An assessment of the evidence on antiseptics : a consensus paper on their use in wound care (original) (raw)
Related papers
The downside of antimicrobial agents for wound healing
European Journal of Clinical Microbiology & Infectious Diseases, 2018
The use of topical antimicrobials is beneficial for infection control in wound care because wound infection is the major cause of delayed healing. The advantages of topical over systemic antimicrobials include a higher concentration at the target site, fewer systemic adverse effects, and a lower incidence of antimicrobial resistance. Nowadays, topical antimicrobials are divided into three groups: disinfectants, antiseptics, and antibiotics. Only antiseptics and antibiotics can be applied to living skin; therefore, this review will focus only on these groups. The advantages of each topical antimicrobial are well established; however, their disadvantages remain prominent. It is widely known that antiseptics show higher cytotoxicity and a broader spectrum of activity than antibiotics, whereas antibiotics show a higher probability of bacterial resistance development. However, there are still many adverse effects, resulting from each topical antimicrobial. This review aims to summarize the possible adverse effects of commonly used antiseptics (biguanide, silver, iodine, chlorine compounds, and other antiseptics), antibiotics (bacitracin, mafenide, mupirocin, neomycin, and silver sulfadiazine), and natural antimicrobials (curcumin and honey). Moreover, the antimicrobials that should be avoided in particular populations are also summarized in this review in order to increase awareness for antimicrobial selection in those populations.
Preoperative skin antiseptics for preventing surgical wound infections after clean surgery
2013
Abstract Background Clean surgical site infection rates in the month following surgery vary from 0.6% (knee prosthesis) to 5% (limb amputation). Due to the large number of clean surgical procedures conducted annually the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Preoperative skin antisepsis using antiseptics is performed to reduce the risk of SSIs by removing soil and transient organisms from the skin where a surgical incision will be made. Antiseptics are thought to be toxic to bacteria and therefore aid their mechanical removal. The effectiveness of preoperative skin preparation is thought to be dependent on both the antiseptic used and the method of application, however, it is unclear whether preoperative skin antisepsis actually reduces postoperative wound infection, and, if so, which antiseptic is most effective. Objectives To determine whether preoperative skin antisepsis immediately prior to surgical incision prevents SSI and to determine the comparative effectiveness of alternative antiseptics. Search methods For this second update we searched the The Cochrane Wounds Group Specialised Register (searched 7 August 2012), The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7), Ovid MEDLINE (1950 to July Week 4 2012), Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 06, 2012), Ovid EMBASE (1980 to 2012 Week 31), EBSCO CINAHL (2007 to 3 August 2012). Selection criteria Randomised controlled trials evaluating the use of preoperative skin antiseptics applied immediately prior to incision in clean surgery. There was no restriction on the inclusion of reports based on language of publication, date or publication status. Data collection and analysis Data extraction and assessment of risk of bias were undertaken independently by two review authors. Main results Thirteen studies were included in this review (2,623 participants). These evaluated several different types of skin antiseptics - leading to 11 different comparisons being made. Although the antiseptics evaluated differed between studies, all trials involved some form of iodine. Iodine in alcohol was compared to alcohol alone in one trial; one trial compared Povidone iodine (PI) paint (solution type not reported) with soap and alcohol. Six studies compared different types of iodine-containing products with each other and five compared iodine-containing products with chlorhexidine-containing products. There was evidence from one study suggesting that clean wounds treated with 0.5% chlorhexidine in methylated spirits have a reduced risk of SSI compared with PI (in alcohol) treated wounds: RR 0.47 (95% CI 0.27 to 0.82). However, it is important to note that the trial does not report important details regarding the interventions - such as the concentration of PI paint used. The study was classed as being at low risk of bias for the randomisation sequence domain but unclear for allocation concealment and blinded outcome assessment. There was no evidence of a difference in terms of SSI prevention in any other comparison. Overall the risk of bias in included studies was unclear. A mixed treatment comparison was conducted and this suggested that alcohol containing products had the highest probability of being effective - however, again the quality of this evidence was limited by the included studies. Authors' conclusions A comprehensive review of current evidence found evidence that a 0.5% chlorhexidine solution was more effective in preventing SSIs following clean surgery than a PI (in alcohol) paint. However the limited detail regarding the interventions may limit change to practice based on these findings from a single study. Practitioners may therefore elect to consider other characteristics such as costs and potential side effects when choosing between alternatives. Whilst they are relatively rare, SSIs following clean surgery are an important issue given the large number of people undergoing surgery annually world-wide. Given the large number of treatment options, the design of future trials should be driven by the questions of high priority to decision makers. It may be that investment in at least one large trial (in terms of participants) is warranted in order to add definitive and hopefully conclusive data to the current evidence base. Ideally any future trial would evaluate the iodine-containing and chlorhexidine-containing solutions relevant to current practice as well as the type of solution used (alcohol vs. aqueous).
