Systematic literature review on surgical site preparation in paediatric surgery.

BACKGROUND: Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age. METHODS: A systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections. RESULTS: In total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted. CONCLUSION: Robust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children. TRIAL REGISTRATION: Prospero registration ( CRD42020166193 ).

Preparación de la piel para la prevención de la Infección del Sitio Operatorio: Revisión de Alcance / Skin Preparation for the Prevention of Surgical Site Infection: A Scoping Review / Preparação da pele para a prevenção da infecção do sítio operatório: revisão do escopo

Resumen Introducción La Infección del sitio operatorio genera un impacto económico y social debido a los altos costos durante la recuperación, la estancia hospitalaria y la afectación de la calidad de vida, por esto, es necesario identificar las intervenciones y recomendaciones para la preparación de la piel, encaminadas a la prevención de la infección del sitio operatorio, basado en la evidencia científica. Materiales y Métodos Se realizó una revisión sistemática de alcance en el marco del Instituto Joanna Briggs y los parámetros Prisma-P. En las bases de datos Medline, OVID, Pubmed, Scielo, BVS y Cochrane, publicadas entre los años 2010-2019, en los idiomas inglés, portuges y español. Resultados Se analizaron 28 artículos. De estos, se identificaron 6 de la categoría general incluidas las guías de prevención de infección del sitio operatorio, 6 para el baño preoperatorio, 6 para la realización del rasurado y 10 de asepsia y antisepsia. Discusión Con respecto al baño preoperatorio, es una práctica recomendada internacionalmente, la evidencia demuestra que esta actividad no representa ningún beneficio; en la categoría de rasurado, la recomendación es no remover el vello a menos que sea absolutamente necesario. Frente a la asepsia del sitio quirúrgico, el aporte es más que todo informativo acerca de los antisépticos y se recomienda el uso de la clorhexidina. Conclusiones De acuerdo a la revisión sistemática de alcance de la literatura, no se evidencia una estandarización en las recomendaciones e intervenciones, para la preparación de la piel en la prevención de Infección del Sitio Operatorio.

Abstract Introduction Surgical Site Infections have an economic and social impact due to high costs during recovery, hospital stay and deterioration in quality of life. Therefore, it is required to identify interventions and recommendations for skin preparation aimed at preventing surgical site infection based on a scientific evidence-based approach. Materials and Methods A systematic scoping review was conducted on English, Portuguese and Spanish articles published in Medline, Ovid, PubMed, Scielo, BVS, and Cochrane in 2010-2019 using the Joanna Briggs Institute approach and Prisma-P parameters. Results After analyzing a total of 28 articles, 6 articles were found to be related to the general category (including guidelines for prevention of surgical site infection), 6 for preoperative bathing, 6 for preoperative hair removal and 10 for asepsis and antisepsis. Discussion Although preoperative bathing is an internationally recognized practice, scientific evidence shows that this activity does not have any benefit. As for preoperative hair removal, it is not recommended except where absolutely necessary. As for surgical asepsis, mostly informative aspects are found about the use of antiseptics and chlorhexidine. Conclusions Based on the systematic scoping review of the literature, a lack of standardization was found regarding interventions and recommendations for skin preparation for the prevention of Surgical Site Infection

Resumo Introdução A Infecção do Local Operatório gera impacto econômico e social devido aos altos custos durante a recuperação, internação e o impacto na qualidade de vida, portanto, é necessário identificar as intervenções e recomendações para o preparo da pele, visando à prevenção de cirurgias da infecção local operativo, com base em evidências científicas. Materiais e Métodos Uma revisão sistemática de alcance foi realizada dentro da estrutura do Instituto Joanna Briggs e dos parâmetros Prisma-P. Nas bases de dados Medline, OVID, Pubmed, Scielo, BVS e Cochrane, publicadas entre os anos 2010-2019, nos idiomas inglês, português e espanhol. Resultados Foram analisados 28 artigos. Destes, 6 foram identificados na categoria geral, incluindo as diretrizes de prevenção de infecção de local cirúrgico, 6 para o banho pré-operatório, 6 para barbear e 10 para assepsia e antissepsia. Discussão Em relação ao banho pré-operatório, é uma prática recomendada internacionalmente, as evidências demonstram que esta atividade não representa nenhum benefício; na categoria de barbear, a recomendação é não remover os pelos, a menos que seja absolutamente necessário. Dada à assepsia do local cirúrgico, a contribuição é principalmente informativa sobre os antissépticos e recomenda-se o uso da clorexidina. Conclusões De acordo com a revisão sistemática do alcance da literatura, não há evidências de uma padronização nas recomendações e intervenções, para o preparo da pele na prevenção da Infecção do Local Operatório.

Addition of Povidone-Iodine to Fluoride Varnish for Dental Caries: A Randomized Clinical Trial.

