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The bacterial biofilm formation in the oral cavity and the microbial activity around the implant tissue represent a potential factor on the interface between bone and implant fixture that could induce an inflammatory phenomenon and generate an increased risk for mucositis and peri-implantitis. The aim of the present clinical trial was to investigate the bacterial quality of a new antibacterial coating of the internal chamber of the implant in vivo at six months. The PIXIT implant (Edierre srl, Genova Italy) is prepared by coating the implant with an alcoholic solution containing polysiloxane oligomers and chlorhexidine gluconate at 1%. A total of 15 healthy patients (60 implants) with non-contributory past medical history (nine women and six men, all non-smokers, mean age of 53 years, ranging from 45–61 years) were scheduled to receive bilateral fixed prostheses or crown restorations supported by an implant fixture. No adverse effects and no implant failure were reported at four months. All experimental sites showed a good soft tissue healing at the experimental point times and no local evidence of inflammation was observed. Real-Time Polymerase Chain Reaction (PCR) analysis on coated and uncoated implants showed a decrease of the bacterial count in the internal part of the implant chamber. The mean of total bacteria loading (TBL) detected in each PCR reaction was lower in treated implants (81,038 units/reaction) compared to untreated implants (90,057 units/reaction) (p < 0.01). The polymeric chlorhexydine coating of the internal chamber of the implant showed the ability to control the bacterial loading at the level of the peri-implant tissue. Moreover, the investigation demonstrated that the coating is able to influence also the quality of the microbiota, in particular on the species involved in the pathogenesis of peri-implantitis that are involved with a higher risk of long-term failure of the dental implant restoration.

背景：抗藥性菌株會引發菌血症、休克及死亡之嚴重後果，也會增加住院天數及醫療消費，影響甚鉅，因此降低抗藥性菌株的散播是非常重要的議題。期望透過專案的進行，降低急診加護病房抗藥性菌株移生個案數，增加重症照護品質。目的：透過專案的進行，降低急診加護病房抗藥性菌株移生個案數，增加重症照護品質。解決方案：專案執行過程中，運用chlorhexidine gluconate（CHG）擦澡標準流程的建立、製作CHG擦澡技術評核表、規劃教育訓練課程、擬定床簾更換頻率、水槽清潔原則、定期稽核等方式，進行專案的分析與改善。結果：2018年10－12月萬古黴素抗藥性腸球菌（Vancomycin-resistant Enterococci）月平均移生個案數由6.08位降低至4.33位，多重抗藥性鮑氏不動桿菌（multidrug-resistant Acinetobacter baumannii）月平均移生個案數由4.08位降至1.33位；後續2019年1－7月間追蹤其成效，分別為4位及0.86位，多重抗藥性鮑氏不動桿菌移生個案數的下降達目標值。結論：本專案的結果支持，透過CHG擦澡的執行，能有效降低抗藥性菌株移生個案數，也降低感染密度，建議CHG擦澡可運用於臨床，提升重症照護品質。

Background Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. Methods Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. Results A total of 3483 patients and 7941 catheters were observed in 16 intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108 catheters, respectively. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28–2.31, p  = 0.68) and CRBSI (HR 1.13, 95% CI 0.34–3.70, p  = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60–0.86, p  < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51–5.15, p  < 0.01). However, gel-dress increased the risk of contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI 1.38–2.71, p  < 0.01). Conclusions We described a similar infection risk for gel-dress and sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of CHG for skin disinfection and CHG-impregnated dressing may significantly increase contact dermatitis. Trials registration These studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235 ).

BackgroundThe excessive usage of chlorhexidine gluconate (CHG) as a broad-spectrum antimicrobial reagent can have a negative impact on the environment and on human health. The aim of this study was to investigate the effectiveness of some plant-derived compounds in reducing the CHG concentration required to exert its antiviral activity.MethodsAntiviral assays were conducted according to EN 14476 (2019) against herpes simplex virus type 1 (HSV-1), H1N1 influenza A virus, and adenovirus type 5 (Ad-5) as enveloped and non-enveloped viral models to assess the synergistic interaction of CHG and natural additive compounds.ResultsThe effective concentration of 0.247 mM CHG against HSV-1 was decreased tenfold in combination with 0.0125 mM salicylic acid, with a titer reduction of 1.47 ⋅ 104 CCID50/ml. The time required for complete inactivation of HSV-1 particles was reduced to 15 min when the virus was exposed to 0.061 mM CHG and 0.0125 mM salicylic acid. Additionally, the presence of salicylic acid protected the CHG activity against interfering substances.ConclusionOur supplemented CHG formulation showed immediate antiviral effectiveness, which is important for management of the infections. CHG can be combined with salicylic acid to exhibit synergistic antiviral activity at lower concentrations and reduce the time required for inactivation. Furthermore, in the presence of interfering substances, the combination has higher antiviral activity than CHG alone.

