povidone-iodine and Sepsis

The most effective skin antiseptic solution to reduce the incidence of catheter-related bloodstream infections (CRBSI) remains unknown.. To compare solutions with different chlorhexidine (CHG)-based concentrations and povidone-iodine (PVI) in adults with a central venous catheter (CVC) or arterial catheter, and identify an association with the incidence of CRBSI.. This study evaluated randomized controlled trials comparing CHG and PVI antiseptic agents in patients aged ≥18 years with an underlying illness and a CVC or arterial catheter. The primary outcome was CRBSI rate. Network meta-analysis was performed by a frequentist-based approach with multi-variate random effects meta-analysis, and the effect size was expressed as relative risk (RR) with 95% confidence interval (CI).. The search yielded 1511 records, of which five studies (2815 catheters) were included in the network meta-analysis. The risk of CRBSI was significantly lower with 1% CHG-alcohol than with 0.5% CHG-alcohol (RR 0.40, 95% CI 0.16-0.98; high certainty) or 10% PVI-aqueous (RR 0.31, 95% CI 0.15-0.63; high certainty). There was no significant difference in the risk of CRBSI between 1% CHG-alcohol and 2% CHG-aqueous (RR 0.35, 95% CI 0.12-1.04; moderate certainty) or other antiseptic solutions. The hierarchy of efficacy in reducing CRBSI was 1% CHG-alcohol, 0.5% CHG-alcohol, 2% CHG-aqueous and 10% PVI-aqueous.. Antiseptic agents containing 1% CHG-alcohol were more strongly associated with reduced risk for CRBSI compared with agents containing 0.5% CHG-alcohol or 10% PVI-aqueous.

Topics: Adult; Alcohols; Anti-Infective Agents, Local; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Chlorhexidine; Humans; Incidence; Network Meta-Analysis; Povidone-Iodine; Randomized Controlled Trials as Topic; Sepsis

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is beneficial to give additional antibiotics or an iodine washout after an emergency re-sternotomy on the intensive care unit. Using the reported search, 527 papers were identified. Nine papers represented the best evidence on the subject and the author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. The quality and level of evidence was assessed using the International Liaison Committee on Resuscitation guideline recommendations. For patients who require an emergency re-sternotomy on the intensive care unit, the incidence of sternal wound infection or sepsis after this emergency treatment is around 5%. We found only seven papers that documented the incidence of infection after emergency re-sternotomy. Of these seven papers, five documented that they routinely gave additional intravenous antibiotics and a povodine-iodine washout. The other two papers did not report whether this was done. We conclude that even though the incidence of subsequent infection is low in the cardiac arrest situation, full aseptic technique including gown and gloves might be regarded as best practice. It is common practice also to give additional antibiotics and a povodine-iodine washout although we could identify no studies other than uncontrolled cohort studies in support of this.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Benchmarking; Cardiac Surgical Procedures; Emergency Medical Services; Evidence-Based Medicine; Humans; Intensive Care Units; Patient Selection; Povidone-Iodine; Practice Guidelines as Topic; Reoperation; Risk Assessment; Sepsis; Sternum; Surgical Wound Infection; Therapeutic Irrigation

Bloodstream infections related to use of catheters, particularly central-line catheters, are an important cause of patient morbidity, mortality, and increased health care costs. This study evaluated the efficacy of skin disinfection with chlorhexidine gluconate compared with povidone-iodine solution in preventing catheter-related bloodstream infection.. Multiple computerized databases (1966 to 2001), reference lists of identified articles, and queries of principal investigators and antiseptic manufacturers.. Randomized, controlled trials comparing chlorhexidine gluconate with povidone-iodine solutions for catheter-site care.. Using a standardized form, two reviewers abstracted data on study design, patient population, intervention, and incidence of catheter-related bloodstream infection from all included studies.. Eight studies involving a total of 4143 catheters met the inclusion criteria. All studies were conducted in a hospital setting, and various catheter types were used. The summary risk ratio for catheter-related bloodstream infection was 0.49 (95% CI, 0.28 to 0.88) in patients whose catheter sites were disinfected with chlorhexidine gluconate instead of povidone-iodine. Among patients with a central vascular catheter, chlorhexidine gluconate reduced the risk for catheter-related bloodstream infection by 49% (risk ratio, 0.51 [CI, 0.27 to 0.97]).. These results suggest that incidence of bloodstream infections is significantly reduced in patients with central vascular lines who receive chlorhexidine gluconate versus povidone-iodine for insertion-site skin disinfection. Use of chlorhexidine gluconate is a simple and effective means of reducing vascular catheter-related infections.