INTRODUCTION: Dental caries is the most common chronic childhood disease. Products of metabolism by bacteria populating the tooth surface induce development and progression of cavities. OBJECTIVES: We sought to determine whether a polyvinylpyrrolidone-iodine (PVP-I; povidone-iodine) and NaF topical varnish was superior to one containing only NaF in prevention of new dental caries lesions in a single-center randomized active-controlled trial based on a double-blind, parallel-group design. METHODS: The site was Pohnpei State, Federated States of Micronesia. The study population was healthy children 49 to 84 mo old who were enrolled in early childhood education: 284 were randomized (1:1 allocation), and 273 were included in year 1 analysis and 262 in year 2. The test varnish contained 10% PVP-I and 5.0% NaF. The comparator contained only 5.0% NaF but was otherwise identical. Varnishes were applied every 3 mo during 2 y. The primary outcome was the surface-level primary molar caries lesion increment (d2-4mfs) at 2 y. Caries lesion increments from baseline to year 1 and year 2 were compared between conditions with log-linear regression, adjusting for age and sex and whether the tooth was sound at baseline (free of caries lesions). RESULTS: At year 1, the caries lesion increment for primary molars sound at baseline was 0.9 surfaces (SD = 1.5) for the test varnish versus 1.8 (SD = 2.2) for the comparator varnish with fluoride alone (adjusted rate ratio, 0.50; 95% CI, 0.31 to 0.81; P = .005). At year 2, the caries lesion increment for primary molars sound at baseline was 2.3 surfaces (SD = 2.8) for the test varnish as compared with 3.3 (SD = 2.7) for the comparator (adjusted rate ratio, 0.74; 95% CI, 0.52 to 1.03; P = .073). Teeth that were already cavitated at baseline did not show a preventive effect. There were no harms. CONCLUSIONS: A dental varnish containing PVP-I and NaF is effective in the primary prevention of cavities in the primary dentition (NCT03082196). KNOWLEDGE TRANSFER STATEMENT: This study demonstrates that periodic application of a varnish containing NaF and PVP-I is effective in prevention of caries lesions and useful in assessing the potential of combined treatment.

Dilute Povidone-Iodine Solution Prevents Intraoperative Contamination of Sterile Water Basins During Total Joint Arthroplasty.

BACKGROUND: Periprosthetic joint infection is a major complication of total joint arthroplasty (TJA). The intraoperative splash basin has been found to be a potential source of contamination. Although consensus recommendations against the use of splash basin have been made, splash basin use continues to be taught and utilized in practice. This study aims to investigate the effect of dilute betadine addition to the sterile water (SW) contents (0.02% solution) of the splash basin on contamination rates. This intervention could preserve the functionality and preferential use of the splash basin. The primary outcome of this study is the rate of splash basin contamination, with secondary outcomes of prevalence of culture speciation and mean operative times association with the rate of positive cultures. METHODS: Patients undergoing primary TJA were enrolled in a randomized controlled trial with assignment to either the intervention/betadine group, in which dilute betadine was added to the standard SW splash basin, or the control/standard SW group. For a total cohort of 104 patients, a 120 mL aliquot sample of basin fluid was collected at incision ("preprocedure") and closure ("postprocedure"). Samples were cultured and monitored for 48 hours for growth, with further testing as necessary to identify microbial speciation. RESULTS: Of the final 100 postprocedure samples, 0 (0.0%) were positive in the betadine group, while there were 23 (47.9%) positive samples in the SW group (P < .001). Of the positive cultures, the most common species grown were coagulase-negative Staphylococcus, Corynebacterium, and Micrococcus. The mean operative time was an average of 11 minutes longer for cases with positive cultures. CONCLUSION: In conclusion, treating SW splash basins with dilute povidone-iodine (0.02% solution) eliminates intraoperative contamination of splash basins in TJA procedures. This intervention is simple, low cost, and readily implementable, making it a reasonable addition to TJA protocols. LEVEL OF EVIDENCE: Level 1, Controlled Laboratory Study.

Evaluación de un gel antiséptico de aplicación intravaginal para pacientes con infecciones cervicovaginales multitratadas / Evaluation of an antiseptic gel of intravaginal application for multitreated patients for infectious cervicovaginitis

