Comparative Effectiveness between Chlorhexidine Gluconate 0.2% and Povidone-Iodine 1% as an Antiseptic to Decrease Density Level of Intraoral Germs in Maxillofacial Fracture Surgery
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Nosocomial infection remains a complex problem in hospitals, with high morbidity and mortality. It cause a longer treatment time and spend a lot of cost. WHO reported nosocomial infection prevalence varies between 3% - 21%, and surgical wound infection include 5% - 34% of the total number of nosocomial infections. This research comparing Chlorhexidine gluconate 0.2% and Povidone iodine 1% as an antiseptic to decrease density level of intraoral germs in maxillofacial fracture surgery. The result is there is no difference between the use of Chlorhexidine gluconate 0.2% and 1% povidone iodine as an antiseptic in reducing the level of intra-oral bacterial density in maxillofacial fracture surgery (p = 0.698). Chlorhexidine gluconate 0.2% as an antiseptic on the intra-oral maxillofacial fractures can significantly reduce the level of intra-oral bacterial density (p = 0.0001). Povidone iodine 1% as an antiseptic on the intra-oral maxillofacial fractures can significantly reduce the level of intra-oral bacterial density (p = 0.0001).Keywords:
Antiseptic
Chlorhexidine gluconate
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The extensive literature on the efficacy of chlorhexidine is reviewed. Personal experience with the substance in the daily and preoperative disinfection of the hands of medical and paramedical personnel in a surgical department, and the medication of surgical wounds, over a period of one year confirmed its low toxicity and long effectiveness against notoriously intractable Gram-negative forms.
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Background: Surgical Site infection (SSI) has been known as a hospital-acquired infection that need a proper and efficient treatment. SSI cause adverse impacts for clients and Hospitals, include length of stay, delayed recovery, those lead morbidity and mortality especially in developing country. This systematic
review aims to compare the effectiveness of Chlorhexidine-alcohol, Chlorhexidine and povidone-iodine to reduce SSI. Method: Literature are obtained by searching the ScienceDirect, Scopus, PubMed and BMJ databases between the year 2013 and 2017. The literature inclusion criteria are those using Randomized Controlled Trial (RCT) design and comparing the use of Chlorhexidine-alcohol, Chlorhexidine and povidone-iodine as skin preparation to reduce SSI. Result: Chlorhexidine-alcohol concentration is mostly used and recommended to reduce SSI. Conclusion: Chlorhexidine-alcohol is more effective on reducing SSI than Chlorhexidine, and povidone-iodine.
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This paper presents a critical analysis of studies regarding the effectiveness of preoperative skin preparation solutions. The aim was to allow evidence based practice at a local level.
Chlorhexidine gluconate
Preoperative care
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To evaluate the positive value of bacterial cultures which were collected soon after various types of ophthalmic surgery, from eyelids and conjunctiva disinfected by dilute chlorhexidine gluconate or povidone-iodine solution.This study evaluated 179 cases (mean age, 65.6 +/- 15.3) (210 eyes) who underwent cataract surgery, vitrectomy and scleral buckling performed by the same surgeon between April 2005 and December 2005. We divided all the cases into two groups: cases whose eyelids and conjunctiva were disinfected with dilute 0.05% solution of chlorhexidine gluconate, and the other cases whose eyelids were disinfected with 10% solution of povidone-iodine, and the conjunctiva was treated with 16 times dilute povidone-iodine solution. Soon after surgery, samples for bacterial culture were scraped from all eyelids and conjunctiva by swabs.From the eyelids, bacteria were detected from 39 of the 107 eyes in the chlorhexidine gluconate group, and 19 of the 103 eyes in the povidone-iodine group (p<0.01). There was no significant difference between the chlorhexidine gluconate and povidone-iodine groups with respect to the number of positive cases from the conjunctiva. However, a higher positive value in bacterial culture collected from eyelids was shown in the chlorhexidine gluconate group.Therefore, based on this result, we consider that povidone-iodine solution has a superior disinfectant effect compared to chlorhexidine gluconate.