Topics: Aged; Anti-Infective Agents, Local; Catheterization, Central Venous; Chlorhexidine; Disinfectants; Humans; Middle Aged; Povidone-Iodine; Randomized Controlled Trials as Topic; Risk Factors; Sensitivity and Specificity; Sepsis; Solutions

Prostate biopsy is mostly performed through the transrectal route worldwide and infectious complications may occur in up to 7% of cases. Therefore, alternative strategies to decrease infectious complications are needed. Our aim was to evaluate the effectiveness of intrarectal povidone-iodine cleansing plus formalin disinfection of the needle tip in decreasing infectious complications after transrectal ultrasound guided prostate biopsy.. We conducted a prospective, single-center, phase III trial in patients undergoing transrectal ultrasound guided prostate biopsy randomized 1:1 to rectal mucosa cleansing with gauze soaked in 10% povidone-iodine solution wrapped around the gloved index finger and needle tip disinfection by immersion in a 10% formalin solution before each puncture vs control group. The primary end point was the rate of infectious complications defined as 1 or more of the following events: fever, urinary tract infection, or sepsis.. Overall, 633 patients were randomized to the intervention group and 623 to the control group. The infectious complication rate was 3.9% in the intervention group and 6.4% in the control group (RR 0.61; 95% CI 0.36-0.99;. Intrarectal povidone-iodine cleansing plus formalin disinfection of the biopsy needle tip was associated with a reduction in infectious complications after transrectal prostate biopsy.

Topics: Anti-Infective Agents, Local; Biopsy; Disinfection; Formaldehyde; Humans; Male; Povidone-Iodine; Prospective Studies; Prostate; Sepsis; Urinary Tract Infections

Approximately 38% of haemodialysis patients carry. We will perform an open-label, stepped-wedge cluster randomised trial to assess the effectiveness of nasal PVI compared with standard care. Sixteen outpatient haemodialysis units will participate in the study. The 3-year trial period will be divided into a 4-month baseline period and eight additional 4-month time blocks. The primary outcome of the study will be. This study has received IRB approval from all study sites. A Data Safety and Monitoring Board will monitor this multicentre clinical trial. We will present our results at international meetings. The study team will publish findings in peer-reviewed journals and make each accepted peer-reviewed manuscript publicly available.. NCT04210505.

Topics: Humans; Multicenter Studies as Topic; Povidone-Iodine; Randomized Controlled Trials as Topic; Renal Dialysis; Sepsis; Staphylococcal Infections; Staphylococcus aureus

The efficacy of 1% chlorhexidine-gluconate ethanol and 10% povidone-iodine for skin antisepsis of central venous catheter (CVC) sites were compared among hematology patients. The CVC site colonization rates of those groups were 11.9% and 29.2%, respectively, and the catheter-associated blood stream infections were 0.75 and 3.62 per 1,000 catheter-days, respectively. One percent chlorhexidine-gluconate ethanol was superior to povidone-iodine to reduce skin colonizers at CVC sites even when catheters were used for long duration.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Central Venous Catheters; Chlorhexidine; Disinfectants; Disinfection; Ethanol; Female; Hematology; Hospital Departments; Humans; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Sepsis; Skin Diseases, Infectious; Young Adult