Resumen OBJETIVO: Evaluar la efectividad y seguridad de un gel intravaginal antiséptico, elaborado con agua electrolizada, en el tratamiento de infecciones cervicovaginales bacterianas, fúngicas, parasitarias o mixtas, y en el control de los síntomas típicos en pacientes multitratadas. MATERIALES y MÉTODOS: Estudio clínico, comparativo con el tratamiento convencional, de dos brazos, multicéntrico, al azar, con escalamiento de dosis efectuado en pacientes atendidas entre mayo de 2017 y mayo de 2018 en el servicio de Ginecología y Obstetricia del Hospital General de Ecatepec Las Américas, en el Estado de México y en el Centro Hospitalario Unión, de Colima. Grupo control: esquema convencional, antibiótico-antifúngico (7 días); grupos experimentales, gel antiséptico durante 3, 5 o 10 días. Seguimiento del pH vaginal, agente etiológico y síntomas. RESULTADOS: Se incluyeron 62 pacientes, con límites de edad de 18 y 42 años, con vaginitis bacteriana en 25 de 62, candidiasis 10 de 62, tricomoniasis 6 de 62 o infección mixta en 21 de 62, multitratadas. La aplicación del gel durante 5 o 10 días erradicó el agente etiológico en 14 de 15 y en 18 de 20 pacientes; con el tratamiento control lo lograron 8 de 14 pacientes (p = 0.021 y 0.030, respectivamente). El gel antiséptico aplicado durante 5 o 10 días fue casi 3 veces más eficaz que el tratamiento control para erradicar el agente infeccioso, eliminar los síntomas y normalizar el pH vaginal. CONCLUSIONES: El tratamiento durante 5 o 10 días con el gel antiséptico intravaginal fue casi 3 veces más efectivo que el convencional (antibiótico-antimicótico) en pacientes con cervicovaginitis infecciosa multitratada, útil en la eliminación de los síntomas típicos y bien tolerado.

Abstract OBJECTIVE: To evaluate the efficacy and safety of an intravaginal antiseptic gel, made of electrolyzed water, against bacterial, yeast, parasitic and mixed cervical infections, and to control typical symptoms in multi-treated patients. MATERIALS AND METHODS: Clinical study, comparative with conventional treatment, two arms, multicentric, randomized, with dose escalation carried out in patients attended between May 2017 and May 2018 in the gynecology and obstetrics service of the Hospital General de Ecatepec La Américas, in the Estado de Mexico and the Centro Hospitalario Unión, of Colima. Control group: conventional scheme, antibiotic-antifungal (7 days); Experimental groups, antiseptic gel for 3, 5 or 10 days. Monitoring of vaginal pH, etiologic agent and symptoms. RESULTS: 62 multi-treated patients (18-42 years old) were enrolled, presenting bacterial vaginosis 25/62, yeast infection 10/62, trichomoniasis 6/62 or mixed infection 21/62; bacteria and yeast). Treatment with antiseptic gel during 5 or 10 days eradicated etiological agent, respectively in 14/15 patients and 18/20 patients; control treatment did it in 8/14 patients (p = 0.021, p = 0.026, respectively). Additionally, gel treatment for 5 or 10 days was 3 times more effective than control treatment to eradicate the infection, control symptoms and to normalize vaginal pH. CONCLUSIONS: Intravaginal antiseptic gel (5-10 days) was almost 3 times more effective than conventional therapy (antibiotics/antimycotics) against multi-treated cervical infections; as well as useful to control typical symptoms and well tolerated.

Outcomes of debridement and implant retention in treating periprosthetic joint infection after primary total joint ar?throplasty / 中华骨科杂志

Objective To present clinical effects of debridement, antibiotics, irrigation and retention of implant (DAIR) with integrated antibiotics application in treating periprosthetic joint infection (PJI) occurred within 3 months after primary surgery. Methods We retrospectively analyzed patients who received DAIR between January 2011 and October 2015. A total of 49 pa?tients with a mean age of 62.38±14.56 years (range, 26-82 years) were included in this study, including 29 males and 20 females. There are 27 knees and 22 hips. Twenty?three patients has sinus tract. Failure was defined as subsequent surgical intervention for infection after the index procedure; persistent fistula, drainage, or excessive joint pain at the last follow?up; death related to the PJI; chronic suppression with antibiotics. Results There were 18 (36.7%) culture negative cases and 31 (63.3%) culture positive cases, including 28.6% (14/49) methicillin?sensitive staphylococcus aureus, 4% (2/49) methicillin?resistant staphylococcus aure?us, 2% (1/49) methicillin?resistant staphylococcus epidermidis, 2%(1/49) mixed infection with fungus and so on. Within the 68.34± 14.02 months (range, 39-94 months) follow?up duration, the Knee Society Score (KSS) score was improved from 38.37 ± 12.39 points (range, 18-62 points) pre?operatively to 82.26±10.50 points (range, 49-96 points) post?operatively (t=-17.09, P<0.001). KSS function score was improved from 42.19±10.14 points (range, 26-67 points) pre?operatively to 75.22±11.60 points (range, 41-90 points) post?operatively (t=-12.53, P<0.001). Harris hip score was improved from 47.41±8.39 points (range, 32-58 points) pre?operatively to 86.41±6.07 points (range, 71-96 points) post?operatively (t=-23.38, P<0.001). There were 6 patients receiving sub?sequent surgical intervention as failure. The mean duration from the index surgery to failure was 5.75±3.00 months (range, 1.5-10 months). Conclusion The present protocol of DAIR for dealing with early?stage PJI, which is less than 3 months after primary TKA or THA, is fairly effective.