Systematic review of antimicrobial agents used for chronic wounds
British Journal of Surgery, 2001
Background:This paper is one of a series of eight systematic reviews that aim to identify effective interventions for chronic wounds. Here, antimicrobial agents are evaluated.This paper is one of a series of eight systematic reviews that aim to identify effective interventions for chronic wounds. Here, antimicrobial agents are evaluated.Methods:Electronic databases and other relevant sources were accessed to identify published and unpublished material. Studies were eligible for inclusion if they used concurrent controls, recruited participants with chronic wounds, evaluated an intervention designed to prevent or treat chronic wounds, and incorporated an objective assessment of wound healing. All included studies were assessed against a comprehensive checklist for methodological quality. A narrative overview was conducted.Electronic databases and other relevant sources were accessed to identify published and unpublished material. Studies were eligible for inclusion if they used concurrent controls, recruited participants with chronic wounds, evaluated an intervention designed to prevent or treat chronic wounds, and incorporated an objective assessment of wound healing. All included studies were assessed against a comprehensive checklist for methodological quality. A narrative overview was conducted.Results:Thirty trials were included, 25 of randomized design. Small sample size and other methodological problems meant that findings were often difficult to interpret. Results do not support the routine use of systemic antibiotics for leg ulcers or diabetic foot ulcers without acute infection, but they may be useful as an adjunct to surgery for pilonidal sinuses. Several topical preparations may be helpful, including dimethyl sulphoxide, silver sulphadiazine, benzoyl peroxide, oxyquinoline and gentamicin.Thirty trials were included, 25 of randomized design. Small sample size and other methodological problems meant that findings were often difficult to interpret. Results do not support the routine use of systemic antibiotics for leg ulcers or diabetic foot ulcers without acute infection, but they may be useful as an adjunct to surgery for pilonidal sinuses. Several topical preparations may be helpful, including dimethyl sulphoxide, silver sulphadiazine, benzoyl peroxide, oxyquinoline and gentamicin.Conclusion:Most of this research requires replication in larger, well designed studies to establish both clinical and cost effectiveness. © 2001 British Journal of Surgery Society LtdMost of this research requires replication in larger, well designed studies to establish both clinical and cost effectiveness. © 2001 British Journal of Surgery Society Ltd
When antibiotics can be avoided in skin inflammation and bacterial colonization
Current Opinion in Infectious Diseases, 2014
Purpose of review This review looks at the recent evidence on the safety, toxicity, microbiology and the prevention and management of acute and chronic wound infections with regard to antiseptics and antiseptic wound dressings. It is timely and relevant because of the global concerns of antimicrobial resistance and the need to address the inappropriate use of antimicrobials in the healthcare setting. Recent findings There have been a number of recent Cochrane reviews that have concluded that there is little evidence to delineate clinical outcomes between antiseptics and antiseptic dressings. Published in-vitro evidence offers some new techniques and evaluates some new dressings and antiseptics. There are no economic evaluations of antiseptics and antiseptic dressings.