Blood culture is the gold standard for diagnosis of septicemia. However; false-positive blood cultures are associated with increased health care costs due to unnecessary treatment.. To evaluate the efficacy of 2% chlorhexidine gluconate in 70% alcohol compared with 10% povidone iodine in reducing blood culture contamination inpediatricpatients.. This is a prospective study of pediatric patients who were admitted at a tertiary-care hospital. Pediatric patients who neededpercutaneous blood cultures were recruitedfrom two general pediatric wards and the pediatric intensive care unit. The authors used 10% povidone iodine as an antiseptic in odd months and 2% chlorhexidine gluconate in 70% alcohol as an antiseptic in even months in obtaining the blood culture samples.. There were 1,269 blood culture specimens taken from 821 patients. 654 specimens used 10%povidone iodine as an antiseptic and 619 specimens used 2% chlorhexidine gluconate in 70% alcohol as an antiseptic. The 10% povidone iodine group and the 2% chlorhexidine gluconate in 70% alcohol group had the risk of blood culture contamination of 3.21% (95%CI: 2.00%-4.87%) and 2.28% (95% CI: 1.25%-3.79%) respectively. The risk difference ofblood culture contamination was 0.93% (95% confidence interval: 0. 86-2.72%) with p = 0.31. The most common contamination organism was Coagulase negative staphylococci (68.57%). No adverse skin reactions were observed in both antiseptic solutions groups.. Use of2% chlorhexidine gluconate in 70% alcohol as an antiseptic seems to reduce the risk of blood culture contamination compared to use of 10% povidone iodine. In addition, neither of the antiseptic solutions resulted in adverse skin reactions.

Topics: Adolescent; Anti-Infective Agents, Local; Antisepsis; Blood Specimen Collection; Child; Child, Preschool; Chlorhexidine; Culture Techniques; Ethanol; False Positive Reactions; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Povidone-Iodine; Prospective Studies; Sepsis; Skin

The objective of the study was to determine whether vaginal preparation with povidone iodine before cesarean delivery decreased the risk of postoperative maternal morbidities.. The design of the study was a randomized, controlled trial in women undergoing cesarean delivery with subjects assigned to have a preoperative vaginal cleansing with povidone iodine or to a standard care group (no vaginal wash). The primary outcome was a composite of postoperative fever, endometritis, sepsis, readmission, wound infection, or complication.. There were 155 vaginal cleansing subjects and 145 control subjects. Overall, 9.0% developed the composite outcome, with fewer women in the cleansing group (6.5%) compared with the control group (11.7%), although the difference was not statistically significant (relative risk, 0.55; 95% confidence interval, 0.26-1.11; P = .11). Length of surgery, being in labor, and having a dilated cervix were all associated with the composite morbidity outcome.. Vaginal cleansing with povidone iodine before cesarean delivery may decrease postoperative morbidities, although the reduction is not statistically significant.

Topics: Adult; Anti-Infective Agents, Local; Cesarean Section; Endometritis; Female; Fever; Gravidity; Humans; Labor Stage, First; Labor, Obstetric; Parity; Patient Readmission; Postoperative Complications; Povidone-Iodine; Pregnancy; Preoperative Care; Sepsis; Surgical Stapling; Surgical Wound Infection; Sutures; Vagina

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

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

In a prospective study on 81 patients undergoing transrectal needle biopsy of the prostate, the efficacy of prophylaxis in preventing postbiopsy infectious complications was determined. The patients were divided randomly into four groups, and a comparison of the rate of postbiopsy complications in each group was made. In 11 and 17% of the patients in Group A (n = 18) who received povidone-iodine enema alone, bacteriuria and bacteraemia, respectively, occurred. When parenteral piperacillin alone in Group B (n = 22) was administered, the rates of the same complications were 9 and 14%, respectively, while both rates were as low as 4% in Group C (n = 25) when piperacillin in combination with povidone-iodine enema was given. On the other hand, in 31 and 37.5% of the patients in Group D (n = 16), who served as controls, bacteriuria and bacteraemia developed. The study has thus shown that parenteral piperacillin in combination with povidone-iodine enema significantly reduces the incidence of infectious complications associated with transrectal prostatic biopsy.

Topics: Aged; Bacteriuria; Biopsy, Needle; Drug Therapy, Combination; Enema; Humans; Male; Piperacillin; Povidone-Iodine; Premedication; Prospective Studies; Prostate; Sepsis

We studied etiologic factors important in colonization of 179 central venous catheters (CVCs) in patients randomized into group 1 (who received daily topical applications of povidone-iodine) or group 2 (who received only dry dressing changes). Colonization rates of CVC tips were similar between group 1 (18/84 or 21%) and group 2 (22/95 or 23%). Peripheral blood cultures grew Candida in eight hyperalimented patients (evenly divided between groups 1 and 2), S epidermidis in four other patients (also evenly divided), and gram-negative bacteria in three patients. Colonization rates for CVCs in place for 0 to seven days was 15.6% (17/109) and 76.7% (23/30) if used from eight to 30 days. Inflammatory signs at CVC sites were often absent when CVCs became colonized or produced bacteremia. Unimportant determinants of CVC colonization included skin securement of CVCs, antibiotic infusions through CVC lines, and masking and gowning of physicians before CVC placement. Daily applications of povidone-iodine did not reduce colonization of CVCs as compared to dry dressing changes.

