Antimicrobial Assay of Chlorhexidine-Wetted Textile Napkins for Surgical Site Disinfection in Ocular Surgery
Author(s)
Amir Reza Daneshmand Eslami*
Affiliation(s)
Department of Ophthalmology, National Medical Academy of Postgraduate Education, Kiev, Ukraine.
Department of Ophthalmology, National Medical Academy of Postgraduate Education, Kiev, Ukraine.
ABSTRACT
Background: As a new intraoperative disinfection method, chlorhexidine-wetted textile napkins have been employed in order to cover the upper and lower eyelid edges, eyelid skin, eyelashes, lid margins and palpebral conjunctiva during phacoemulsification cataract extraction. This study was conducted to compare the antimicrobial activity of textile napkins before and after their use. Methods: This study evaluated 80 textile napkins wetted with 0.02% aqueous solution of chlorhexidine. All textile napkins were divided into groups. The study group consisted of 60 used textile napkins which were collected from 29 patients (30 eyes) at the end of phacoemulsification, and the control group included 20 unused sterile textile napkins. Antimicrobial assay was performed by means of measuring the growth inhibition zones of the standard or clinical isolate strains under the textile napkins on the surface of agar media. Results: The number of textile napkins and the diameter of the growth inhibition zones (mm) in the study group and in the control group relating to gram-positive, gram-negative, and fungi were: 24/31 vs. 8/31, 32/30 vs. 8/30, and 4/30 vs. 4/30. The diameter of the growth inhibition zones of gram-positive bacteria was more than other investigated microorganisms. In the growth inhibition zones, exogenous microorganism colonies were not found. Conclusion: Antimicrobial activity of textile napkins wetted with 0.02% aqueous solution of chlorhexidine against gram-positive bacteria is more than gram-negative bacteria and fungi, and is preserved to the end of the phacoemulsification.
KEYWORDS
Chlorhexidine; Endophthalmitis; Levofloxacin; Phacoemulsification; Surgical Site Disinfection
Chlorhexidine; Endophthalmitis; Levofloxacin; Phacoemulsification; Surgical Site Disinfection
Cite this paper
A. Eslami, "Antimicrobial Assay of Chlorhexidine-Wetted Textile Napkins for Surgical Site Disinfection in Ocular Surgery," International Journal of Clinical Medicine, Vol. 4 No. 12, 2013, pp. 577-581. doi: 10.4236/ijcm.2013.412099.
A. Eslami, "Antimicrobial Assay of Chlorhexidine-Wetted Textile Napkins for Surgical Site Disinfection in Ocular Surgery," International Journal of Clinical Medicine, Vol. 4 No. 12, 2013, pp. 577-581. doi: 10.4236/ijcm.2013.412099.
References
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http://dx.doi.org/10.1016/S0161-6420(01)00899-5 [14] A. Safar and M. C. Dellimore, “The Effect of Povidone Iodine Flush versus Drops on Conjunctival Colonization before Intravitreal Injections,” International Ophthalmology, Vol. 27, No. 5, 2007, pp. 307-312.
http://dx.doi.org/10.1007/s10792-007-9073-6 [15] D. S. Hughes and R. J. Hill, “Infectious Endophthalmitis after Cataract Surgery,” British Journal of Ophthalmology, Vol. 78, No. 3, 1994, pp. 227-232.
http://dx.doi.org/10.1136/bjo.78.3.227 [16] M. N. Shi, H. J. Guan, Y. J. Ye, M. S. Chen and C. T. Yu, “Comparative Study of Gentamycin and Povidone-Iodine on Eliminating the Conjunctival Bacteria,” Chinese Journal of Ophthalmology, Vol. 44, No. 12, 2008, pp. 1098-1102. [17] J. Feys, A. Salvanet-Bouccata, J. P. Emond and A. Dublanchet, “Vancomycin Prophylaxis and Intraocular Contamination during Cataract Surgery,” Journal of Cataract Refractive Surgery, Vol. 23, No. 6, 1997, pp. 894-897.
http://dx.doi.org/10.1016/S0886-3350(97)80250-7 [18] J. C. Lloyd and R. Braga-Mele, “Incidence of Postoperative Endophthalmitis in a High-Volume Cataract Surgicentre in Canada,” Canadian Journal Ophthalmology, Vol. 44, No. 3, 2009, pp. 288-292.
http://dx.doi.org/10.3129/i09-052 [19] G. A. Peyman, P. L. Lee and D. V. Seal, “Endophthalmitis,” Martin Dunitz, London, 2004. [20] M. B. Hamill, M. S. Osato and K. R. Wilhelmus, “Experimental Evaluation of Chlorhexidine Gluconate for Ocular Antisepsis,” Antimicrobial Agents and Chemotherapy, Vol. 26, No. 6, 1984, pp. 793-796.