Efeitos do banho pré-operatório na prevenção de infecção cirúrgica: estudo clínico piloto / Effects of pre-operative bath in the prevention of surgical infection: pilot clinical study / Efectos del baño pre-operatorio en la prevención de la infección quirúrgica: estudio clínico piloto

As infecções articulares periprotéticas ocorridas nas artroplastias do quadril são um grande desafio para o paciente, equipe e instituições de saúde. Estudo do tipo ensaio clínico piloto, randomizado, controlado e cego para avaliar o efeito do banho pré-operatório utilizando as soluções gluconato de clorexidina 4%, polivinilpirolidona iodo (PVP-I) 10% degermante ou sabão sem antisséptico na prevenção de infecção de sítio cirúrgico (ISC), em pacientes submetidos à cirurgia de artroplastia do quadril. A amostra foi composta por 45 pacientes adultos submetidos à cirurgia eletiva de artroplastia total do quadril, que não tinham relato de infecção no local cirúrgico e alergia às soluções utilizadas e que não eram portadores nasais de Staphylococcus aureus. Os grupos de pacientes randomizados apresentaram homogeneidade em relação às características epidemiológicas e clínicas. A taxa de ISC entre os grupos foi de 20% para clorexidina, 6,7 para o PVP-I e sabão sem antisséptico, respectivamente. Não foram encontradas diferenças estatísticas entre os três grupos de intervenção. É necessária cautela ao recomendar o banho pré-operatório com clorexidina como estratégia para reduzir infecção de sítio cirúrgico. Clinical Trials nº NCTO3001102.

Periprosthetic joint infections in hip arthroplasties are a major challenge for the patient, staff, and health institutions. A randomized, controlled, blinded pilot clinical trial to evaluate the effect of the preoperative bath using 4% chlorhexidine gluconate solutions, polyvinylpyrrolidone iodine (PVP-I)10% degermant or non-antiseptic soap in the prevention of surgical site infection (SSI), in patients undergoing hip arthroplasty surgery. The sample consisted of 45 adult patients submitted to elective total hip arthroplasty, who had no reports of infection at the surgical site and allergy to the solutions used, and who were not nasal carriers of Staphylococcus aureus. The groups of patients randomized presented homogeneity in relation to the epidemiological and clinical characteristics. The SSI rate between the groups was 20% for chlorhexidine, 6.7 for PVP-I and soap without antiseptic, respectively. No statistical differences were found between the three intervention groups. Caution is needed when recommending preoperative chlorhexidine bath as a strategy to reduce surgical site infection. Clinical Trials nº NCTO3001102.

Adherence and factors related to acceptance of alcohol for antiseptic hand rubbing among nursing professionals / Adhesión y factores relacionados con la aceptación del alcohol para fricción antiséptica de las manos entre profesionales de enfermería

Abstract OBJECTIVE Identify rates of adhesion and related factors to acceptance of an alcohol based preparation to hands antiseptic friction among nursing professionals in a unit of intensive therapy. METHOD A cross-sectional study, which involved direct observation of hand hygiene opportunities and nursing professionals’ completion of questionnaires, was conducted at a university hospital between January and July 2015. Descriptive and univariate analyses were performed, with a 5% significance level. RESULTS It was observed 956 opportunities of hand hygiene among 46 nursing professionals. The rate of adhesion to alcohol-based handrub (ABH) was 34.8% and about 87.0% preferred handwashing. Nurses used ABH more frequently than nursing technicians (p <0.001), and the report of feeling of clean hands after using the alcohol product was directly related to higher rates of adherence to antiseptic friction through observation (P <0.05). CONCLUSION The finding indicating low ABH usage highlights the need for greater institutional investment in strategies that help health professionals to recognize the advantages of this type of HH with respect to time spent, ease of access to dispensers, effectiveness in eliminating microorganisms, and maintaining skin moisturization.

Resumo OBJETIVO Identificar as taxas de adesão e os fatores relacionados à aceitação do produto alcoólico para fricção antisséptica das mãos entre profissionais da enfermagem de uma unidade de terapia intensiva. MÉTODO Foi realizado um estudo transversal, que envolveu a observação direta de oportunidades de higienização das mãos e o preenchimento de questionários pelos profissionais de enfermagem, em um hospital universitário, entre janeiro e julho de 2015. As análises descritivas e univariadas foram realizadas, com um nível de significância de 5%. RESULTADOS Foram observadas 956 oportunidades de higiene das mãos entre 46 profissionais de enfermagem. A taxa de adesão à fricção antisséptica foi de 34,8% e cerca de 87,0% profissionais relataram preferir a higiene de mãos simples. Enfermeiros realizaram a fricção antisséptica com mais frequência que os técnicos de enfermagem (p<0,001), e o relato da sensação de ter as mãos limpas após o uso do produto alcoólico esteve diretamente relacionado a taxas mais altas de adesão à fricção antisséptica por meio da observação direta (p<0,05). CONCLUSÃO A baixa adesão à fricção antisséptica encontrada aponta para a necessidade de maior investimento da instituição em estratégias que subsidiem os profissionais de saúde a reconhecer as vantagens desse tipo de higiene de mãos quanto ao tempo dispendido, à facilidade de acesso aos dispensadores e, sobretudo, à sua efetividade na eliminação de microrganismos e manutenção da pele hidratada.