Clinical and Microbiological Aspect of Wound Infection: A Review Update
Bangladesh Journal of Infectious Diseases, 2015
Wound infection is frequently found. Infection of the wound happened due to entry of the bacteria through breached skin. These bacteria stop healing and produce sign and symptoms. From the beginning of the civilization scientist are fighting against infection. It is evident that wound infection is a challenging situation for the physicians. Multiple organisms can cause wound infection. For the treatment of infection a large number of antibiotics are used. Both broad spectrum and narrow spectrum antibiotics are available nowadays. It is ideal to give proper antibiotic after culture and sensitivity of the wound swab, pus or infected tissue. Improper and irrational use of antibiotics and genetic and non-genetic drug resistant mechanisms of bacteria lead to drug resistance. Wound infection can be recognized by various sign symptoms. The inflammatory response is a protective mechanism that aims to neutralize and destroy any toxic agents at the site of an injury and restore tissue homeost...
The Open emergency medicine journal, 2013
Background: antibiotic therapy and prophylaxis of epidermal wounds in emergency room are often made empirically in case of clinics due to infective complications, although there are no scientific evidences supporting their validity yet. Furthermore, resistance to many antibiotics is a constantly growing problem, especially in Lombardy, Italy. When needed, better prefer beta-lactams or macrolides for their large-spectrum activity. Methods: We identified all patients (pts) treated to our emergency room for epidermal wounds in a period between 1st and 31st july 2012. Then, we performed a retrospective, observational analysis of epidemiological, clinical and therapeutic features of those pts. <12 years old individuals were exluded. We considered at high risk of infections pts with at least one of the following comorbidities: diabetes, neoplastic disease, therapy with corticosteroids, immunodepression. Results: A total of 201 pts were evaluated, 143 males (71.1%) and 58 females (28.9%). The median age was 46,3 yrs. Among the pts 101 (50.2%) needed treatment with suture. 13 (6.5%) pts came after at least 12 hrs after the accident. 107 (53,2%) pts did not need therapy, while in 82 (40.8%) cases antibiotic prophylaxis (89% beta-lactams, 9.8% macrolides, 1.2% others) has been prescribed; 4 (2%) were adviced to start antibiotic therapy only in case of acute epidermal infection development at home; we don't have this information about 8 pts (4%). In 185 (93.5%) pts clinical signs of acute epidermal infection were missing. 15 (7.5%) pts had an high risk of developing infections in history taking; 3 of them received antibiotic prophylaxis, 8 didn't, 4 not known. In 143 individuals (71,1%) the history taking has been insufficient. Conclusions: Even if acute local infection is possible in wounded pts, only subjects at high risk should be closely screened and monitored to detect early infection, in order to evaluate the necessity of specific antibiotic therapy. Clinical evaluation should also include comorbilities as valvulopathy or immunosuppression.
American journal of infection control, 2016
Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions. To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates. We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization. Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both...
Journal of the American College of Surgeons, 2014
for the Surgical Care and Outcomes Assessment Program Collaborative BACKGROUND: Surgical site infections (SSI) are an important source of morbidity and mortality. Chlorhexidine in isopropyl alcohol is effective in preventing central venous-catheter associated infections, but its effectiveness in reducing SSI in clean-contaminated procedures is uncertain. Surgical studies to date have had contradictory results. We aimed to further evaluate the relationship of commonly used antiseptic agents and SSI, and to determine if isopropyl alcohol has a unique effect. STUDY DESIGN: We performed a prospective cohort analysis to evaluate the relationship of commonly used skin antiseptic agents and SSI for patients undergoing mostly clean-contaminated surgery from January 2011 through June 2012. Multivariate regression modeling predicted expected rates of SSI. Risk adjusted event rates (RAERs) of SSI were compared across groups using proportionality testing.
European Journal of Medical and Health Sciences, 2020
Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109, 5% Po...