http://dx.doi.org/10.1128/AAC.26.6.793 [21] M. T. Suller and A. D. Russell, “Antibiotic and Biocide Resistance in Methicillin-Resistant Staphylococcus Aureus and Vancomycin-Resistant Enterococcus,” Journal of Hospital Infection, Vol. 43, No. 4, 1999, pp. 281-291.
http://dx.doi.org/10.1016/S0195-6701(99)90424-3 [22] E. Dabrowska, M. Letko, W. Roszkowska-Jakimiec, R. Letko and J. Sadowski, “Effect of Chlorhexidine Mouthrinse on Cathepsin C Activity in Human Saliva,” Advances in Medical Sciences, Vol. 51, No. 1, 2006, pp. 96-99. [23] T. Gershanik, S. Benzeno and S. Benita, “Interaction of a Self-Emulsifying Lipid Drug Delivery System with the Everted Rat Intestinal Mucosa as a Function of Droplet Size and Surface Charge,” Pharmaceutical Research, Vol. 15, No. 6, 1998, pp. 863-869.
http://dx.doi.org/10.1023/A:1011968313933 [24] S. Tamilvanan, “Oil-in-Water Lipid Emulsions: Implications for Parenteral and Ocular Delivering Systems,” Progress in Lipid Research, Vol. 43, No. 6, 2004, pp. 489-533. http://dx.doi.org/10.1016/j.plipres.2004.09.001 [25] Y. Rojanasakul and J. R. Robinson, “Transport Mechanisms of the Cornea: Characterization of Barrier Permselectivity,” International Journal of Pharmaceutics, Vol. 55, No. 2-3, 1989, pp. 237-246.
http://dx.doi.org/10.1016/0378-5173(89)90047-1 [26] J. Liaw, Y. Rojanasakul and J. R. Robinson, “The Effect of Drug Charge Type and Charge Density on Corneal Transport,” International Journal of Pharmaceutics, Vol. 88, No. 1-3, 1992, pp. 111-124.
http://dx.doi.org/10.1016/0378-5173(92)90308-O
[1] G. A. Peyman, J. T. Paque and H. I. Meisels, “Postoperative Endophthalmitis: A Comparison of Methods for Treatment and Prophylaxis with Gentamicin,” Ophthalmic Surgery, Vol. 6, No. 1, 1975, pp. 45-55. [2] A. Pathengay, M. Khera, T. Das, S. Sharma, D. Miller and H. W. Flynn Jr., “Acute Postoperative Endophthalmitis Following Cataract Surgery: A Review,” Asia-Pacific Journal of Ophthalmology, Vol. 1, No. 1, 2012, pp. 35-42. http://dx.doi.org/10.1097/APO.0b013e31823e574b [3] C. B. Walker and C. M. Claoue, “Incidence of Conjunctival Colonisation by Bacteria Capable of Causing Post-Operative Endophthalmitis,” Journal of the Royal Society of Medicine, Vol. 79, No. 9, 1986, pp. 520-521. [4] M. G. Speaker, F. A. Milch, M. K. Shah, W. Eisner and B. N. Kreiswirth, “Role of External Bacterial Flora in the Pathogenesis of Acute Postoperative Endophthalmitis,” Ophthalmology, Vol. 98, No. 5, 1991, pp. 639-649.
http://dx.doi.org/10.1016/S0161-6420(91)32239-5 [5] G. W. Denton, “Chlorhexidine,” In: S. S. Block, Ed., Disinfection, Sterilization, and Preservation, 5th Edition. Lippincot Williams & Wilkins, Philadelphia, 2001, pp. 321-336. [6] N. M. Sergienko, Y. N. Kondratenko, N. V. Chumak and A. Daneshmand, “Results of Prophylaxis of Bacterial Endophthalmitis in Cataract Surgery,” Proceedings of The Joint Congress of SOE/AAO, Geneva, June 2011, p. 51. [7] K. Green, V. Livingston, K. Browman and D. S. Hull, “Chlorhexidine Effects on Corneal Epithelium and Endothelium,” Archives of Ophthalmology, Vol. 98, No. 7, 1980, pp. 1273-1278.
http://dx.doi.org/10.1001/archopht.1980.01020040125020 [8] N. L. Burstein, “Preservative Cytotoxic Threshold for Benzalkonium Chloride and Chlorhexidine Digluconate in Cat and Rabit Corneas,” Journal Investigative Ophthalmology & Visual Science, Vol. 19, No. 3, 1980, pp. 308-313. [9] A. W. Bauer, W. M. Kirby, J. C. Sherris and M. Turck, “Antibiotic Susceptibility Testing by Standardized Single Disc Method,” American Journal of Clinical Pathology, Vol. 45, No. 4, 1966, pp. 493-496. [10] L. D. Perry and C. Skaggs, “Preoperative Topical Antibiotics and Lash Trimming in Cataract Surgery,” Ophthalmic Surgery, Vol. 8, No. 5, 1977, pp. 44-48. [11] S. J. Isenberg, L. Apt, R. Yoshimori, C. Pham and N. K. Lam, “Efficacy of Topical Povidone-Iodine during the First Week after Ophthalmic Surgery,” American Journal of Ophhalmology, Vol. 124, No. 1, 1997, pp. 31-35. [12] T. J. Liesegang, “Use of Antimicrobials to Prevent Postoperative Infection in Patients with Cataracts,” Current Opinion in Ophthalmology, Vol. 12, No. 1, 2001, pp. 68-74.