Topics: Administration, Topical; Antisepsis; Bacteria; Candida; Candidiasis; Catheterization; Catheters, Indwelling; Central Venous Pressure; Female; Humans; Male; Middle Aged; Parenteral Nutrition, Total; Povidone-Iodine; Premedication; Prospective Studies; Sepsis; Staphylococcal Infections; Staphylococcus epidermidis; Time Factors

Topics: Actinomyces; Bacteroides; Blood; Clinical Trials as Topic; Gingiva; Gingivectomy; Humans; Lactobacillus; Moraxella; Mouth; Mouthwashes; Povidone; Povidone-Iodine; Sepsis; Staphylococcus; Streptococcus; Veillonella

To assess the effects of three different bowel preparation methods on the incidence of infectious complications in patients who underwent transrectal ultrasonography-guided prostate biopsy.. The standard bowel preparation protocol for prostate biopsy has not been established.. A retrospective study in a single centre.. From January 2013-December 2015, the clinical records of 1,130 patients who underwent prostate biopsy were, respectively, reviewed. All the patients received metronidazole prophylaxis before biopsy. The patients were divided into three groups according to the bowel preparation methods: patients in Group A (n = 402) received only soapy enema; patients in Group B (n = 413) received polyethylene glycol; while patients in Group C (n = 315) received polyethylene glycol plus povidone-iodine enema. Infectious complications were classified as fever (>37.5°C), urinary tract infection and sepsis. The postoperative adverse events were also observed.. The overall postbiopsy infectious complications were observed in 48 (4.25%) patients of all the cases, including 23 (5.72%) cases in Group A, 20 (4.84%) cases in Group B and five patients (1.59%) in Group C. There was significant difference among the groups (p = .018). In detail, these infectious complications included 22 (1.95%) cases of fever and 26 (2.30%) cases of urinary tract infection. No sepsis was observed among the total patients. The incidence of adverse events was 14.43% (58/402) occurred in Group A, 25.91% (107/413) in Group B and 26.67% (84/315) in Group C. The difference was statistically significant.. Our study confirmed that combined preparation regimens of polyethylene glycol with povidone-iodine enema could significantly reduce the postbiopsy infection rate. Conventional soapy enema is associated with less adverse events.. Findings of this study provide useful evidence-based information for healthcare professionals. The application of combined preparation regimens of polyethylene glycol with povidone-iodine enema resulted in better improvement in the prevention of postbiopsy infection.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Biopsy; Cathartics; Enema; Humans; Male; Middle Aged; Polyethylene Glycols; Postoperative Complications; Povidone-Iodine; Prostate; Retrospective Studies; Sepsis; Treatment Outcome; Ultrasound, High-Intensity Focused, Transrectal; Urinary Tract Infections

To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol.. A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring.. Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring.. What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

Topics: Administration, Topical; Aged; Anti-Infective Agents, Local; Antisepsis; Chlorhexidine; Critical Care; Hospitalization; Humans; Image-Guided Biopsy; Male; Middle Aged; Patient Safety; Povidone-Iodine; Prostate; Quality Improvement; Sepsis; Urinary Tract Infections

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacterial Infections; Biopsy, Needle; Ciprofloxacin; Humans; Male; Povidone-Iodine; Prostate; Prostatic Neoplasms; Reproducibility of Results; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional; Urinary Tract Infections

