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The Lancet. Microbe Oct 2022Surgical site infection (SSI) is the most common postoperative complication and substantially increases health-care costs. Published meta-analyses and international... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgical site infection (SSI) is the most common postoperative complication and substantially increases health-care costs. Published meta-analyses and international guidelines differ with regard to which preoperative skin antiseptic solution and concentration has the highest efficacy. We aimed to compare the efficacy of different skin preparation solutions and concentrations for the prevention of SSIs, and to provide an overview of current guidelines.
METHODS
This systematic review and network meta-analysis compared different preoperative skin antiseptics in the prevention of SSIs in adult patients undergoing surgery of any wound classification. We searched for randomised controlled trials (RCTs) in MEDLINE, Embase, and Cochrane CENTRAL, published up to Nov 23, 2021, that directly compared two or more antiseptic agents (ie, chlorhexidine, iodine, or olanexidine) or concentrations in aqueous and alcohol-based solutions. We excluded paediatric, animal, and non-randomised studies, and studies not providing standard preoperative intravenous antibiotic prophylaxis. Studies with no SSIs in both groups were excluded from the quantitative analysis. Two reviewers screened and reviewed eligible full texts and extracted data. The primary outcome was the occurrence of SSI (ie, superficial, deep, and organ space). We conducted a frequentist random effects network meta-analysis to estimate the network effects of the skin preparation solutions on the prevention of SSIs. A risk-of-bias and Grading of Recommendations, Assessment, Development, and Evaluation assessment were done to determine the certainty of the evidence. This study is registered with PROSPERO, CRD42021293554.
FINDINGS
Overall, 2326 articles were identified, 33 studies were eligible for the systematic review, and 27 studies with 17 735 patients reporting 2144 SSIs (overall incidence of 12·1%) were included in the quantitative analysis. Only 2·0-2·5% chlorhexidine in alcohol (relative risk 0·75, 95% CI 0·61-0·92) and 1·5% olanexidine (0·49, 0·26-0·92) significantly reduced the rate of SSIs compared with aqueous iodine. For clean surgery, we found no difference in efficacy between different concentrations of chlorhexidine in alcohol. Seven RCTs were at high risk of bias, 24 had some concerns, and two had low risk of bias. Heterogeneity across the studies was moderate (I=27·5%), and netsplitting did not show inconsistencies between direct and indirect comparisons. Five of ten studies that mentioned adverse events related to the skin preparation solutions reported no adverse events, and five reported a total of 56 mild events (mainly erythema, pruritus, dermatitis, skin irritation, or mild allergic symptoms); none reported a substantial difference in adverse events between groups.
INTERPRETATION
For adult patients undergoing a surgical procedure of any wound classification, skin preparation using either 2·0-2·5% chlorhexidine in alcohol or 1·5% olanexidine is most effective in the prevention of SSIs. For clean surgery, no specific concentration of chlorhexidine in alcohol can be recommended. The efficacy of olanexidine was established by a single randomised trial and further investigation is needed.
FUNDING
Dutch Association for Quality Funds Medical Specialists.
Topics: Anti-Infective Agents, Local; Biguanides; Chlorhexidine; Ethanol; GRADE Approach; Humans; Incidence; Iodine; Network Meta-Analysis; Povidone-Iodine; Surgical Wound Infection
PubMed: 35985350
DOI: 10.1016/S2666-5247(22)00187-2 -
BMC Ophthalmology Jan 2020Dr. Gnanasekaran et al. reported the bactericidal activity of various concentrations of povidone iodine (PI) solution in an agar plate experiment of respiratory flora....
Dr. Gnanasekaran et al. reported the bactericidal activity of various concentrations of povidone iodine (PI) solution in an agar plate experiment of respiratory flora. The study design and the pharmacokinetic properties of PI solution ensured that dilute PI would not be effective in this study. These results may not replicate the typical clinical situation and are significantly different than a previously reported agar plate experiment, again owing to subtle but very significant differences in methodology.
Topics: Anti-Infective Agents, Local; Bacteria; Colony-Forming Units Assay; Endophthalmitis; Eye Infections, Bacterial; Humans; Povidone-Iodine; Research Design
PubMed: 31952486
DOI: 10.1186/s12886-020-1313-9 -
Otolaryngologic Clinics of North America Dec 2020This review summarizes the challenges and adaptations that have taken place in rhinology and facial plastics in response to the ongoing coronavirus disease-19 pandemic.... (Review)
Review
This review summarizes the challenges and adaptations that have taken place in rhinology and facial plastics in response to the ongoing coronavirus disease-19 pandemic. In particular, the prolonged exposure and manipulation of the nasal and oral cavities portend a high risk of viral transmission. We discuss evidence-based recommendations to mitigate the risk of viral transmission through novel techniques and device implementation as well as increasing conservative management of certain pathologies.
Topics: COVID-19; Coronavirus Infections; Elective Surgical Procedures; Female; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Male; Mouth; Nasal Cavity; Occupational Health; Pandemics; Patient Safety; Pneumonia, Viral; Rhinoplasty; Rhytidoplasty; Safety Management
PubMed: 33039097
DOI: 10.1016/j.otc.2020.08.002 -
MicrobiologyOpen Sep 2020Ethanol and povidone-iodine (PVP-I) are important microbicides that inactivate bacteria and viruses. The present study provides a review of literature data on the... (Review)
Review
Ethanol and povidone-iodine (PVP-I) are important microbicides that inactivate bacteria and viruses. The present study provides a review of literature data on the concentration-dependent bactericidal and virucidal activity of ethanol and PVP-I in vitro. A systematic search was performed using the meta-database for biomedicine PubMed. Eventually, 74 studies with original data on the reduction of bacterial and viral infectivity using in vitro tests were analyzed. A safe bactericidal effect of ethanol can be expected at concentrations between 60% and 85%, and the exposure times vary between ≤0.5 and ≥5 min. Within an exposure of up to 5 min, 80%-90% ethanol also exerts virucidal/low-level activity, which includes its action against enveloped viruses plus adeno-, noro-, and rotaviruses. For PVP-I, the best bactericidal and virucidal/high-level effect is present at a concentration range of approx. 0.08%-0.9% depending on the free iodine concentration. The maximum exposure times are 5 min for bacteria and 60 min for viruses. The available data may help optimize the significant inactivation of bacteria and viruses in various areas. However, as the conditions in application practice can vary, concrete recommendations for the application can only be derived to a limited extent.
Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antiviral Agents; Bacteria; Disinfectants; Ethanol; Microbial Sensitivity Tests; Microbial Viability; Povidone-Iodine; Viruses
PubMed: 32567807
DOI: 10.1002/mbo3.1097 -
British Dental Journal Jun 2020
Topics: Mouthwashes; Povidone-Iodine
PubMed: 32591671
DOI: 10.1038/s41415-020-1794-1 -
Eye (London, England) Oct 2021
Topics: Anti-Infective Agents, Local; Cataract Extraction; Humans; Povidone-Iodine
PubMed: 33594245
DOI: 10.1038/s41433-021-01447-8 -
Current Pain and Headache Reports Mar 2021This review aims to provide relevant, aggregate information about a variety of disinfectants and antiseptics, along with potential utility and limitations. While not... (Review)
Review
PURPOSE OF REVIEW
This review aims to provide relevant, aggregate information about a variety of disinfectants and antiseptics, along with potential utility and limitations. While not exhaustive, this review's goal is to add to the body of literature available on this topic and give interventional providers and practitioners an additional resource to consider when performing procedures.
RECENT FINDINGS
In the current SARS-CoV2 epidemiological environment, infection control and costs associated with healthcare-associated infections (HAIs) are of paramount importance. Even before the onset of SARS-CoV2, HAIs affected nearly 2million patients a year in the USA and resulted in nearly 90,000 deaths, all of which resulted in a cost to hospitals ranging from US$28 billion to 45 billion. The onset SARS-CoV2, though not spread by an airborne route, has heightened infection control protocols in hospitals and, as such, cast a renewed focus on disinfectants and their utility across different settings and organisms. The aim of this review is to provide a comprehensive overview of disinfectants used in the inpatient setting.
Topics: Chlorine Compounds; Cross Infection; Disinfectants; Ethanol; Formaldehyde; Glutaral; Humans; Hydrogen Peroxide; Iodophors; Oxides; Peracetic Acid; Phenol; Povidone-Iodine; Quaternary Ammonium Compounds; Sodium Hypochlorite; Triazines
PubMed: 33693989
DOI: 10.1007/s11916-021-00938-3 -
British Dental Journal Sep 2020
Topics: Iodine; Povidone-Iodine
PubMed: 32917988
DOI: 10.1038/s41415-020-2127-0 -
Romanian Journal of Ophthalmology 2021Endophthalmitis remains a serious complication following intraocular procedures. Preoperative prophylactic measures for endophthalmitis decrease the morbidity associated... (Review)
Review
Endophthalmitis remains a serious complication following intraocular procedures. Preoperative prophylactic measures for endophthalmitis decrease the morbidity associated with this disease and represent a standard of care prior to ophthalmic surgery. The literature supports as measures for ocular antisepsis: povidone-iodine solution for ocular surface preparation, chlorhexidine in patients with iodine allergy and application of topical antibiotics. Povidone-iodine is regarded as the most effective antiseptic associated with significant reduction in ocular surface bacterial counts. Currently, the recommended preoperative management is the application of 5% povidone-iodine solution in the conjunctival fornix, prior to surgery. This paper reviews the preoperative measures for ocular antisepsis, used in order to decrease the risk of culture-proven endophthalmitis.
Topics: Anti-Infective Agents, Local; Antisepsis; Conjunctiva; Endophthalmitis; Humans; Povidone-Iodine
PubMed: 34179575
DOI: 10.22336/rjo.2021.25 -
Ophthalmology and Therapy Jun 2022Ophthalmologists frequently face patients who refuse asepsis protocols involving povidone-iodine (PI) due to claims of an allergy to iodine. Such patients usually base...
Ophthalmologists frequently face patients who refuse asepsis protocols involving povidone-iodine (PI) due to claims of an allergy to iodine. Such patients usually base this claim on previous reactions to shellfish consumption or to imaging procedures that used iodine-based contrast agents. Allergy to iodine, however, is biologically impossible, and iodine deficiency causes severe developmental problems, including mental retardation. Furthermore, shellfish allergy is due to tropomyosins in muscle tissue, and reactions to intravascular contrast dyes are due to hyperosmolar solutions; neither "allergy" is due to iodine. PI, which contains 9-12% iodine, is the preferred antiseptic for ophthalmic procedures. Experience shows that PI can be administered safely to patients claiming iodine allergy. True allergy to PI is rare and, if indicated, skin patch testing can be performed prior to surgery. Patients who react adversely to highly concentrated (5-10%) PI usually experience toxicity to the corneal and conjunctival epithelium after topical administration. Dilute (0.1-0.25%) PI kills microbes quicker than higher concentrations but for shorter periods of time because the total dose of iodine is smaller. Repeated administration (every 20-30 s) of dilute PI effectively kills microbes for as long as necessary with little risk of epithelial toxicity.
PubMed: 35461399
DOI: 10.1007/s40123-022-00502-1