Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial

The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open, controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units at a university hospital undergoing chemotherapy for haematological or oncological malignancies requiring central venous catheters (CVCs) expected to remain in place for at least 5 days. Six hundred and one patients with 9,731 catheterization days were studied between January 2004 and January 2006. Patients admitted for chemotherapy received chlorhexidine and silver sulfadiazine-impregnated triple-lumen CVCs under standardized conditions and were randomized to the groups receiving a chlorhexidine gluconate-impregnated wound dressing or a standard sterile dressing. Daily routine included clinical assessment of the insertion site (swelling, pain, redness), temperature, white blood count and C-reactive protein. Catheters remained in place until they were no longer needed or when a CVC-related infection was suspected. Infection was confirmed with blood cultures via the catheter lumina and peripheral blood cultures according to the time-to-positivity method. Six hundred and one patients were included. The groups were comparable with respect to demographic and clinical data. The incidence of CVC-related infections were 11.3% (34 of 301) and 6.3% (19 of 300) in the control and chlorhexidine-impregnated wound dressing groups, respectively (p = 0.016, relative risk 0.54; confidence interval 0.31–0.94). Especially, catheter-related infections at internal jugular vein insertions could be reduced (p = 0.018). No adverse effects related to the intervention were observed. The use of chlorhexidine-impregnated wound dressings significantly reduced the incidence of CVC-related infections in patients receiving chemotherapy.     

A rapid,sensitive, and greener stability-indicating normal-phase HPTLC method with univariate calibration for the estimation of chlorhexidine acetate in its commercial formulations

Till date, there is no report on high-performance thin-layer chromatography (HPTLC) analysis of chlorhexidine (CHD) or its salts like CHD acetate (CHD-A), CHD gluconate, and CHD hydrochloride. Therefore, a rapid, sensitive, and greener normal-phase HPTLC method has been reported for the analysis of CHD-A in its four different commercial dosage forms. The quaternary combination of ethyl acetate: ethanol: water: formic acid (75:10:10:5, v v v v^?1) was optimized as the green solvent system/mobile phase for CHD-A analysis. The CHD-A detection was carried out at 264 nm. The greener normal-phase HPTLC assay was linear in the range of 10–2000 ng band^?1. In addition, the proposed method was accurate, precise, sensitive, and selective for CHD-A analysis. The greener normal-phase HPTLC method was able to detect CHD-A in the presence of its degradation products, suggesting the stability-indicating property of this method. The content of CHD-A in commercial products A, B, C, and D was detected as 0.18, 2.02, 1.46, and 0.19% w w^?1, respectively. The greenness scale for the greener normal-phase HPTLC assay was estimated as 0.88 utilizing “analytical GREEnness (AGREE)” calculator, suggested the greener nature of the normal-phase HPTLC assay. Overall, these data suggested that the greener normal-phase HPTLC method can be successfully used for the determination of CHD-A in its commercial products.     

The effect of mouthrinses on severe acute respiratory syndrome coronavirus 2 viral load: A systematic review

BackgroundConsidering that the oral cavity is a major entryway and reservoir for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the aim of the authors was to perform a systematic review of in vivo and in vitro studies to assess the effectiveness of mouthrinses on SARS-CoV-2 viral load.Types of Studies ReviewedThe authors searched PubMed, Web of Science, Scopus, MedRxiv, and bioRxiv databases, including in vitro and in vivo studies assessing the virucidal effect of mouthrinses on SARS-CoV-2 or surrogates. From a total of 1,622 articles retrieved, the authors included 39 in this systematic review.ResultsPovidone-iodine was the most studied mouthrinse (14 in vitro and 9 in vivo studies), frequently showing significant reductions in viral load in in vitro assays. Similarly, cetylpyridinium chloride also showed good results, although it was evaluated in fewer studies. Chlorhexidine gluconate and hydrogen peroxide showed conflicting results on SARS-CoV-2 load reduction in both in vitro and in vivo studies.Practical ImplicationsPovidone-iodine–based mouthrinses appear to be the best option as an oral prerinse in the dental context for SARS-CoV-2 viral load reduction. Although the results of primary studies are relevant, there is a need for more in vivo studies on mouthrinses, in particular, randomized controlled clinical trials, to better understand their effect on SARS-CoV-2 viral load and infection prevention.     

Phospholipase activity of Candida albicans isolates from patients with denture stomatitis: the influence of chlorhexidine gluconate on phospholipase production

BACKGROUND AND OBJECTIVES: The extracellular phospholipases of Candida albicans are considered to play a significant role in the pathogenesis of human infections. Therefore 23 clinical oral isolates of C. albicans from patients with denture stomatitis and 22 commensal oral isolates obtained from the palatal mucosa of healthy subjects were assayed for phospholipase activity. It is generally accepted that chlorhexidine gluconate is an appropriate adjunct or an alternative to antimycotic therapy in the management of oral candidiasis. However, the intraoral concentrations of this antiseptic fluctuate considerably due to the dynamics of the oral cavity. So the second main objective of this study was to investigate the effect of brief exposure (30 min) to two sub-therapeutic concentrations (0.002% and 0.0012%) of chlorhexidine gluconate on the value of phospholipase production (Pz) of C. albicans. METHOD: An in vitro phospholipase production was done by plate assay method using an egg yolk-agar medium. RESULTS: No significant differences were found in the number of C. albicans isolates producing phospholipase between two groups. However, the mean value of Pz produced by the isolates from patients with denture stomatitis was significantly (p<0.05) higher than the commensals. Exposure of the isolates to 0.002% and 0.0012% chlorhexidine led to a significant (p<0.001 and p<0.01, respectively) reduction in the amount of phospholipase. CONCLUSION: The results of this study imply that sub-therapeutic levels of chlorhexidine may modulate candidal phospholipase activity, thereby suppressing pathogenicity of C. albicans.     

The danger of chlorhexidine in lignocaine gel: A case report of anaphylaxis during urinary catheterisation

This article describes a case of anaphylaxis secondary to chlorhexidine during urethral catheterisation. Despite little evidence for the use of antiseptic lubricants in preventing catheter-associated urinary tract infections, the distribution and use of such products continues to be widespread. Chlorhexidine-free lubricating gel is widely available and should be used for urological procedures wherever possible.     

HPLC法测定复方醋酸氯己定洗剂中醋酸氯己定和克霉唑含量

目的:建立复方醋酸氯己定洗剂的含量测定方法.方法:采用高效液相色谱法,μBndapak-C18柱(5μm,250 mm×3.9 mm);流动相为乙腈-甲醇-水(21:37:42),每1000ml内含磷酸5ml,三氟乙酸1 ml,三乙胺调pH3.9～4.0;流速为1 ml·min-1;检测波长为230 nm.结果:醋酸氯己定和克霉唑分别在10～125μg·m1和2～25 μg·ml-1范围内线性关系良好;平均回收率分别为95.6%及96.5%(RSD 1.2%,1.5%).结论:本法色谱分离效率高,专属性好,同时测定两种成份,方法简便.