ABSTRACT
BACKGROUND: Open-heart surgery can result in adhesions, which can complicate resternotomy. AIMS: To document the occurrence of adhesions after the use of a new collagen membrane; to evaluate its tolerability; and to compare surgical parameters with control patients. METHODS: Paediatric patients who underwent cardiac surgery with the collagen membrane (Cova™ CARD; Biom'up, Saint Priest, France) were analysed retrospectively for levels of adhesion and tolerability. The times of dissection and intervention and the transfusion of packed red blood cells and haemostatic products were compared to a historic cohort who did not receive an anti-adhesion device. RESULTS: From January 2010 to December 2011, 36 patients received a collagen membrane. Nineteen re-interventions were performed, after a mean of 169 days. No grade 3 adhesions were observed and no tolerability problems were reported. During re-interventions after more than 30 days, the propensity score-adjusted durations of dissection and the total process for patients with and without a collagen membrane were 32 vs 41 minutes and 151 vs 182 minutes, respectively (not significant). The mean quantities of red blood cells and biological glue administered in the two groups were 98 vs 139 mL and 1.2 vs 0.5 mL, respectively (not significant). CONCLUSIONS: This feasibility study shows the potential use of the new membrane in paediatric patients, both in terms of prevention from severe adherence and tolerability. This is the first study of this membrane in humans. A prospective, controlled study is necessary to provide strong evidence of its efficiency.
Subject(s)
Absorbable Implants , Biocompatible Materials , Cardiac Surgical Procedures/adverse effects , Collagen/therapeutic use , Tissue Adhesions/prevention & control , Adolescent , Age Factors , Child , Child, Preschool , Collagen/adverse effects , Erythrocyte Transfusion , Feasibility Studies , Female , Hemostatics/therapeutic use , Humans , Infant , Male , Operative Time , Reoperation , Retrospective Studies , Time Factors , Tissue Adhesives/therapeutic use , Treatment OutcomeABSTRACT
In the present study, an original chlorhexidine-loaded nanocapsule-based gel (Nanochlorex) was tested as hand rub gel against the resident skin flora in comparison with 2-propanol 60% (v/v) and 62% (v/v) ethanol-based gel (Purell). After 30-s hand rub, the immediate bactericidal effect of Nanochlorex was found comparable to 2-propanol 60% (v/v) (reduction factor, RF: 0.30+/-0.35 versus 0.38+/-0.55, P>0.05) against aerobic bacteria, whereas the post-values of surviving anaerobes were shown significantly lower from Nanochlorex (P<0.001) and insignificant from 2-propanol 60% (v/v) (P>0.05). Sustained antibacterial effect of Nanochlorex was confirmed against the resident and transient hand flora in two sets of experiment. In the first, the results obtained with the glove-juice technique showed that the bactericidal effect induced by Nanochlorex hand rub persisted throughout 3-h period, while Purell failed to reduce significantly the post-values of surviving bacteria. In the second, repeated artificial contaminations with Staphylococcus epidermidis was carried out onto ex vivo human skin pre-treated by either Nanochlorex or Purell for 5min, then maintained in cell diffusion apparatus for 4h. The log(10) reduction of surviving bacteria was significantly higher with Nanochlorex than that determined with Purell after three successive contaminations (from approximately 5.5 to 1.5 log(10) reduction for Nanochlorex between the first and the third contamination; approximately 1log(10) reduction for Purell throughout the experiment), confirming the sustained antibacterial effect of chlorhexidine-loaded nanocapsule-based gel. The immediate and sustained antibacterial effect of Nanochlorex was explained by chlorhexidine carrier system which improved the drug targeting to bacteria and reduced from osmotic gel further bacterial growth on the skin. Nanochlorex) might constitute a promising approach for hygienic hand disinfection in care practice performing multiple procedures.
Subject(s)
Anti-Infective Agents, Local/pharmacology , Chlorhexidine/pharmacology , Disinfection/methods , Hand Disinfection/methods , Nanocapsules/chemistry , 1-Propanol/pharmacology , Bacteria, Aerobic/drug effects , Bacteria, Anaerobic/drug effects , Cross-Over Studies , Drug Delivery Systems , Ethanol/pharmacology , Gels/chemistry , Hand/microbiology , Humans , Microbial Sensitivity Tests , Osmosis , Skin/microbiology , Staphylococcus epidermidis/drug effectsABSTRACT
The present mini-review explores the current methods used for the delivery of antiseptics and topical antimicrobials. Relevance of hand scrub with antiseptic liquid soap (e.g. chlorhexidine, PVP-iodine, triclosan) and alcohol-based hand rub is discussed and compared in terms of bactericidal activity, skin tolerance, and medical staff observance. New strategies for antibacterial delivery focus on the challenge of colloidal drug carrier such as liposomes, micro- and nanoparticles enabling sustained bactericidal effect and effective bacterial targeting.
