens and continue to cause a large number of hospital-acquired infections. AGNB residing in the oral cavity and oropharynx have been linked to nosocomial pneumonia and septicemia. Although AGNB are not considered members of the normal oral and oropharyngeal flora, medically compromised patients have been demonstrated to be susceptible to AGNB colonization.. A literature search was conducted to retrieve articles that evaluated the effectiveness of oral hygiene interventions in reducing the oral and oropharyngeal carriage of AGNB in medically compromised patients.. Few studies have documented the use of mechanical oral hygiene interventions alone against AGNB. Although a number of studies have employed oral hygiene interventions complemented by antiseptic agents such as chlorhexidine and povidone iodine, there appears to be a discrepancy between their in vitro and in vivo effectiveness.. With the recognition of the oral cavity and oropharynx as a reservoir of AGNB and the recent emergence of multidrug and pandrug resistance in hospital settings, there is a pressing need for additional high-quality randomized controlled trials to determine which oral hygiene interventions or combination of interventions are most effective in eliminating or reducing AGNB carriage.

Topics: Anti-Infective Agents, Local; Bacteria, Aerobic; Bacteria, Anaerobic; Chlorhexidine; Cross Infection; Gram-Negative Bacteria; Humans; Mouth; Oral Hygiene; Oropharynx; Pneumonia, Bacterial; Povidone-Iodine

Aspiration of potentially pathogenic bacteria (PPB) colonized in the upper airway is a major cause of bacterial pneumonia. We hypothesized that PVP-I nasal inhalation is effective in removing PPB from the upper airway. The aim of this study was to investigate the effectiveness and safety of PVP-I nasal inhalation.. Patients with asymptomatic PPB (MRSA and/or aerobic GNB i.e. Pseudomonas aeruginosa, Enterobacteriaceae) colonization in the pharynx were enrolled in this study. These patients were divided randomly into two groups as follows: a PVP-I nasal inhalation group (N group) which was asked to inhale 1% PVP-I solution x 2/day nasally by a jet nebulizer and gargling with PVP-I solution x 2/day, and a control group (C group), which was asked to gargle with PVP-I solution x 2/day. The study period was 2 weeks in both groups.. Group N consisted of 16 cases, which included 9 (56%) cases with chronic respiratory complications and group C consisted of 14 cases which included 6 (43%) cases with complications. In N and C group, PPB disappearance from the pharynx was observed in 44% and 14% of patients after the study period, respectively. In the patients of group N, without chronic respiratory complication, PPB disappeared in 86% ot the cases. There was no adverse effect correlated with PVP-I nasal inhalation.. We conclude that PVP-I nasal inhalation is a safe procedure for removing PPB from the upper airway, and this method may contribute to preventing bacterial pneumonia.

Topics: Administration, Inhalation; Adult; Aged; Aged, 80 and over; Enterobacteriaceae; Female; Humans; Male; Middle Aged; Mouthwashes; Pharynx; Pneumonia, Bacterial; Povidone-Iodine; Pseudomonas aeruginosa; Safety; Staphylococcus aureus

We investigated the efficacy of disinfection of the upper airway using povidone-iodine against nosocomial pneumonia in geriatric wards. Cases of nosocomial pneumonia were retrospectively analyzed between January 1991 and March 1995 in geriatric wards (190 beds). Moreover, the relationship concerning methicillin-resistant Staphylococcus aureus (MRSA) isolates between patient and environment was investigated using pulsed-field gel electrophoresis (PFGE) with the SmaI restriction enzyme. The incidence of nosocomial pneumonia decreased significantly (p < 0.05). Major causative organisms of nosocomial pneumonia were MRSA and Pseudomonas aeruginosa, which significantly decreased. PFGE studies showed that the patterns of MRSA isolates show a strong association between patient and environment. Our study indicates that disinfection of the upper airways by povidone-iodine is very important in the prevention of nosocomial pneumonia in geriatric wards.

Topics: Aged; Anti-Infective Agents, Local; Bacterial Typing Techniques; Carrier State; Cross Infection; Disease Transmission, Infectious; Electrophoresis, Gel, Pulsed-Field; Environmental Microbiology; Geriatrics; Hospital Units; Humans; Infection Control; Methicillin Resistance; Mouth; Nasal Cavity; Pneumonia, Bacterial; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

We investigated the efficacy of infection control measures against nosocomial pneumonia in geriatric wards. Cases with nosocomial pneumonia were retrospectively analyzed between January 1991 and March 1995. The study period was divided into four annual periods (periods 1, 2, 3 and 4). Period 1, January to December 1991, was applied as the cotrol. We investigated patients with nosocomial pneumonias in geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University. During the study period, nosocomial pneumonia significantly diminished. (period 1 vs periods 2, 3 and 4, p < 0.05, p < 0.05, p < 0.05, respectively). Major causative organisms of nosocomial pneumonia were MRSA and Pseudomonas aeruginosa. During the four periods, a significant reduction in cases with MRSA- and P. aeruginosa-induced nosocomial pneumonia was observed (MRSA: period 1 vs periods 2, 3 and 4, p < 0.05, p < 0.05, p < 0.01, respectively; P. aeruginosa: period 1 vs period 3, p < 0.01, period 2 vs periods 3 and 4, p < 0.01, p < 0.05, respectively). On the other hand, the improvement of decubitus ulcers was associated with a significant reduction in nosocomial pneumonia (period 1 vs. periods 2 and 3, p < 0.05 and p < 0.05, respectively). In conclusion, stringent infection control programs, including a cleaning in the upper airways by povidone iodine, are necessary in geriatric wards to reduce and prevent nosocomial pneumonia.

Topics: Aged; Aged, 80 and over; Cross Infection; Female; Humans; Male; Pneumonia, Bacterial; Povidone-Iodine; Pressure Ulcer; Retrospective Studies