Chlorhexidine belongs to a group of medicines called antiseptic antibacterial agents. Chlorhexidine is commonly used for the care and clean off the skin, hands, and wounds. In recent years, medicinal and aromatic plants have been used for prevention of disease, maintaining health, and improving disease in traditional and modern medicine as a medicament. According to recent research, cineole is the isolated active agent of eucalyptus oil and possesses antimicrobial activity. It was demonstrated that cineole could enhance the antimicrobial effects of the other antiseptics. The aim of this study was to investigate the efficacy of 1,8-cineole on the antimicrobial effect of chlorhexidine against some microorganisms. The effect of 1,8-cineole on antimicrobial activity of chlorhexidine gluconate (CHG) was tested using seven different microorganisms. In this study, CHG (128-0.125 mg/l) and cineole (512-2 g/l) were analyzed together and separately using checkerboard assay. Interactions between CHG and 1,8-cineole have been identified as synergistic, indifferent, or antagonistic. Synergistic activity was demonstrated between CHG and 1,8-cineole against , methicillin-resistant , , , , and . Indifferent interactions for these compounds were demonstrated against . CHG antiseptic properties were found to be increased when CHG was used in combination with 1,8-cineole. In this way, CHG will reveal stronger effect against microorganisms. Cineole has increased the antimicrobial activity of chlorhexidine gluconate against all microorganisms except In topical application, using cineole in combination with chlorhexidine may be easier, eradicate certain resistant bacteria by increasing the antimicrobial efficacy. : CHG: Chlorhexidine gluconate, MRSA: Methicillin-resistant , MHB: Mueller Hinton broth, SDB: Sabouraud dextrose broth, CFU: Colonyforming unit, FIC: Fractional inhibitory concentration, FICI: FIC index, EO: Eucalyptus oil.

Hematopoietic cell transplantation (HCT) is a promising treatment for hematologic malignancies, but intensive conditioning leads to immunosuppression and susceptibility to healthcare-associated infections (HAI). Despite standard prevention measures, bloodstream infections (BSI) impact a significant percentage of immunocompromised HCT patients. Incidence of BSI can be mitigated by chlorhexidine gluconate (CHG) bathing—an underutilized infection-prevention strategy. Gaining HCT recipients’ perceptions on CHG bathing can inform strategies to improve adherence and enhance patient outcomes. Purpose This study explored patients’ perceived facilitators, barriers, and education/knowledge related to CHG bathing and thus addresses the gap in implementation for immunocompromised HCT patients. Methods This study used a qualitative description approach to explore patients’ perceived facilitators, barriers, and knowledge of CHG bathing. Fourteen HCT recipients (mean 51 ± 16 years) completed semi-structured interviews. Data were analyzed using a rapid qualitative analysis approach to identify themes. Results Participants identified facilitators to using CHG wipes including ease of use, comfort, and staff assistance, along with barriers including wait time, discomfort, and physical challenges. Patient education themes encompassed patient understanding of CHG purpose, perceived ease in learning/application, inconsistent instruction, and inconsistent procedures. Conclusion CHG bathing is a valuable infection prevention strategy for HCT patients. Participants’ perspectives highlight the importance of addressing practical challenges and improving education to enhance adherence. This study contributes insights from HCT recipients, emphasizing the need for patient-centered interventions to reduce HAI and improve overall patient care.

Background Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. Methods A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. Results Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention ( p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Conclusions Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. Trial registration ClinicalTrials.gov, NCT03898115 , Registered 28 March 2019.