Resumen OBJETIVO Identificar las tasas de adhesión y los factores relacionados con la aceptación del producto alcohólico para fricción antiséptica de las manos entre profesionales de enfermería de una unidad de cuidados intensivos. MÉTODO Se llevó a cabo un estudio transversal, que involucró la observación directa de oportunidades de higienización de las manos y el llenado de cuestionarios por los profesionales de enfermería, en un hospital universitario, entre enero y julio de 2015. Los análisis descriptivos y univariados fueron realizados con un nivel de significación del 5%. RESULTADOS Se observaron 956 oportunidades de higiene de las manos entre 46 profesionales de enfermería. La tasa de adhesión a la fricción antiséptica fue del 34,8% y un 87,0% de los profesionales relataron preferir la higiene de manos simple. Enfermeros realizaron la fricción antiséptica con más frecuencia que los técnicos de enfermería (p<;0,001), y el relato de la sensación de tener las manos limpias tras el uso del producto alcohólico estuvo directamente relacionado con tasas más altas de adhesión a la fricción antiséptica por medio de la observación directa (p<;0,05). CONCLUSIÓN La baja adhesión a la fricción antiséptica encontrada señala hacia la necesidad de mayor inversión de la institución en estrategias que subsidien los profesionales sanitarios a reconocer las ventajas de ese tipo de higiene de manos en cuanto al tiempo empleado, la facilidad de acceso a los dispensadores y sobretodo su efectividad en la eliminación de microorganismos y mantenimiento de la piel humectada.

Staphylococcus aureus resistance to topical antimicrobials in atopic dermatitis

Abstract: Background: Topical antimicrobial drugs are indicated for limited superficial pyodermitis treatment, although they are largely used as self-prescribed medication for a variety of inflammatory dermatoses, including atopic dermatitis. Monitoring bacterial susceptibility to these drugs is difficult, given the paucity of laboratory standardization. Objective: To evaluate the prevalence of Staphylococcus aureus topical antimicrobial drug resistance in atopic dermatitis patients. Methods: We conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. We used miscellaneous literature reported breakpoints to define S. aureus resistance to mupirocin, fusidic acid, gentamicin, neomycin and bacitracin. Results: A total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. We found a low prevalence of mupirocin and fusidic acid resistance (1.1% and 5.9%, respectively), but high levels of neomycin and bacitracin resistance (42.6% and 100%, respectively). Fusidic acid resistance was associated with more severe atopic dermatitis, demonstrated by higher EASI scores (median 17.8 vs 5.7, p=.009). Our results also corroborate the literature on the absence of cross-resistance between the aminoglycosides neomycin and gentamicin. Conclusions: Our data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible.

Effect of povidone iodine and hydrogen peroxide on fracture healing: a histomorphometric study on rats.

PURPOSE: To evaluate the effect of povidone iodine and hydrogen peroxide on fracture healing in a rat model. METHODS: The middle section of the right femur of 36 male Sprague Dawley rats was osteotomised with a saw. In the control group (n=9), the wound was irrigated with 100 ml 0.9% saline. In the 10% povidone iodine (n=9), 1% povidone iodine (n=9), and 3% hydrogen peroxide (n=9) groups, the wound was completely soaked with the respective solution for 2 minutes, and then irrigated with 100 ml saline. The osteotomy was fixed with an intramedullary Kirschner wire. Rats were euthanised at week 1, 2, and 5. In each femur, the percentage area of osseous, cartilaginous, and fibrous tissue in the callus was evaluated in 3 slides (one median and 2 paramedian). RESULTS: The control group differed significantly to the other 3 groups (p=0.023 to p<0.001) in weeks 1, 2, and 5, except for the 1% povidone iodine group in terms of percentage of osseous (p=0.349) and fibrous (p=0.999) tissue. The healing process was similar in the 1% povidone iodine group and the control group, whereas healing was impaired in the 10% povidone iodine group and 3% hydrogen peroxide group, as indicated by the lower percentage of osseous tissue, higher percentage of fibrous tissue, and increased percentage of cartilaginous tissue between weeks 2 and 5 (delayed bone healing). CONCLUSION: The 1% povidone iodine solution is recommended as the irrigation adjuvant in fracture surgery.

Advances in infection control / Avanços no controle das infecções

ABSTRACT Several initiatives took place in recent years in relation to nosocomial infection control in order to increase patient safety. Some of these initiatives will be commented in this brief review.

