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Edwin Chan - One of the best experts on this subject based on the ideXlab platform.

  • the forgotten role of alcohol a systematic review and meta analysis of the clinical efficacy and perceived role of Chlorhexidine in skin antisepsis
    PLOS ONE, 2012
    Co-Authors: Matthias Maiwald, Edwin Chan
    Abstract:

    Background Skin antisepsis is a simple and effective measure to prevent infections. The efficacy of Chlorhexidine is actively discussed in the literature on skin antisepsis. However, study outcomes due to Chlorhexidine-alcohol combinations are often attributed to Chlorhexidine alone. Thus, we sought to review the efficacy of Chlorhexidine for skin antisepsis and the extent of a possible misinterpretation of evidence. Methods We performed a systematic literature review of clinical trials and systematic reviews investigating Chlorhexidine compounds for blood culture collection, vascular catheter insertion and surgical skin preparation. We searched PubMed, CINAHL, the Cochrane Library, the Agency for Healthcare Research and Quality website, several clinical trials registries and a manufacturer website. We extracted data on study design, antiseptic composition, and the following outcomes: blood culture contamination, catheter colonisation, catheter-related bloodstream infection and surgical site infection. We conducted meta-analyses of the clinical efficacy of Chlorhexidine compounds and reviewed the appropriateness of the authors′ attribution. Results In all three application areas and for all outcomes, we found good evidence favouring Chlorhexidine-alcohol over aqueous competitors, but not over competitors combined with alcohols. For blood cultures and surgery, we found no evidence supporting Chlorhexidine alone. For catheters, we found evidence in support of Chlorhexidine alone for preventing catheter colonisation, but not for preventing bloodstream infection. A range of 29 to 43% of articles attributed outcomes solely to Chlorhexidine when the combination with alcohol was in fact used. Articles with ambiguous attribution were common (8–35%). Unsubstantiated recommendations for Chlorhexidine alone instead of Chlorhexidine-alcohol were identified in several practice recommendations and evidence-based guidelines. Conclusions Perceived efficacy of Chlorhexidine is often in fact based on evidence for the efficacy of the Chlorhexidine-alcohol combination. The role of alcohol has frequently been overlooked in evidence assessments. This has broader implications for knowledge translation as well as potential implications for patient safety.

Matthias Maiwald - One of the best experts on this subject based on the ideXlab platform.

  • the forgotten role of alcohol a systematic review and meta analysis of the clinical efficacy and perceived role of Chlorhexidine in skin antisepsis
    PLOS ONE, 2012
    Co-Authors: Matthias Maiwald, Edwin Chan
    Abstract:

    Background Skin antisepsis is a simple and effective measure to prevent infections. The efficacy of Chlorhexidine is actively discussed in the literature on skin antisepsis. However, study outcomes due to Chlorhexidine-alcohol combinations are often attributed to Chlorhexidine alone. Thus, we sought to review the efficacy of Chlorhexidine for skin antisepsis and the extent of a possible misinterpretation of evidence. Methods We performed a systematic literature review of clinical trials and systematic reviews investigating Chlorhexidine compounds for blood culture collection, vascular catheter insertion and surgical skin preparation. We searched PubMed, CINAHL, the Cochrane Library, the Agency for Healthcare Research and Quality website, several clinical trials registries and a manufacturer website. We extracted data on study design, antiseptic composition, and the following outcomes: blood culture contamination, catheter colonisation, catheter-related bloodstream infection and surgical site infection. We conducted meta-analyses of the clinical efficacy of Chlorhexidine compounds and reviewed the appropriateness of the authors′ attribution. Results In all three application areas and for all outcomes, we found good evidence favouring Chlorhexidine-alcohol over aqueous competitors, but not over competitors combined with alcohols. For blood cultures and surgery, we found no evidence supporting Chlorhexidine alone. For catheters, we found evidence in support of Chlorhexidine alone for preventing catheter colonisation, but not for preventing bloodstream infection. A range of 29 to 43% of articles attributed outcomes solely to Chlorhexidine when the combination with alcohol was in fact used. Articles with ambiguous attribution were common (8–35%). Unsubstantiated recommendations for Chlorhexidine alone instead of Chlorhexidine-alcohol were identified in several practice recommendations and evidence-based guidelines. Conclusions Perceived efficacy of Chlorhexidine is often in fact based on evidence for the efficacy of the Chlorhexidine-alcohol combination. The role of alcohol has frequently been overlooked in evidence assessments. This has broader implications for knowledge translation as well as potential implications for patient safety.