Objectives To compare the cytotoxicity of octenidine dihydrochloride and chlorhexidine gluconate at different concentrations on primary human articular chondrocytes and cartilage.Materials and methodsPrimary cultures of human normal adult articular chondrocytes were exposed to octenidine dihydrochloride (0.001562%, 0.003125%, 0.00625%, 0.0125%, 0.025%, 0.05%, and 0.1%), chlorhexidine gluconate (0.003125%, 0.00625%, 0.0125%, 0.025%, 0.05%, 0.1%, and 0.2%), and control (Dulbecco’s modified Eagle medium or phosphate-buffered saline) for 30 s. Normal human articular cartilage explants were exposed to octenidine dihydrochloride (0.1% versus control) and chlorhexidine gluconate (0.1% versus control) for 30 s. The viability of human articular chondrocytes was measured by Trypan blue staining, Cell Proliferation Reagent WST-1, and Live/Dead staining. The proliferation of human chondrocytes was measured using the Cell Proliferation Reagent WST-1. The viability of human articular cartilage explants was measured by using Live/Dead staining.ResultsOctenidine dihydrochloride and chlorhexidine gluconate exposure decreased cell viability and proliferation in a dose-dependent manner in primary human articular chondrocytes. Octenidine dihydrochloride and chlorhexidine gluconate exposure decreased cell viability in human articular cartilage explant cultures.ConclusionThe degree of toxicity varied between octenidine dihydrochloride and chlorhexidine gluconate, with chlorhexidine gluconate being less toxic than octenidine dihydrochloride at the same concentration. Additionally, both octenidine dihydrochloride and chlorhexidine gluconate evaluation had cytotoxic effects on human articular cartilage. Therefore, dosing for the antimicrobial mouthwash ingredients administration would ideally be determined to remain below IC50.Clinical relevanceThese data support the in vitro safety of antimicrobial mouthwashes on primary adult human articular chondrocytes.

Ventriculoperitoneal (VP) shunting is frequently associated with complications of which shunt-related infections are the most common. However, controversies still exist regarding the underlying factors. This study comparing peri-operative skin preparation agents was aimed at determining which factors among previously documented determinants of shunt infection are implicated in our practice setting. Fifty-four patients with hydrocephalus were allotted into two groups (Group I had pre- surgical skin preparation with povidone– iodine while Group II had pre– surgical skin preparation with 2% chlorhexidine gluconate-alcohol prior to VP shunting). The same brand and dose of prophylactic antibiotics were administered in both groups at induction of anaesthesia. Similar irrigation fluid constituted with similar antibiotics at the same concentration was used in both groups. Chhabra brand of VP shunt system as well as the same types of sutures was used for both groups. The patients were followed up over 6 months for VP shunt infection. Analysis of the data collected was done and p-value was set at ≤ 0.05. Of the 54 patients, 14 (25.9%) patients developed post-operative infections, with 9(64.3%) in Group I and the remaining 5(35.7%) in Group II. The infection rate for Group I (9 out of 30) was 30.0% while the infection rate for Group II (5 out of 24) was 20.8%. There was however no statistically significant difference in the rates of infection between both groups ( p  = 0.445). The occurrence of ventriculoperitoneal shunt infection was not found to be dependent on choice of the skin preparatory agent, cadre of the operating surgeon, duration of surgery, patients’ gender, or body mass index (BMI). Findings from this study support previous recommendations that the choice of skin preparation agent for pre-operative skin antisepsis in VP shunting should simply be based on other factors such as the surgeon’s preference, sound knowledge of the agent itself, its efficacy and cost. Type of study: Clinical research. Level of evidence: Level II. Highlights Ventriculoperitoneal (VP) shunting is frequently associated with complications of which shunt-related infections are the most common. Findings from this study support previous recommendations that the choice of skin preparation agent for pre-operative skin antisepsis in VP shunting should simply be based on other factors such as the surgeon’s preference, sound knowledge of the agent itself, its efficacy and cost.

Objective “To establish an HPLC method for the determination of metronidazole and chlorhexidine gluconate in metronidazole and chlorhexidine lotion. Method Using Agilent Eclipse-XDB-C18 chromatographic column, with 0.05 mol·L-1 potassium dihydrogen phosphate solution 1000 ml plus 13.2 ml 10% tetrabutylammonium hydroxide aqueous solution (pH adjusted to 3.5 by phosphoric acid)-acetonitrile (77:23) as Mobile phase, detection wavelength 230 nm. Results The two components could be separated well. The linear ranges of metronidazole and chlorhexidine acetate were 36.33~59.04 μg·ml-1 (r = 0.9994) and 35.45~220.11 μg·ml-1 (r = 1).); The average recoveries were 100.6% and 100.5 %, and the RSD were 0.42% and 0.58%. Conclusion: The method is simple and specific, and the result is more accurate and reliable. Which is suitable for simultaneous determination of two components in compound preparations.