RESUMO Várias iniciativas aconteceram nos últimos anos em relação ao controle das infecções no ambiente hospitalar para aumentar a segurança do paciente. Algumas dessas iniciativas são comentadas nesta breve revisão.

Auxiliary chemical therapies in the treatment of aggressive periodontitis: current aspects / Terapias químicas auxiliares para o tratamento da periodontite agressiva: aspectos atuais

Aggressive periodontitis, a distinct clinical entity of periodontal disease, is characterized by a pronounced episodic and rapid destruction of periodontal tissues and may result in rapid and early loss of teeth. Some studies have shown that conventional mechanical debridement together with oral hygiene is often not sufficient to disease control. Recent studies of this condition have shown beneficial effects of auxiliary therapies or adjuncts such as the administration of systemic and locally antimicrobials. Among the local adjuncts, the literature presents antiseptics, antibiotics and photodynamic therapy. Antibiotics and anti-inflammatory represent systemic adjuncts. Regardless of the results presented by each of them, the difficulty of establishing a single protocol for all cases is recognized depending on the individual response shown by each patient. The aim of the present study was to review the current results about chemical adjuncts administration associated with conventional treatment in cases of aggressive periodontitis and suggest clinical protocols.

A periodontite agressiva, uma entidade clínica distinta da doença periodontal, é caracterizada por uma pronunciada destruição episódica e rápida dos tecidos periodontais e pode resultar em perda rápida e precoce dos dentes. Alguns trabalhos têm mostrado que o debridamento mecânico convencional juntamente com higiene oral muitas vezes não é suficiente para o controle da doença. Apesar de não existir consenso, estudos recentes desta condição mostram efeitos benéficos de terapias auxiliares ou coadjuvantes como a administração de antimicrobianos sistêmicos e locais. Entre os coadjuvantes locais, a literatura apresenta os antissépticos, antibióticos e terapia fotodinâmica. Dentre os sistêmicos são representados os antibióticos e antiinflamatórios. Independentemente dos resultados apresentados por cada um deles, se reconhece a dificuldade em se estabelecer um protocolo único para todos os casos em função da resposta individual apresentada por cada paciente. O objetivo do presente estudo foi revisar os resultados atuais sobre administração de coadjuvantes químicos associados à terapia convencional em casos de periodontite agressiva e sugerir protocolos clínicos.

The role of antiseptic agents in atopic dermatitis.

The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.

Desafio ao uso das preparações alcoólicas para higienização das mãos nos serviços de saúde / The challenge in the use of alcoholic preparations for hand hygiene in healthcare services

Objetivo: Propor uma reflexão teórica sobre os aspectos relacionados ao uso das preparações alcoólicas para higienização das mãos, no contexto dos serviços de saúde, na perspectiva das recomendações internacionais e nacionais, da eficácia antimicrobiana e fatores associados. Método: Reflexão teórica acerca do uso das preparações alcoólicas para a higienização das mãos nos serviços de saúde, fundamentada nas normativas internacionais e nacionais vigentes. Resultados: A comprovação da eficácia antimicrobiana das preparações alcoólicas por métodos rigorosos que simulam condições práticas de uso é fundamental para a utilização destes produtos nos serviços de saúde. Coexistem ainda outras variáveis envolvidas na eficácia do procedimento de higienização das mãos, tais como a sua duração, o volume do produto a ser aplicado e a aceitabilidade. Conclusão: Identificam-se lacunas nas normativas oficiais, referentes aos aspectos supracitados que podem comprometer um dos componentes mais importantes do controle de infecções e a segurança do paciente.

The role of antiseptic agents in atopic dermatitis

The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.

Incidência de infecção do sítio cirúrgico com o preparo pré-operatório utilizando iodopolividona 10% hidroalcoólica e clorexidina alcoólica 0,5% / Incidence of surgical site infection with pre-operative skin preparation using 10% polyvidone-iodine and 0.5% chlorhexidine-alcohol

OBJETIVO: analisar a incidência de infecção do sítio cirúrgico, quando o preparo pré-operatório da pele foi realizado com iodopolividona 10% em solução hidroalcoólica e clorexidina 0,5% alcoólica, MÉTODOS: estudo longitudinal randomizado, a partir de variáveis obtidas de pacientes submetidos à operações limpas e potencialmente contaminadas. Os envolvidos foram alocados em dois grupos. No grupo 1 (G1) participaram 102 pacientes com pele preparada com iodopolividona e do grupo 2 (G2) 103 que utilizaram clorexidina. No terceiro, sétimo e 30º dia de pós-operatório avaliou-se o sítio cirúrgico, buscando-se sinais de infecção. RESULTADOS: os dados relacionados ao perfil clínico como: diabete melito, tabagismo, alcoolismo, dados hematológicos (Hb, VG e leucócitos), idade e sexo, e as variáveis relativas como: número de dias de internamento pré-operatório, tricotomia, topografia da incisão, antibioticoprofilaxia e a participação de residentes na operação, não foram evidenciadas como fatores predisponentes a infecção do sítio cirúrgico. Dois pacientes do G1 e oito do G2 submetidos à operações limpas apresentaram algum tipo de infecção (p=0,1789), cinco do G1 e três do G2 submetidos à operações potencialmente contaminadas apresentaram algum tipo de infecção (p=0,7205). CONCLUSÃO: a incidência de infecção do sítio cirúrgico em operações classificadas como limpas e potencialmente contaminadas, cujo preparo da pele foi feito com iodopolividona 10% em solução hidroalcoólica e clorexidina alcoólica 0,5%, foi semelhante.