Dentists generally recognize the importance of periodontal treatment in patients with leukemia, with the most attention paid to preventing the development of odontogenic infection. For physicians, the worst type of infection is one caused by multidrug-resistant bacteria. Here, we report a patient with an abnormal increase in multidrug-resistant opportunistic bacteria in the gingiva during hematopoietic cell transplantation (HCT).. A 53-year-old woman receiving HCT for leukemia had an insufficient blood cell count for invasive periodontal treatment before HCT. Even brushing caused difficulties with hemostasis. Therefore, frequent pocket irrigation and local minocycline administration were performed.. The multidrug-resistant opportunistic bacterium Stenotrophomonas maltophilia was detected first in phlegm 2 days before HCT, and it was detected in a gingival smear and a blood sample 7 and 11 days after HCT, respectively. The patient developed sepsis on day 11 and died 14 days after HCT. Frequent irrigation and local antibiotic application were ineffective against S. maltophilia on the gingiva. Inflammatory gingiva without scaling and root planing showed bleeding tendency, and this interfered with the eradication of this bacterium.. The gingiva in patients undergoing leukemia treatment acts as sites of proliferation and reservoirs for multidrug-resistant opportunistic bacteria. Severe systemic infection by multidrug-resistant bacteria in such patients with leukemia also may involve the gingiva. To prevent abnormal increases in such bacteria on the gingiva, scaling and/or root planing before chemotherapy, which reduces bleeding on brushing during the neutropenic period caused by chemotherapy, may contribute to infection control in such patients, although it was impossible in this case.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Drug Resistance, Multiple, Bacterial; Fatal Outcome; Female; Gingival Diseases; Gingivitis; Gram-Negative Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Middle Aged; Minocycline; Opportunistic Infections; Periodontitis; Povidone-Iodine; Sepsis; Stenotrophomonas maltophilia; Transplantation Conditioning; Whole-Body Irradiation

Catheter-related bloodstream infections (CRBSI) are an important cause of patient morbidity, mortality, and increased health care costs. Use of an antiseptic solution for skin disinfection at the catheter insertion site helps prevent catheter-related infections. In Thailand, povidone-iodine solution is the most commonly used agent for this purpose. However, the results of several studies including a meta-analysis indicated that the use of chlorhexidine gluconate is more effective than the use of povidone-iodine as an antiseptic for preventing CRBSI. This study evaluated the cost-effectiveness of chlorhexidine gluconate versus povidone-iodine for catheter-site care using the Siriraj Hospital perspective.. We used a decision analytic modeling for estimating the cost-effectiveness of antiseptic solutions. The CRBSI rate was obtained from the Center for Nosocomial Infection Control at Siriraj Hospital, while the efficacy of cholorhexidine compared to povidone-idone was based on a meta-analysis. The cost of managing infections was derived from the Thai Drug Related Group (DRG). A series of sensitivity analyses were performed. Since the time horizon of the analysis was less than 1 year, there was no need for discounting.. We found that the use of chlorhexidine, rather than povidone iodine, for central catheter site care resulted in a 1.61% decrease in the incidence of CRBSI, a 0.32 % decrease in the incidence of death, and savings of 304 baht per catheter used. For peripheral catheter site care, the results were similar although the differences were smaller.. Use of chlorhexidine gluconate in place of the current standard solution for vascular catheter site care is a cost-effective method of improving patient safety in Siriraj Hospital.

Topics: Anti-Infective Agents, Local; Catheterization; Catheterization, Central Venous; Chlorhexidine; Cost-Benefit Analysis; Decision Support Techniques; Equipment Contamination; Hospitalization; Humans; Meta-Analysis as Topic; Models, Theoretical; Povidone-Iodine; Sepsis; Thailand

Topics: Aged; Anti-Infective Agents, Local; Catheterization, Central Venous; Chlorhexidine; Disinfectants; Humans; Povidone-Iodine; Randomized Controlled Trials as Topic; Risk Factors; Sepsis; Solutions

Topics: Bandages; Catheterization, Central Venous; Child; Chlorhexidine; Humans; Neoplasms; Nursing Evaluation Research; Povidone-Iodine; Sepsis

This article indicates that using local degerming agents in conjunction with traditional antibiotics prevents dental bacteremia more effectively than either procedure alone. In many patients at risk for endocarditis who practice home-care procedures than can produce bacteremia from gingival bleeding, daily antibiotic prophylaxis is impractical and contraindicated. This article discusses an effective method to control daily bacteremia with 0.2% chlorhexidine mouthwash. The article also attempts to identify patients at risk, determine the degree that they are exposed to potentially bacteremic situations, and encourage an aggressive team approach of physician and dentist to protect such patients adequately. Recommendations to prevent bacteremia are offered to supplement traditional antibiotic regimens.

