Evaluation of three experimental in vitro models for the assessment of the mechanical cleansing efficacy of wound irrigation solutions

Klasinc, Romana; Augustin, Lee Ann; Below, Harald; Baguhl, Romy; Assadian, Ojan; Presterl, Elisabeth; Krämer, Axel

doi:10.1111/iwj.12850

Cited by 16 publications

(13 citation statements)

References 14 publications

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“…In combination with undecylenamidopropyl betaine (Betaine), the antimicrobial effect is enhanced because of altered physical properties [80,81], while in vitro cytotoxicity is reduced [80] and cleaning performance is improved [82]; the latter one could not be confirmed in a newer study because of the interference of the surfactant with the protein measurement [322]. Intracellular elimination is remarkable, as shown for E. coli [83], MRSA [84], and Acanthamoeba species [85].…”

Section: Polihexanidementioning

confidence: 99%

Consensus on Wound Antisepsis: Update 2018

Krämer

Dissemond²,

Kim³

et al. 2017

Skin Pharmacol Physiol

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256

215

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Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

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Section: Polihexanidementioning

confidence: 99%

Consensus on Wound Antisepsis: Update 2018

Krämer

Dissemond²,

Kim³

et al. 2017

Skin Pharmacol Physiol

Self Cite

256

215

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“…[75][76][77] Clinical evidence PHMB is available as solutions, gels and in wound dressings. 78 In wound antisepsis, PHMB solutions are commonly used at concentrations of 0.01, 0.02 and 0.04%, in a wound cleanser 0.1% PHMB is combined with 0.1% betaine to improve the cleansing efficacy, 79 in gels 0.04 and 0.1%, and in antiseptic dressings (including gauze, biocellulose dressings and foam) 0.2%-0.5%. 78,[80][81][82][83] In the latter, PHMB impregnated and PHMB-donating dressings must be distinguished.…”

Section: Risks: Mutagenicity Teratogenicity and Carcinogenicitymentioning

confidence: 99%

Re-evaluation of polihexanide use in wound antisepsis in order to clarify ambiguities of two animal studies

et al. 2019

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Objective: Due to classification of the agent polihexanide (PHMB) in category 2 ‘may cause cancer’ by the Committee for Risk Assessment of the European Chemicals Agency in 2011, the users of wound antiseptics may be highly confused. In 2017, this statement was updated, defining PHMB up to 0.1% as a preservative safe in all cosmetic products. In the interest of patient safety, a scientific clarification of the potential carcinogenicity of PHMB is necessary. Methods: A multidisciplinary team (MDT) of microbiologists, surgeons, dermatologists and biochemists conducted a benefit-risk assessment to clarify the hazard of antiseptic use of PHMB. Results: In two animal studies, from which the assessment of a carcinogenic risk was derived, PHMB was administered orally over two years in extremely high concentrations far above the NO(A)EL (no-observed-(adverse-) effect level) in rats and mice. Feeding in the NO(A)EL range resulted in no abnormal effects. In one male in the highest dose group of 4000ppm PHMB, an adenocarcinoma was found, which the author attributed to chronic inflammation of the colon with systemic atypical exposure. The increasing incidence of hemangiosarcomas highly probably resulted from increased endothelial proliferation, triggered by the exceedingly high dosage fed, because PHMB is not genotoxic and there is no evidence for epigenetic effects. Discussion: It is well known that PHMB is not absorbed when applied topically. Considering the absence of genotoxicity and epigenetic effects together with the interpretation of the animal studies, it is the consensus of the multidisciplinary experts that a carcinogenic risk from PHMB-use for wound antisepsis can be ruled out. Conclusion: On this basis and considering their effectiveness, tolerability and clinical evidence, the indications for PHMB based wound antiseptics are justified.

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“…Pencucian luka dapat dilihat sebagai bagian integral dari persiapan luka dalam menciptakan lingkungan luka yang optimal dengan cara melepaskan benda asing, mengurangi jumlah bakteri dan mencegah aktivitas biofilm pada permukaan luka (Wolcott & Fletcher, 2014). Pencucian luka merupakan komponen penting dan merupakan tujuan standar selama perawatan luka akut dan kronis, pencucian luka melibatkan penggunaan cairan pembersih yang pemilihannya harus didasarkan pada efektivitas dan kurangnya sitotoksitas dari larutan pembersih tersebut (Klasinc et al, 2017). Berbagai penelitian yang dilakukan terhadap pemilihan bahan larutan sebagai pencucian luka seperti Normal saline, tap water, povidone-iodine (Bellingeri et al, 2016), larutan ringer lactat (Klasinc et al, 2017), hypochlorous acid (Bongiovanni, 2014), polyhexamethylene biguanide (PHMB) (Creppy, 2014), Natrium hipoklorit (NaClO), dan electrolyzed strong water acid ( ESWA) (Cheng, et al 2016).…”