OBJECTIVE: To analyze the incidence of surgical site infection when the preoperative skin preparation was performed with 10% povidone-iodine and 0.5% chlorhexidine-alcohol. METHODS: We conducted a randomized, longitudinal study based on variables obtained from patients undergoing clean and potentially contaminated operations. Those involved were divided into two groups. In group 1 (G1) we included 102 patients with skin prepared with povidone-iodine, and in group 2 (G2), 103, whose skin was prepared with chlorhexidine. In the third, seventh and 30th postoperative days we evaluated the surgical site, searching for signs of infection. RESULTS: Data related to clinical profile, such as diabetes mellitus, smoking, alcoholism, haematological data (Hb, VG and leukocytes), age and gender, and the related variables, such as number of days of preoperative hospitalization, shaving, topography of incision, antibiotic prophylaxis and resident participation in the operation were not predisposing factors for surgical site infection. Two patients in G1 and eight in G2 undergoing clean operations had some type of infection (p = 0.1789), five in G1 and three in G2 undergoing potentially contaminated operations had some type of infection (p = 0.7205). CONCLUSION: The incidence of surgical site infection in operations classified as clean and as potentially contaminated for which skin preparation was done with 10% povidone-iodine and 0.5% chlorhexidine-alcohol was similar.

Can a new antiseptic agent reduce the bacterial colonization rate of central venous lines in post-cardiac surgery patients?

BACKGROUND: Central venous (CV) catheters play an essential role in the management of critically ill patients in the Intensive Care Unit (ICU). CV lines are, however, allied to catheter-associated blood stream infections. Bacterial colonization of CV lines is deemed the main cause of catheter-associated infection. The purpose of our study was to compare bacterial colony counts in the catheter site before CV line insertion in two groups of post-cardiac surgery patients: a group receiving Sanosil (an antiseptic agent composed of H2O2 and silver) and a control group. METHODS: This interventional prospective double-blinded clinical trial recruited the patients in three post-cardiac surgery ICUs of a heart center. The participants were divided into interventional (113 patients) and control (136 patients) groups. Sanosil was added to the routine preparation procedure (Chlorhexidine bath one day before and scrub with Povidone-Iodine just before the CV line insertion). After the removal of the CV lines, the catheters tips were sent for culture and evaluation of colony counts. RESULTS: Catheter colonization occurred in 55 (22.1%) patients: 26 (23%) patients in the Sanosil group and 29 (21.3%) in the control group; there was no significant statistical difference between the two groups (p value = 0.75, RR = 1.05, 95% CI: 0.76-1.45). The most common organism having colonized in the cultures of the catheter tips was staphylococcus epidermis: 20 cases in the control group and 16 cases in the intervention group. CONCLUSION: Catheter colonization frequently occurs in post-cardiac surgery patients. However, our results did not indicate the effectiveness of adding Sanosil to the routine preparation procedure with respect to reducing catheter bacterial colonization.

A cluster-randomized controlled trial of handrubs for prevention of infectious diseases among children in Colombia / Ensayo controlado aleatorizado por conglomerados sobre el uso de antisépticos para las manos para la prevención de enfermedades infecciosas en los niños en Colombia

OBJECTIVE: To evaluate the effectiveness of alcohol-based handrubs (ABH) in reducing acute diarrheal diseases (ADD) and acute respiratory infections (ARI) among children 1-5 years of age in childcare centers with limited tap water. METHODS: This was the first cluster-randomized controlled trial in a developing country. The study took place at 42 childcare centers with sporadic and limited water availability in six towns in Colombia. Participants were randomly assigned to use ABH as a complement to handwashing (intervention arm: 21 centers/794 children); or to continue existing handwashing practices (control arm: 21 centers/933 children). ADD and ARI cases were identified through teacher-reported signs and symptoms of illness. Adverse events were monitored. Hazard ratios (HR) were obtained using Cox proportional hazards multivariate regression shared frailty models. RESULTS: Child-days of surveillance totaled 336 038. Loss to follow up was 14.5%. For both ADD and ARI, there were no differences in hazard ratios during the first trimester of the study. In the second and third trimesters, significant reductions in the risk of ADD were found in the intervention compared to control arm (HR = 0.55, P < 0.001 and HR = 0.44, P < 0.001, respectively). There were also significant risk reductions for ARI in the second trimester (HR = 0.80, P < 0.05) and in the third trimester (HR = 0.69, P < 0.001). No adverse events occurred. CONCLUSIONS: ABH effectively prevent ADD and ARI, and are safe. Colombia's national public health policies for prevention of these diseases should include use of ABH, especially in settings where handwashing with soap and water is limited by water availability.