Topics: Animals; Chlorhexidine; Dental Care; Endocarditis, Bacterial; Humans; Mouthwashes; Povidone-Iodine; Rabbits; Sepsis

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteria; Chlorhexidine; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Povidone; Povidone-Iodine; Sepsis; Therapeutic Irrigation; Tooth Extraction

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Bacterial Infections; Diagnosis, Differential; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Immunity, Cellular; Infant, Newborn; Povidone-Iodine; Pregnancy; Prognosis; Sepsis

The purpose of this investigation was to determine the effectiveness of irrigating periodontal pockets with povidone-iodine in reducing the incidence of bacteremia found during subgingival scaling. Twenty male patients requiring subgingival scaling had the following factors recorded on two contralateral groups of three posterior teeth: age, race, mean pocket depth, mobility, and scores of gingival, plaque, calculus, bleeding indices. In control areas, 5 ml blood samples were taken before, during and after scaling through an in dwelling Minicath. In experimental areas, the patients first rinsed with a povidone-iodine mouthwash for 1 minute, and the teeth then received a 3-minute sulcus irrigation with 10% povidone-iodine. Blood samples were taken as with the controls, and also 2 minutes after the irrigation. Blood samples were anaerobically cultured, and isolates were classified by Gram staining and cellular morphology. No significant difference in factors between control and experimental areas was noted. All preoperative blood cultures, including those taken 2 minutes after irrigation, were negative. In the 11 patients (55%0 who showed positive cultures during the scaling, cultures were positive in both control and experimental areas. None of the preoperatively recorded factors in either control or experimental ares were significantly correlated with the occurrence of bacteremia. Local degerming by mouthrinsing and sulcus irrigation with povidone-iodine prior to subgingival scaling seems neither to increase nor decrease the incidence of bacteremia.

Topics: Adult; Dental Prophylaxis; Dental Scaling; Gingivitis; Humans; Male; Middle Aged; Periodontal Index; Povidone; Povidone-Iodine; Sepsis; Subgingival Curettage; Therapeutic Irrigation

Topics: Adult; Aged; Bacteriological Techniques; Cross Infection; Diagnosis, Differential; Disease Outbreaks; Drug Contamination; Humans; Middle Aged; Povidone; Povidone-Iodine; Pseudomonas; Pseudomonas Infections; Sepsis

This presentation reviews the course of burn wound sepsis in a group of 621 acute patients treated at the Shriners Burns Institute, Cincinnati Unit, between 1970 and 1976. During this period of time, the overall mortality rate fell from 14% in 1970 to 3 and 5%, respectively, in 1975 and 1976. Staphylococcus aureus was the most commonly recovered organism from the burn wound, colonizing 85% of the burn patients. Beta hemolytic streptococcus represented a potential threat despite the fact that it was recovered from only 5 to 10% of the patients. Pseudomonas aeruginosa showed a decrease in colonization during the period of this study, from 50% of the wounds in 1970 to 21% in 1976. Candida albicans was the fungal organism most commonly recovered from the burn wound and from the blood stream. Fifteen deaths occurred in this group as a result of invasive infection, one from S. aureus, five from P. aeruginosa, two from Klebsiella-Enterobacter, and one from Escherichia coli, as well as six fungal deaths, five from Candida albicans and one from mucormycosis. Therapeutic measures used to control burn wound sepsis consisted of prevention of contamination from exogenous sources, control of burn wound pathogens, early recognition of invasive burn wound sepsis, aggressive management of the burn wound, and optimal nutritional support. During this period the extent of burn associated with a survival of 50% has risen from 50% in 1970 to 80% in 1976. This improvement in survival is directly related to progressive improvement in local and systemic measures available for the control of infection.