Chlorhexidine gluconate
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The aim of the study to assess the effectiveness of povidone iodine mouthwash versus chlorhexidine mouthwash on radiation or chemotherapy induced oral mucositis among cancer patients. A quasi experimental two group pre test post test study was adopted. The study was conducted in Caritas Hospital, Kottayam. The objectives of the study were to assess the radiation or chemotherapy induced oral mucositis in cancer Patients. Assess the effectiveness of povidone iodine mouth wash on radiation or chemotherapy induced oral mucositis in cancer patients. Assess the effectiveness of chlorhexidine mouthwash on radiation or chemotherapy induced oral mucositis in cancer patients. Compare the effectiveness of povidone iodine and chlorhexidine mouth wash on radiation or chemotherapy induced oral mucositis in cancer patients. Purposive sampling technique was adopted to select the desired samples. The samples obtained were 46(each group 23 patients with oral mucositis). The data was collected by means of interview, medical record and through observation checklist (oral mucositis assessment tool). Subjects were assessed with the grade of oral mucosistis before and after povidone iodine mouthwash and chlorhexidine mouthwash. Patients were allotted for treatment either povidone iodine or chlorhexdine mouthwash alternatively. Patients were instructed to rinse their mouth with 10ml of mouthwash and swish it for two minutes in mouth and expectorate it. Treatment was given twice a day daily, and post assessment were done every third day. This was th th continued till the discharge of the patient. In both povidone iodine group and chlorhexidine group maximum of 18th day and minimum of 9th day assessment was done. Paired t value shows the effect of povidone iodine mouth wash ( t = 8.7) and chlorhexidine mouthwash ( t= 4.73) on radiation or chemotherapy induced oral mucositis at the level of 0.05. It was statistically significant. Independent t value (t= 4.78) shows povidone iodine mouthwash is more effective than chlorhexidine mouthwash on radiation or chemotherapy induced oral mucositis. Healing of oral mucositis was faster in povidone iodine group than chlorhexidine group.
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Background: Surgical Site Infections are the third most commonly reported nosocomial infections all over the world 1 .Patient's skin is a major source of pathogens that cause Surgical Site Infection.Povidone-Iodine (5%) is being used for preoperative skin preparation in surgeries since 1955 and is preferred universally.But it fails to control surgical site infection which is a major post operative complication.. Chlorhexidine alcohol has been widely used as an oral antiseptic solution and its efficacy has been recently made it as an antiseptic and disinfectant 2 .This study compares the efficacy of Chlorhexidine-Gluconate (2.5%v/v) & Isopropyl Alcohol (63%) to Povidone-Iodine (5%) in preventing surgical site infections in elective midline laparotomy surgeries.Aim of Study: To compare the efficacy of chlorhexidine alcohol versus povidone iodine for pre-operative skin preparation in preventing surgical site infection in elective midline laparotomies. Materials and Methods: A total of 200 patients were taken for this study. 100 patients underwent draping with chlorhexidine alcohol (Group A) who were compared with 100 patients who underwent draping with povidone iodine (Group B). Variables used in this study are wound infection and ASEPSIS score.Results: In the povidone-iodine group 14 (14%) patients had wound infection and in the chlorhexidine alcohol group 10(10%) patients had wound infection.Even though SSI is lower in chlorhexidine group, the difference was not statistically significant (p value 0.384). Conclusion:There is no significant difference between chlorhexidine alcohol and povidone iodine in preventing surgical site infection in elective midline laparotomy surgeries.
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Chlorhexidine gluconate
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Study Design: This is a prospective comparative study. Objective: We evaluated the efficacy of 2 standard antiseptic solutions, chlorhexidine-gluconate (CHG) and povidone-iodine (PD-I), in eliminating bacterial pathogens from surgical sites in posterior spine surgeries. Summary of Background Data: Previous studies have shown that CHG is more effective for skin antisepsis than PD-I in joint surgeries. However, few studies have investigated the preoperative use of antiseptic solutions in spine surgery. Materials and Methods: A total of 190 patients who received posterior spine surgeries were included in this study. The patients were allocated to the group treated with 0.5% CHG in ethanol (N=98) or 10% PV-I (N=92). Sterile culture swabs were used to obtain samples from the skin area adjacent to the planned incision site before preparation, after preparation, and after wound closure. Results: No differences were found between the CHG-treated and the PD-I-treated groups in the patients’ age, sex, disease status, surgical site, operating time, and intraoperative blood loss. Before surgical skin preparation, bacteria grew in the cultures of specimens of 83.7% of the patients; no significant difference was found between the 2 groups. The common organisms isolated from both the cervical and lumbar spine surgical sites were Staphylococcus sp., Corynebacterium sp., and Bacillus sp. After the skin preparation, there were no significant differences observed in the culture positive rate between the CHG (3.1%) and PD-I (5.1%) ( P =0.49) solutions. The culture positive rates became higher after wound closure (preop=4.2%, postop=8.4%; P =0.07). The positive rate after wound closure in the CHG-treated group (5.1%) was smaller than in the PD-I-treated group (14.1%) ( P =0.046). However, no difference was found in infection rates between the 2 groups. Conclusions: While CHG-ethanol and PD-I were equally effective at eliminating the bacterial flora from the surgical site, CHG-ethanol showed a more favorable long-lasting effect for skin antisepsis in posterior spine surgeries.
Antiseptic
Microbiological culture
Chlorhexidine gluconate
Surgical Site Infection
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