Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter–related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?

McCann, Margaret; Fitzpatrick, Fidelma; Mellotte, George; Clarke, Michael

doi:10.1016/j.ajic.2016.02.019

Cited by 13 publications

(5 citation statements)

References 5 publications

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“…After 4 h incubation with CLH-coated PVC, logarithmic reductions of up to 2.0 in the planktonic S. aureus suspension were achieved relative to the bacterial population in contact with the uncoated PVC, and after 24 h the logarithmic reductions in planktonic P. mirabilis approximated 6.0 in the presence of CLH-coated PVC. Chlorhexidine solutions and dressings are routinely used to cleanse central venous catheter exit sites toward the prevention of catheter-associated bloodstream infections, and while similar solutions have been used for periurethral cleansing before indwelling catheterization, there are to-date no marketed catheters containing this agent localized at the surface. − The facile manipulation, drug incorporation, and drug-releasing capabilities of the lubricious surfaces engineered herein offer exciting potential for increasing resistance of biomaterial surfaces to colonizing bacteria and ultimately preventing associated infections.…”

Section: Resultsmentioning

confidence: 99%

Multifunctional, Low Friction, Antimicrobial Approach for Biomaterial Surface Enhancement

Irwin

Bryant

McCoy

et al. 2020

ACS Appl. Bio Mater.

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Poly(vinyl chloride) (PVC) biomaterials perform a host of life-saving and life-enhancing roles when employed as medical devices within the body. High frictional forces between the device surface and interfacing tissue can, however, lead to a host of complications including tissue damage, inflammation, pain, and infection. We herein describe a versatile surface modification method using multifunctional hydrogel formulations to increase lubricity and prevent common device-related complications. In a clinically relevant model of the urinary tract, simulating the mechanical and biological environments encountered in vivo, coated candidate catheter surfaces demonstrated significantly lower frictional resistance than uncoated PVC, with reductions in coefficient of friction values of more than 300-fold due to hydration of the surface-localized polymer network. Furthermore, this significant lubrication capacity was retained following hydration periods of up to 28 days in artificial urine at pH 6 and pH 9, representing the pH of physiologically normal and infected urine, respectively, and during 200 repeated cycles of applied frictional force. Importantly, the modified surfaces also displayed excellent antibacterial activity, which could be facilely tuned to achieve reductions of 99.8% in adherence of common hospital-acquired pathogens, Staphylococcus aureus and Proteus mirabilis, relative to their uncoated counterparts through incorporation of chlorhexidine in the coating matrix as a model antiseptic. The remarkable, and pH-independent, tribological performance of these lubricious, antibacterial, and highly durable surfaces offers exciting promise for use of this PVC functionalization approach in facilitating smooth and atraumatic insertion and removal of a wide range of medical implants, ultimately maintaining user health and dignity.

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Section: Resultsmentioning

confidence: 99%

Multifunctional, Low Friction, Antimicrobial Approach for Biomaterial Surface Enhancement

Irwin

Bryant

McCoy

et al. 2020

ACS Appl. Bio Mater.

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“…Chlorhexidine 2 per cent significantly reduced the number of microorganisms on the skin, but did not reduce the incidence of SSI. In addition, McCann et al 15 found no significant difference in catheter-related or catheter-associated bloodstream infections in patients disinfected with 2 per cent chlorhexidine compared with other concentrations.…”

Section: Discussionmentioning

confidence: 97%

Cluster‐randomized crossover trial of chlorhexidine–alcohol versus iodine–alcohol for prevention of surgical‐site infection (SKINFECT trial)

et al. 2019

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Background: Surgical-site infection (SSI) is a serious surgical complication that can be prevented by preoperative skin disinfection. In Western European countries, preoperative disinfection is commonly performed with either chlorhexidine or iodine in an alcohol-based solution. This study aimed to investigate whether there is superiority of chlorhexidine-alcohol over iodine-alcohol for preventing SSI. Methods: This prospective cluster-randomized crossover trial was conducted in five teaching hospitals. All patients who underwent breast, vascular, colorectal, gallbladder or orthopaedic surgery between July 2013 and June 2015 were included. SSI data were reported routinely to the Dutch National Nosocomial Surveillance Network (PREZIES). Participating hospitals were assigned randomly to perform preoperative skin disinfection using either chlorhexidine-alcohol (0⋅5 per cent/70 per cent) or iodine-alcohol (1 per cent/70 per cent) for the first 3 months of the study; every 3 months thereafter, they switched to using the other antiseptic agent, for a total of 2 years. The primary endpoint was the development of SSI. Results: A total of 3665 patients were included; 1835 and 1830 of these patients received preoperative skin disinfection with chlorhexidine-alcohol or iodine-alcohol respectively. The overall incidence of SSI was 3⋅8 per cent among patients in the chlorhexidine-alcohol group and 4⋅0 per cent among those in the iodine-alcohol group (odds ratio 0⋅96, 95 per cent c.i. 0⋅69 to 1⋅35). Conclusion: Preoperative skin disinfection with chlorhexidine-alcohol is similar to that for iodine-alcohol with respect to reducing the risk of developing an SSI.

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“…The CDC recommends >0.5% chlorhexidine (CHG) with 70% alcohol as the antiseptic of choice (O'Grady et al 2011a). A recent study by McCann et al did not find a statistically significant improvement in CLABSI rates when increasing CHG to 2% in alcohol over more routinely used concentrations (McCann et al 2016). While no agent can completely rid the skin of every microorganism, CHG is proven to be effective over the most common infecting microbes.…”

Section: Appropriate Skin Decontaminationmentioning

confidence: 97%

Insertion Related Infection Prevention with Vascular Access Devices

DeVries

2019

Vessel Health and Preservation: The Right Approach for Vascular Access

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The goal of vascular access devices is to provide for the administration of the therapies required to help the patient recover while causing the least amount of damage to the patient's vascular system. One of the ways to preserve patient vasculature is through the prevention of infections associated with these devices. The central line bundle, created by Peter Pronovost in a landmark study known as the keystone study in Michigan, consists of five components that, when strictly adhered to during the insertion of a central line catheter, are known to reduce the risk of catheter-related BSIs. The five components include hand hygiene, maximal barrier precautions during insertion, use of chlorhexidine as a skin antisepsis, optimal catheter site selection with avoidance of the femoral vein for central venous access in adult patients, and daily review of line necessity with prompt removal of unnecessary lines. These five components to prevent infection during the insertion of a central catheter are reviewed within this chapter. Care and maintenance considerations, equally important in the prevention of infection, are covered in detail throughout the rest of this book.

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Is 2% chlorhexidine gluconate in 70% isopropyl alcohol more effective at preventing central venous catheter–related infections than routinely used chlorhexidine gluconate solutions: A pilot multicenter randomized trial (ISRCTN2657745)?

Cited by 13 publications

References 5 publications

Multifunctional, Low Friction, Antimicrobial Approach for Biomaterial Surface Enhancement

Multifunctional, Low Friction, Antimicrobial Approach for Biomaterial Surface Enhancement

Cluster‐randomized crossover trial of chlorhexidine–alcohol versus iodine–alcohol for prevention of surgical‐site infection (SKINFECT trial)

Insertion Related Infection Prevention with Vascular Access Devices

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