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Infection prevention and control
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Loveday et al. (2014) reviewed hand-cleaning preparations. They concluded that, generally, washing hands effectively with soap and water removes transient microorganisms and renders hands socially clean, which is sufficient for most care activities. Antimicrobial soap is not required for the majority of healthcare activities but should be used when there is the potential for resident flora to cause infection i.e., surgical procedures. Some antiseptics such as chlorhexidine gluconate have a residual effect, which can be beneficial where it is desirable to have sustained suppression of the growth of microorganisms. Alcohol-based hand sanitisers come in many forms; rub, gel and foam and provide an effective way to rapidly clean the hands, reducing both transient and resident flora, particularly in those locations with limited access to clean water. However, alcohol-based products are rapidly inactivated in the presence of organic matter and so should not be used on visibly soiled hands, nor are they effective against spores, so should not be used when caring for individuals with C. difficile. Alcohol hand rubs have been shown to increase the frequency of hand hygiene and so improve hand hygiene compliance, particularly if located at the point of care (Wilson 2019).
Epidemiology of Acinetobacter spp.: Surveillance and Management of Outbreaks
Published in E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner, Acinetobacter, 2020
M.-L. Joly-Guillou, C. Brun-Buisson
It has been reported that Acinetobacter spp. can survive exposure to chlorhexidine, gluconate and phenol-based disinfectants, particularly if the exact recommended concentrations are not strictly adhered to (Berry et al., 1990). The presence of contaminating organic matter was shown to favour the survival of Acinetobacter spp. in the presence of disinfectants. In addition, radiation resistance of Acinetobacter clinical isolates was demonstrated by Christensen et al. (1991). Radiation resistance has been described previously for genomic species 12 (A. radioresistens), but some other species, including A. baumannii and A. Iwoffii, were shown in this study to have increased their radiation resistance compared with similar isolates collected in 1970. These results indicate that special attention should be paid to medical devices that are normally sterilised by irradiation, and particularly devices used in ICUs.
Drug Therapy in Laryngology and Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Mouthwashes are usually aqueous solutions in a concentrated form of substances with deodorant, antiseptic, local anaesthetic or astringent properties. Sometimes they should be diluted before use. They have a mechanical cleansing action. Hydrogen peroxide mouthwash is a 6% solution and 15 mL should be diluted in half a cup of warm water two to three times daily. It contains an oxidizing agent and is useful in the treatment of acute ulcerative gingivitis. It froths in contact with oral debris, thereby having a mechanical cleansing effect, hence its use in the management of secondary tonsillectomy haemorrhages. Chlorhexidine gluconate, used when tooth-brushing is not possible or in combating oral infection, inhibits plaque formation on teeth but has the side effect of causing reversible brown staining of the teeth. Since chlorhexidine gluconate can interact with some of the ingredients in toothpaste, a 30-minute interval is advised between using this mouthwash and toothpaste.1
Clinical evidence for washing and cleansers in acne vulgaris: a systematic review*
Published in Journal of Dermatological Treatment, 2018
Thomas Stringer, Arielle Nagler, Seth J. Orlow, Vikash S. Oza
Chlorhexidine gluconate may act through a dual mechanism by permitting its vehicle, macrogol, to dissolve free fatty acids on the skin while acting as an antimicrobial (16). Hibiclens (4% chlorhexadine gluconate) has been tested against a 5% BP leave-on formulation (Oxy 5®) and two components of Hibiclens’® vehicle in 50 mild-moderate facial AV patients over a twelve-week period (17). No statistical differences were found between Hibiclens and the BP leave-on formulation, and both significantly improved AV counts compared to vehicle (p < .001). Chlorhexidine gluconate cleanser was able to significantly reduce mean comedone count compared to BP (p < .05). Though chlorhexidine performed well against BP therapy in this trial, given the scarcity of patient-centered evidence and oft-reported side effects of skin irritation it is difficult to issue a recommendation as monotherapy for mild AV (18).
Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections
Published in Cogent Medicine, 2019
Marc Darrow, Brent Shaw, Nicholas Schmidt, Gabrielle Boeger, Saskia Budgett
Patients were in the prone position and sterilized with 10% Povidone-Iodine on the skin above the posterior superior iliac spine (PSIS). Next, 4% Chlorhexidine Gluconate (Hibiclens) was administered with sterile gauze in a circular motion starting at the PSIS. Patients were then anesthetized with 10 cc of 1% lidocaine and 2 cc of 8.4% sodium bicarbonate, injected locally on and around the patient’s posterior superior iliac spine. After local anesthesia was achieved, a fenestrated 11 gauge, 4-inch disposable needle was drilled to penetrate the PSIS and extract bone marrow. A 20-cc syringe prepared with 1 cc of heparin (1,000 USP Units/cc) was used to extract bone marrow for a total yield of 19 cc. To maximize stem cell yield and avoid an excess of peripheral blood, the needle was rotated slowly within the ilium cavity and penetrated deeper as required. If the patient received a BMC injection, the aspirated bone marrow was spun in a centrifuge, and the upper portion without visible red cells was isolated from the centrifuged bone marrow. About 1-cc of ropivacaine was added to 5-cc of centrifuged BMC to ensure that the area was less painful after injection. Ropivacaine has shown limited toxicity to MSCs (Breu, Eckl, Zink, Kujat, & Angele, 2013). If the patient received WBM treatment the bone marrow was aspirated and then injected with a filter attachment to prevent clotting. The BMC or WBM was injected by the physician into the glenohumeral joint and labrum under ultrasound guidance with a 2 inch 25 gauge needle, and then into the supraspinatus, infraspinatus, teres minor, and subdeltoid bursa depending on the patient’s pain and pathology determined by our physician.
Advances in non-surgical treatment for pediatric patients with short bowel syndrome
Published in Expert Opinion on Orphan Drugs, 2020
Danielle Wendel, Beatrice E. Ho, Tanyaporn Kaenkumchorn, Simon P. Horslen
Historically, Betadine, a 10% povidone-iodine solution, was used commonly as an antiseptic. Chlorhexidine gluconate has been shown to decrease CLABSI rates in comparison to Betadine and has therefore become standard of care [59]. This change in practice has likely contributed to iodine deficiency in patients on significant PN support. Iodine deficiency has been seen in both pediatric and adult patients with intestinal failure with one pediatric study that showed 33% of patients with hypothyroidism and 85% with low spot urine iodine levels [58,60].