Section: Latar Belakangunclassified

“…Pencucian luka merupakan komponen penting dan merupakan tujuan standar selama perawatan luka akut dan kronis, pencucian luka melibatkan penggunaan cairan pembersih yang pemilihannya harus didasarkan pada efektivitas dan kurangnya sitotoksitas dari larutan pembersih tersebut (Klasinc et al, 2017). Berbagai penelitian yang dilakukan terhadap pemilihan bahan larutan sebagai pencucian luka seperti Normal saline, tap water, povidone-iodine (Bellingeri et al, 2016), larutan ringer lactat (Klasinc et al, 2017), hypochlorous acid (Bongiovanni, 2014), polyhexamethylene biguanide (PHMB) (Creppy, 2014), Natrium hipoklorit (NaClO), dan electrolyzed strong water acid ( ESWA) (Cheng, et al 2016). Meskipun bahan larutan tersebut dapat digunakan sebagai bahan pencucian luka namun tidak semua bahan pencucian luka memiliki aktivitas bakterisida sehingga Tujuan dari studi literatur ini adalah untuk mengetahui penggunaan wound cleansing terhadap perubahan kolonisasi bakteri pada luka DM.…”

Section: Latar Belakangunclassified

“…Pada penelitian Akbar et al, 2013 dengan tujuan Untuk mengetahui efektivitas hydrogen peroksida sebagai pembersih luka dengan kolonisasi mikroba luka bakar kronik menunjukkan hasil bahwa Staphylococcus adalah yang paling sering mengisolasi kolonisasi bakteri pada pasien (59,2%) Rata-rata pengambilan pencangkokan kulit adalah 82,85% pada tungkai kanan, dan 65,61% di tangan kiri yang berbeda secara signifikan (P <0,05), Pemberian hidrogen peroksida intraoperatif aman dan secara signifikan meningkatkan rerata tingkat keberhasilan rata-rata pada luka kronis. Penelitian yang dilakukan Klasinc et al, 2017 untuk membandingkan solusi pembilasan luka yang berbeda, untuk menentukan perbedaan dalam efisiensi, dan untuk mengevaluasi tiga model in vitro yang berbeda dalam pembersihan luka. Larutan-larutan pembilasan luka yang berbeda (larutan garam fisiologis, larutan ringer laktat untuk irigasi luka, air dan larutan yang mengandung polihexanide dan surfactant undecylenamidopropyl-betain), dalam penelitian ini semua percobaan dilakukan dalam kondisi yang identik, hanya berbeda dalam larutan pembersihan yang diuji untuk memungkinkan perbandingan, masing-masing ditantang dengan tiga uji luka terstandardisasi yang berbeda dengan hasil Dalam tiga model uji yaitu air, larutan laktat ringer dan larutan garam tidak berbeda dalam kinerja pembilasan, larutan garam fisiologis lebih unggul daripada larutan laktat ringer di ketiga model, sedangkan air dapat membantu efektifitas model dasar yang paling efisien dalam model sel aliran, metode yang cocok untuk perbandingan solusi luka-pembilasan adalah metode sel aliran, Tidak ada keunggulan yang jelas antara dua larutan yang mengandung elektrolit yang terdeteksi dalam model biofilm.…”

Section: Metodeunclassified

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Peranan Pencucian Luka Terhadap Penurunan Kolonisasi Bakteri Pada Luka Kaki Diabetes

Nurbaya

Tahir²,

Yusuf³

2018

JKM

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Background: Diabetic ulcer is a major complication of diabetes and is the main cause of infection. One of the efforts or interventions to reduce infection by doing wound cleansing, but research on the effects of wound cleansing on bacterial colonization is still limited. The purpose of this literature study was to determine the effectiveness of using a type of wound cleansing on changes in bacterial colonization in DM wounds. Methods: The data base used in making this review literature is Pubmed, Science Direct, Google Scholar and Cochrane. there are 144 articles identified and published from 2010-2018. Of the 144 articles 8 articles that met the inclusion criteria. Results: Various wound cleansing solutions are used to optimize the wound healing process and the effect is quite good in decreasing bacterial colonies in DM wounds. Conclusion: wound cleansing type ESWA has a bactericidal effect, is effective in reducing bacterial colonization, and economically it is expected to be a concern in the treatment process injury, research is needed as to whether ESWA washing types can be used to reduce bacterial colonization in DM wounds.

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Evaluation of three experimental in vitro models for the assessment of the mechanical cleansing efficacy of wound irrigation solutions

Cited by 16 publications

References 14 publications

Consensus on Wound Antisepsis: Update 2018

Consensus on Wound Antisepsis: Update 2018

Re-evaluation of polihexanide use in wound antisepsis in order to clarify ambiguities of two animal studies

Peranan Pencucian Luka Terhadap Penurunan Kolonisasi Bakteri Pada Luka Kaki Diabetes

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