Michael W Ellis - One of the best experts on this subject based on the ideXlab platform.

Visanu Thamlikitkul - One of the best experts on this subject based on the ideXlab platform.

  • randomized controlled trial and meta analysis of oral decontamination with 2 Chlorhexidine solution for the prevention of ventilator associated pneumonia
    Infection Control and Hospital Epidemiology, 2008
    Co-Authors: Hutsaya Tantipong, Chantana Morkchareonpong, Songyod Jaiyindee, Visanu Thamlikitkul
    Abstract:

    OBJECTIVE: To determine the effectiveness of oral decontamination with 2% Chlorhexidine solution for the prevention of ventilator-associated pneumonia (VAP). DESIGN: Randomized controlled trial and meta-analysis. SETTING: A tertiary care university hospital in Bangkok, Thailand. PARTICIPANTS: Adult patients who received mechanical ventilation and who were hospitalized in intensive care units and general medical wards. METHODS: The patients were randomized to receive oral decontamination with 2% Chlorhexidine solution or normal saline solution 4 times per day until their endotracheal tubes were removed. The outcome measures were the development of VAP and oropharyngeal colonization with gram-negative bacilli. Meta-analysis was performed by combining the results of the present study with those from another randomized controlled trial that also used a 2% Chlorhexidine formulation for oral decontamination. RESULTS: The characteristics of the patients in the Chlorhexidine group (n=102) and the normal saline group (n=105) were not significantly different. The incidence of VAP in the Chlorhexidine group was 4.9% (5 of 102), and the incidence in the normal saline group was 11.4% (12 of 105) (P=.08). The rate of VAP in the Chlorhexidine group was 7 episodes per 1,000 ventilator-days, and the rate in the normal saline group was 21 episodes per 1,000 ventilator-days (P=.04). Irritation of the oral mucosa was observed in 10 (9.8%) of the patients in the Chlorhexidine group and in 1 (0.9%) of the patients in the normal saline group (P=.001). Oropharyngeal colonization with gram-negative bacilli was either reduced or delayed in the Chlorhexidine group. Overall mortality of the patients did not differ significantly between the groups. Meta-analysis of 2 randomized controlled trials revealed an overall relative risk of VAP for patients in the Chlorhexidine group of 0.53 (95% confidence interval, 0.31-0.90; P=.02). CONCLUSION: Oral decontamination with 2% Chlorhexidine solution is an effective and safe method for preventing VAP in patients who receive mechanical ventilation.

Premanand M Kamath - One of the best experts on this subject based on the ideXlab platform.

  • antimicrobial activity of 2 5 sodium hypochlorite and 0 2 Chlorhexidine gluconate separately and combined as endodontic irrigants
    Journal of Endodontics, 1998
    Co-Authors: Jane Rachel Kuruvilla, Premanand M Kamath
    Abstract:

    Sodium hypochlorite irrigant is known to be toxic to periapical tissues. Chlorhexidine gluconate, a safer and effective antimicrobial irrigant, is not known to dissolve pulpal tissues. To obtain their optimal properties, their combined action within the root canal was evaluated. Ten single rooted nonvital anterior teeth were irrigated using either 2.5% sodium hypochlorite alone, 0.2% Chlorhexidine gluconate alone, 2.5% sodium hypochlorite and 0.2% Chlorhexidine gluconate combined within the root canal, or 0.9% saline, respectively. Microbiological samples for culture and Gram's staining were taken before and proceeding irrigation. This study indicates that the use of sodium hypochlorite and Chlorhexidine gluconate combined within the root canal resulted in the greatest percentage reduction of postirrigant positive cultures. This may be due to formation of “Chlorhexidine chloride,” which increases the ionizing capacity of the Chlorhexidine molecule. This reduction was significant compared to use of sodium hypochlorite alone but not significant compared to use of Chlorhexidine gluconate alone.