Topics: Burns; Gentamicins; Humans; Mafenide; Nitrofurazone; Povidone-Iodine; Sepsis; Silver Nitrate; Silver Sulfadiazine; Wound Infection

Pseudomonas cepacia was recovered from the blood cultures of 52 patients in four hospitals in New York over 6 months from April through October 1980. Epidemiologic investigation in one hospital indicated that the positive results of blood culture represented pseudobacteremias and implicated a 10% povidone-iodine solution used as an antiseptic and disinfectant (Pharmadine; Sherwood Pharmaceutical Company, Mahwah, New Jersey) as the source of contamination. Physicians who drew blood cultures positive for P. cepacia were more likely to have left povidone-iodine on the skin before venipuncture (p = 0.026) and were more likely to have applied povidone-iodine to the blood culture bottle tops and to have left it there while inoculating the blood culture media (p = 0.007) than those who drew cultures negative for P. cepacia. Direct inoculation of Pharmadine into brain-heart infusion broth yielded P. cepacia; however, 2 weeks after the first cultures, the same Pharmadine bottles were culture negative. The iodine concentrations of the contaminated Pharmadine solutions were similar to those of 10% povidone-iodine solutions distributed by other manufacturers.

Topics: Blood Specimen Collection; Drug Contamination; Humans; Povidone; Povidone-Iodine; Pseudomonas Infections; Sepsis

Topics: Aged; Biopsy; Humans; Male; Middle Aged; Povidone; Povidone-Iodine; Prostate; Rectum; Sepsis

Topics: Adult; Agranulocytosis; Anti-Bacterial Agents; Burns; Humans; Iodine; Male; Neutropenia; Povidone; Povidone-Iodine; Sepsis

Two degerming mouthrinses, a 1% povidone-iodine and a 0.2% aqueous solution of chlorhexidine gluconate, were tested with regard to their degerming effect on the saliva. The study comprised two parts. In the first part 19 dental students with good oral hygiene rinsed their mouths at weekly intervals with 10 ml of the povidone-iodine and 10 ml of the chlorhexidine solution. A control group of 12 students and nurses with healthy teeth and gums rinsed their mouths with 10 ml of plain water. In the second part 11 adult patients with periodontal disease used the two test rinses at weekly intervals both before and after periodontal prophylaxis including scaling of the teeth. Non-stimulated saliva was simpled immediately before and 5, 30, 60, and 120 min after each rinse. Part of the saliva was cultured on blood agar plates to show the growth of aerobic microbes. The remainder of the saliva was poured over a Dentocult dip-slide for determination of the number of acidophilic bacteria. The results showed that in the water control group the bacterial count increased in spite of the rinse. When compared with the prerinse values, both test rinses clearly reduced the amounts of bacteria. Chlorhexidine reduced the bacterial count 5 min after the rinse about one logarithm more than povidone-iodine, did, and the degerming effect of chlorhexidine was also of longer duration than that of the povidone-iodine solution. The periodontal prophylaxis in the adult group did not seem to lower the pre-rinse bacterial counts but did slightly improve the duration of the effect of both test solutions. The dip-slide tests showed that 28% of the subjects had no growth of acidophilic bacteria. This absence was not dependent on the other bacterial flora of the saliva. In the cases with a positive dip-slide test, the number of acidophilic bacteria decreased with both test solutions according to the pattern revealed by the blood agar plate cultures.

Topics: Adult; Aged; Bacteria; Biguanides; Cell Count; Chlorhexidine; Humans; Middle Aged; Mouthwashes; Oral Hygiene; Periodontal Diseases; Povidone; Povidone-Iodine; Saliva; Sepsis

Topics: Animals; Bacteria; Colon; Dogs; Erythromycin; Evaluation Studies as Topic; Feces; Neomycin; Povidone; Povidone-Iodine; Preoperative Care; Sepsis; Surgical Wound Infection; Wound Healing

Topics: Dental Prophylaxis; Gingiva; Humans; Mouthwashes; Povidone-Iodine; Sepsis; Tooth Extraction

Topics: Catheterization; Colitis, Ulcerative; Crohn Disease; Female; Gastrostomy; Glucose; Humans; Insulin; Male; Methods; Middle Aged; Mycoses; Parenteral Nutrition; Penicillins; Postoperative Complications; Potassium Chloride; Povidone-Iodine; Sepsis; Serum Albumin; Sodium Chloride; Vena Cava, Superior; Vitamins

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Endocarditis, Bacterial; Gingiva; Humans; Male; Middle Aged; Mouthwashes; Povidone; Povidone-Iodine; Sepsis; Therapeutic Irrigation; Tooth Extraction

Topics: Adolescent; Adult; Aged; Blood; Erythromycin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin V; Povidone-Iodine; Sepsis; Time Factors; Tooth Extraction