OBJETIVO: Evaluar la eficacia del uso de antisépticos para las manos a base de alcohol en la disminución de las enfermedades diarreicas agudas y las infecciones respiratorias agudas en niños de 1 a 5 años de edad en los centros de atención infantil donde el lavado de las manos con agua y jabón no es factible. MÉTODOS. El presente fue el primer ensayo controlado y aleatorizado por conglomerados llevado a cabo en un país en desarrollo. El estudio tuvo lugar en 42 centros de atención infantil con disponibilidad de agua esporádica y limitada ubicados en seis ciudades de Colombia. Se asignó aleatoriamente a los participantes a usar antisépticos a base de alcohol como complemento del lavado de las manos (grupo de intervención: 21 centros/794 niños) o a continuar llevando a cabo las prácticas de lavado de las manos habituales (grupo de referencia: 21 centros/933 niños). Los casos de enfermedades diarreicas agudas e infecciones respiratorias agudas fueron identificados mediante la notificación de los signos y síntomas de enfermedad por los maestros. Se efectuó un seguimiento de los acontecimientos adversos. Se obtuvieron las razones de riesgos instantáneos (HR) usando modelos de regresión multivariante de riesgos proporcionales de Cox con fragilidad compartida. RESULTADOS: Se alcanzó un total de 336 038 niño-días de vigilancia. La pérdida de contacto durante el seguimiento fue de 14,5%. Durante el primer trimestre del estudio no hubo diferencias en las razones de riesgo para las enfermedades diarreicas agudas ni para las infecciones respiratorias agudas. En el segundo y tercer trimestres se encontraron disminuciones significativas del riesgo de enfermedades diarreicas agudas en el grupo de intervención en comparación con el grupo de referencia (HR = 0,55, P < 0,001 y HR = 0,44, P < 0,001, respectivamente). Para las infecciones respiratorias agudas se observaron disminuciones significativas del riesgo durante el segundo trimestre (HR = 0,80, P ...

Uso da clorexidina como agente preventivo e terapêutico na Odontologia / Chlorhexidine use as a preventive and therapeutic agent in Dentistry

A clorexidina é um antimicrobiano sintético que apresenta alto nível de atividade sem, no entanto, ter os efeitos secundários que a maioria dos antimicrobianos apresenta. Pequenas concentrações de sais de clorexidina são geralmente suficientes para inibir o processo reprodutivo ou exterminar a maioria dos microrganismos, além do que, sendo praticamente isenta de toxicidade e efeitos corrosivos, proporciona extrema segurança no seu emprego. O conhecimento das propriedades e o uso da clorexidina permitem ao cirurgião-dentista desenvolver suas atividades com segurança, voltadas à prevenção e ao tratamento de doenças, além de minimizar os riscos de infecção cruzada à equipe odontológica e ao paciente.

The chlorhexidine is a synthetic antimicrobial agent that has a high level of activity without having side effects that most of antimicrobial present. Small concentrations of chlorhexidine salts are usually sufficient to inhibit the reproductive process or exterminate the most of microorganisms, in addition to that, being free of toxicity and corrosive effects, it provides extreme security in its use. The knowledge of properties and use of chlorhexidine allows dentists to develop their activities in safety and direct to the prevention and treatment of diseases, and minimize the risk of cross infection to dentistry staff and patient.

Proposal for the teaching of the chemical control of supragingival biofilm

The mechanical control of supragingival biofilm is accepted as one of the most important measures to treat and prevent dental caries and periodontal diseases. Nevertheless, maintaining dental surfaces biofilm-free is not an easy task. In this regard, chemical agents, mainly in the form of mouthwashes, have been studied to help overcome the difficulties involved in the mechanical control of biofilm. The aim of this paper was to discuss proposals for the teaching of supragingival chemical control (SCC) in order to improve dentists' knowledge regarding this clinical issue. Firstly, the literature regarding the efficacy of antiseptics is presented, clearly showing that chemical agents are clinically effective in the reduction of biofilm and gingival inflammation when used as adjuvant agents to mechanical control. Thus, it is suggested that the content related to SCC be included in the curricular grid of dental schools. Secondly, some essential topics are recommended to be included in the teaching of SCC as follows: skills and competencies expected of a graduate dentist regarding SCC; how to include this content in the curricular grid; teaching-learning tools and techniques to be employed; and program content.