Nasal photodisinfection and chlorhexidine wipes decrease surgical site infections: a historical control study and propensity analysis

Bryce, Elizabeth; Wong, Tiffany Cho‐Lam; Forrester, Leslie; Masri, Bassam A.; Jeske, Daniel R.; Barr, Keira; Errico, Sonia; Roscoe, Diane

doi:10.1016/j.jhin.2014.06.017

Cited by 42 publications

(23 citation statements)

References 23 publications

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“…In a small cohort study, Bryce et al found that the colonization rates for MSSA and MRSA were 24.4% and 0.9%, respectively, before PDT therapy (94). Of those who received PDT (0.1% methylene blue plus laser), 85% had a reduced S. aureus burden in the anterior nares as measured by semiquantitative colony counts (95).…”

Section: Photodynamic Therapymentioning

confidence: 99%

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Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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Section: Photodynamic Therapymentioning

confidence: 99%

“…Overall compliance was 94%. However, the study was limited, since the benefits of CHG alone compared to PDT alone were not evaluated (94).…”

Section: Photodynamic Therapymentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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“…Furthermore new supporting strategies for effective MRSA decolonization of patients is of interest in respect to control and prevent bacteria spread in hospital daily routine. Bryce et al could demonstrate that the combination of a newly developed nasal photodisinfection device and chlorhexidine decrease surgical site infections [76]. 3068 patients were treated with chlorhexidine 24 h preceding surgeries and additional received an intranasal photodynamic treatment in the pre-operative area [76].…”

Section: Discussionmentioning

confidence: 99%

Strategies to optimize photosensitizers for photodynamic inactivation of bacteria

Maisch

2015

Journal of Photochemistry and Photobiology B: Biology

150

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“…1 Nasal PDT appears to be an attractive technology; however, further studies are needed beyond an observational study design with a post-hoc propensity score analysis to show the utility and effectiveness of this technology, with or without CHG bathing, in preventing SSIs.…”

Section: Sirmentioning

confidence: 99%