Chlorhexidine and the prevention of surgical site infection

Surgical site infections (SSI) are a prevalent health care-associated infection (HAl). Prior to the mid-19th century, surgical sites commonly developed postoperative wound complications. It was in the 1860's, after Joseph Lister introduced carbolic acid and the principles of antisepsis that postoperative wound infection significantly decreased. Today, patient preoperative skin preparation with an antiseptic agent prior to surgery is a standard of practice. Povidone-iodine and chlorhexidine gluconate are currently the most commonly used antimicrobial agents used to prep the patient's skin. In this current study, the epidemiology, diagnosis, surveillance and prevention of SSI with chlorhexidine were investigated. The antimicrobial activity of chlorhexidine was assessed. In in-vitro and in-vivo studies the antimicrobial efficacy of 2% (w/v) chlorhexidine gluconate (CHG) in 70% isopropyl alcohol (IPA) and 10% povidoneiodine (PVP-I) in the presence of 0.9% normal saline or blood were examined. The 2% CHG in 70% IPA solutions antimicrobial activity was not diminished in the presence of 0.9% normal saline or blood. In comparison, the traditional patient preoperative skin preparation, 10% PVP-I antimicrobial activity was not diminished in the presence of 0.9% normal saline, but was diminished in the presence of blood. In an in-vivo human volunteer study the potential for reduction of the antimicrobial efficacy of aqueous patient preoperative skin preparations compromised by mechanical removal of wet product from the application site (blot) was assessed. In this evaluation, 2% CHG and 10% povidone-iodine (PVP-I) were blotted from the patient's skin after application to the test site. The blotting, or mechanical removal, of the wet antiseptic from the application site did not produce a significant difference in product efficacy. In a clinical trial to compare 2% CHG in 70% IPA and PVP-! scrub and paint patient preoperative skin preparation for the prevention of SSI, there were 849 patients randomly assigned to the study groups (409 in the chlorhexidine-alcohol and 440 in the povidone-iodine group) in the intention-to-treat analysis. The overall surgical site infection was significantly lower in the 2% CHG in 70% IPA group than in the PVP-I group (9.5% versus 16.1 %, p=0.004; relative risk, 0.59 with 95% confidence interval of 0.41 to 0.85). Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to povidone-iodine in preventing surgical site infection after clean-contaminated surgery.

Infection risk associated with a closed luer access device

The potential for microbial contamination associated with a recently developed needleless closed luer access device (CLAD) (Q-Syte™ Becton Dickinson, Sandy, UT, USA) was evaluated in vitro. Compression seals of 50 multiply activated Q-Syte devices were inoculated with Staphylococcus epidermidis NCTC 9865 in 25% (v/v) human blood and then disinfected with 70% (v/v) isopropyl alcohol followed by flushing with 0.9% (w/v) sterile saline. Forty-eight of 50 (96%) saline flushes passed through devices that had been activated up to a maximum of 70 times remained sterile. A further 25 Q-Syte CLADs that had undergone multiple activations were challenged with prefilled 0.9% (w/v) sterile saline syringes, the external luer tips of which had been inoculated with S. epidermidis NCTC 9865 prior to accessing the devices. None of the devices that had been accessed up to 70 times allowed passage of micro-organisms, despite challenge micro-organisms being detected on both the syringe tip after activation and the compression seals before decontamination. These findings suggest that the Q-Syte CLAD may be activated up to 70 times with no increased risk of microbial contamination within the fluid pathway. The device may also offer protection from the external surface of syringe tips contaminated with micro-organisms. © 2005 Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Polymer optical fiber Bragg grating acting as an intrinsic biochemical concentration sensor

We demonstrate an intrinsic biochemical concentration sensor based on a polymer optical fiber Bragg grating. The water content absorbed by the polymer fiber from a surrounding solution depends on the concentration of the solution because of the osmotic effect. The variation of water content in the fiber causes a change in the fiber dimensions and a variation in refractive index and, therefore, a shift in the Bragg wavelength. Saline solutions with concentration from 0% to 22% were used to demonstrate the sensing principle, resulting in a total wavelength shift of 0.9 nm, allowing high-resolution concentration measurements to be realized.

An intrinsic biochemical concentration sensor using a polymer optical fibre Bragg grating

A new type of fibre-optic biochemical concentration sensor based on a polymer optical fibre Bragg grating (POFBG) is proposed. The wavelength of the POFBG varies as a function of analyte concentration. The feasibility of this sensing concept is demonstrated by a saline concentration sensor. When polymer fibre is placed in a water based solution the process of osmosis takes place in this water-fibre system. An osmotic pressure which is proportional to the solution concentration, will apply to the fibre in addition to the hydraulic pressure. It tends to drive the water content out of the fibre and into the surrounding solution. When the surrounding solution concentration increases the osmotic pressure increases to drive the water content out of the fibre, consequently increasing the differential hydraulic pressure and reducing the POFBG wavelength. This process will stop once there is a balance between the osmotic pressure and the differential hydraulic pressure. Similarly when the solution concentration decreases the osmotic pressure decreases, leading to a dominant differential hydraulic pressure which drives the water into the fibre till a new pressure balance is established. Therefore the water content in the polymer fibre - and consequently the POFBG wavelength - depends directly on the solution concentration. A POFBG wavelength change of 0.9 nm was measured for saline concentration varying from 0 to 22%. For a wavelength interrogation system with a resolution of 1 pm, a measurement of solution concentration of 0.03% can be expected.

An intrinsic biochemical concentration sensor using a polymer optical fibre Bragg grating

A new type of fibre-optic biochemical concentration sensor based on a polymer optical fibre Bragg grating (POFBG) is proposed. The wavelength of the POFBG varies as a function of analyte concentration. The feasibility of this sensing concept is demonstrated by a saline concentration sensor. When polymer fibre is placed in a water based solution the process of osmosis takes place in this water-fibre system. An osmotic pressure which is proportional to the solution concentration, will apply to the fibre in addition to the hydraulic pressure. It tends to drive the water content out of the fibre and into the surrounding solution. When the surrounding solution concentration increases the osmotic pressure increases to drive the water content out of the fibre, consequently increasing the differential hydraulic pressure and reducing the POFBG wavelength. This process will stop once there is a balance between the osmotic pressure and the differential hydraulic pressure. Similarly when the solution concentration decreases the osmotic pressure decreases, leading to a dominant differential hydraulic pressure which drives the water into the fibre till a new pressure balance is established. Therefore the water content in the polymer fibre - and consequently the POFBG wavelength - depends directly on the solution concentration. A POFBG wavelength change of 0.9 nm was measured for saline concentration varying from 0 to 22%. For a wavelength interrogation system with a resolution of 1 pm, a measurement of solution concentration of 0.03% can be expected.