http://dx.doi.org/10.1097/00055735-200102000-00012 [13] T. A. Ciulla, M. B. Starr and S. Masket, “Bacterial Endophthalmitis Prophylaxis for Cataract Surgery: An Evidence-Based Update,” Ophthalmology, Vol. 109, No. 1, 2002, pp. 13-24.
http://dx.doi.org/10.1016/S0161-6420(01)00899-5 [14] A. Safar and M. C. Dellimore, “The Effect of Povidone Iodine Flush versus Drops on Conjunctival Colonization before Intravitreal Injections,” International Ophthalmology, Vol. 27, No. 5, 2007, pp. 307-312.
http://dx.doi.org/10.1007/s10792-007-9073-6 [15] D. S. Hughes and R. J. Hill, “Infectious Endophthalmitis after Cataract Surgery,” British Journal of Ophthalmology, Vol. 78, No. 3, 1994, pp. 227-232.
http://dx.doi.org/10.1136/bjo.78.3.227 [16] M. N. Shi, H. J. Guan, Y. J. Ye, M. S. Chen and C. T. Yu, “Comparative Study of Gentamycin and Povidone-Iodine on Eliminating the Conjunctival Bacteria,” Chinese Journal of Ophthalmology, Vol. 44, No. 12, 2008, pp. 1098-1102. [17] J. Feys, A. Salvanet-Bouccata, J. P. Emond and A. Dublanchet, “Vancomycin Prophylaxis and Intraocular Contamination during Cataract Surgery,” Journal of Cataract Refractive Surgery, Vol. 23, No. 6, 1997, pp. 894-897.
http://dx.doi.org/10.1016/S0886-3350(97)80250-7 [18] J. C. Lloyd and R. Braga-Mele, “Incidence of Postoperative Endophthalmitis in a High-Volume Cataract Surgicentre in Canada,” Canadian Journal Ophthalmology, Vol. 44, No. 3, 2009, pp. 288-292.
http://dx.doi.org/10.3129/i09-052 [19] G. A. Peyman, P. L. Lee and D. V. Seal, “Endophthalmitis,” Martin Dunitz, London, 2004. [20] M. B. Hamill, M. S. Osato and K. R. Wilhelmus, “Experimental Evaluation of Chlorhexidine Gluconate for Ocular Antisepsis,” Antimicrobial Agents and Chemotherapy, Vol. 26, No. 6, 1984, pp. 793-796.
http://dx.doi.org/10.1128/AAC.26.6.793 [21] M. T. Suller and A. D. Russell, “Antibiotic and Biocide Resistance in Methicillin-Resistant Staphylococcus Aureus and Vancomycin-Resistant Enterococcus,” Journal of Hospital Infection, Vol. 43, No. 4, 1999, pp. 281-291.
http://dx.doi.org/10.1016/S0195-6701(99)90424-3 [22] E. Dabrowska, M. Letko, W. Roszkowska-Jakimiec, R. Letko and J. Sadowski, “Effect of Chlorhexidine Mouthrinse on Cathepsin C Activity in Human Saliva,” Advances in Medical Sciences, Vol. 51, No. 1, 2006, pp. 96-99. [23] T. Gershanik, S. Benzeno and S. Benita, “Interaction of a Self-Emulsifying Lipid Drug Delivery System with the Everted Rat Intestinal Mucosa as a Function of Droplet Size and Surface Charge,” Pharmaceutical Research, Vol. 15, No. 6, 1998, pp. 863-869.
http://dx.doi.org/10.1023/A:1011968313933 [24] S. Tamilvanan, “Oil-in-Water Lipid Emulsions: Implications for Parenteral and Ocular Delivering Systems,” Progress in Lipid Research, Vol. 43, No. 6, 2004, pp. 489-533. http://dx.doi.org/10.1016/j.plipres.2004.09.001 [25] Y. Rojanasakul and J. R. Robinson, “Transport Mechanisms of the Cornea: Characterization of Barrier Permselectivity,” International Journal of Pharmaceutics, Vol. 55, No. 2-3, 1989, pp. 237-246.
http://dx.doi.org/10.1016/0378-5173(89)90047-1 [26] J. Liaw, Y. Rojanasakul and J. R. Robinson, “The Effect of Drug Charge Type and Charge Density on Corneal Transport,” International Journal of Pharmaceutics, Vol. 88, No. 1-3, 1992, pp. 111-124.
http://dx.doi.org/10.1016/0378-5173(92)90308-O