Role of Antiseptics in the Prevention of Surgical Site Infections

Echols, Kathryn; Graves, Michael S.; LeBlanc, Keith G.; Marzolf, Sean; Yount, Avis

doi:10.1097/dss.0000000000000375

Cited by 35 publications

(24 citation statements)

References 88 publications

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“…All preparations contained in the VAH list of disinfectants are bactericidal and effective against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multiresistant gram-negative (MRGN) bacteria [ 7 ] . In practical tests on the skin with a short exposure time, alcohol-based preparations have been shown to be more effective than aqueous povidone-iodine solutions (also refer to the valid VAH disinfectant list) [ 7,8 ] .…”

Section: Patient Preparationmentioning

confidence: 99%

Pre‐ and perioperative aspects of dermatosurgery

Müller

Hübner

Thieme‐Ruffing

et al. 2017

J Deutsche Derma Gesell

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Die Dermatochirurgie nimmt hinsichtlich vieler Punkte eine Sonderstellung unter den operativen Fächern ein. Hierzu gehört in erster Linie die Tatsache, dass bis auf weni-ge Ausnahmen fast alle Eingriffe traditionell in Lokal-bzw. Regionalanästhesie und oft auch in räumlich-infrastruktureller Trennung von den großen Zentral-Operationssälen stattfinden können. Die peri-und postoperative Überwachung obliegt dabei dem der-matochirurgischen Operationsteam. Das sui generis kleinere OP-Team hat somit eine ganze Reihe perioperativer Notwendigkeiten zu beachten, um die sich in den "großen" chirurgischen Fächern eine Vielzahl verschiedener beteiligter Fachgruppen gemeinsam kümmern. Hierzu gehören neben Hygieneaspekten, Kenntnissen in der Überwachung der Patienten sowie dem Aspekt der surgical site infections auch Fragen zur postope-rativen Schmerztherapie sowie detailliertes pharmakologisches Wissen über die zur Anwendung kommenden Lokalanästhetika und das Handling der damit assoziierten toxischen und allergischen Reaktionen. Eine interdisziplinäre Zusammenarbeit und Verantwortung für den Patienten ist notwendig und erfordert die Erarbeitung und Um-setzung qualitätsorientierter und evidenzbasierter Handlungsanweisungen, die im der-matochirurgischen OP-Setting meist weit über das eigentliche Fach hinausgehen. Ziel dieses Weiterbildungsartikels soll die komprimierte Darstellung der genannten fach-übergreifenden Standpunkte bezüglich der wichtigsten perioperativen Aspekte sein. Summary Dermatosurgery occupies an exceptional position among all surgical disciplines. Above all, this includes the fact that, with very few exceptions, the vast majority of surgical interventions can be performed under local or regional anesthesia, usually in smaller procedure rooms that are spatially separated from larger operating suites. Thus, peri-and postinterventional patient monitoring is the responsibility of the dermatosurgeon and his team. Though inherently smaller, this team still has to observe numerous peri-operative requirements that-in larger surgical specialties-would be attended to by a host of various specialists working in concert. Said requirements include hygienic aspects , knowledge concerning pre-and intraoperative patient monitoring, managing surgical site infections, adequate postsurgical pain management, as well as detailed pharmacological knowledge with respect to common local anesthetics and the toxic and allergic reactions associated therewith. Not only does this require interdisciplinary collaboration and shared responsibility for the patient. It also necessitates the development and implementation of quality-oriented and evidence-based guidelines that, in the dermatosurgical setting, usually extend far beyond the scope of the specialty per

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Section: Patient Preparationmentioning

confidence: 99%

Pre‐ and perioperative aspects of dermatosurgery

Müller

Hübner

Thieme‐Ruffing

et al. 2017

J Deutsche Derma Gesell

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“…Despite these findings, humans are constantly working to disrupt skin microbial communities in both clinical and non-clinical settings (9)(10)(11)(12). While antimicrobial agents are largely employed to reduce infection by pathogenic microorganisms (13)(14)(15), these treatments can also act on resident cutaneous species (16)(17)(18). This is especially true for antiseptics, a group of antimicrobial agents used specifically for their indiscriminate mechanisms of action (19,20).…”

Section: Introductionmentioning

confidence: 99%

Antiseptic Agents Elicit Short-Term, Personalized and Body Site-Specific Shifts in Resident Skin Bacterial Communities

SanMiguel

Meisel

Horwinski

et al. 2017

Preprint

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Despite critical functions in cutaneous health and disease, it is unclear how resident skin microbial communities are altered by topical antimicrobial interventions commonly used in personal and clinical settings. Here we show that acute exposure to antiseptic treatments elicits rapid but short-term depletion of microbial community diversity and membership. Thirteen subjects were enrolled in a longitudinal treatment study to analyze the effects of topical treatments (ethanol, povidone-iodine, chlorhexidine, water) on the skin microbiome at two skin sites of disparate microenvironment: forearm and back. Treatment effects were highly dependent on personalized and body site-specific colonization signatures, which concealed community dynamics at the population level when not accounted for in this analysis. The magnitude of disruption was influenced by the identity and abundance of particular bacterial inhabitants. Lowly abundant members of the skin microbiota were more likely to be displaced, and subsequently replaced by the most abundant taxa prior to treatment. Members of the skin commensal family Propionibactericeae were particularly resilient to treatment, suggesting a distinct competitive advantage in the face of disturbance. These results provide insight into the stability and resilience of the skin microbiome, while establishing the impact of topical antiseptic treatment on skin bacterial dynamics and community ecology.peer-reviewed)

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“…In spite of the treatment difficulties associated with hospital-acquired MRSA (HA-MRSA) infections, improved hygiene and disinfection strategies are decreasing the number of invasive infections (3). Indeed, the increased application of antiseptics has been able to reduce the number of hospital-acquired infections (HAI) in certain settings (4,5). However, our dependency on antiseptics is not without consequence, as bacteria are evolving an increased tolerance to some common biocides (6,7).…”

mentioning

confidence: 99%

Systematic Analysis of Efflux Pump-Mediated Antiseptic Resistance in Staphylococcus aureus Suggests a Need for Greater Antiseptic Stewardship

LaBreck

Bochi-Layec

Stanbro

et al. 2020

mSphere

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Staphylococcus aureus-associated infections can be difficult to treat due to multidrug resistance. Thus, infection prevention is critical. Cationic antiseptics, such as chlorhexidine (CHX) and benzalkonium chloride (BKC), are liberally used in health care and community settings to prevent infection. However, increased administration of antiseptics has selected for S. aureus strains that show reduced susceptibilities to cationic antiseptics. This increased resistance has been associated with carriage of specific efflux pumps (QacA, QacC, and NorA). Since prior published studies focused on different strains and on strains carrying only a single efflux gene, the relative importance of these various systems to antiseptic resistance is difficult to ascertain. To overcome this, we engineered a collection of isogenic S. aureus strains that harbored norA, qacA, and qacC, individually or in combination. MIC assays showed that qacA was associated with increased resistance to CHX, cetrimide (CT), and BKC, qacC was associated with resistance to CT and BKC, and norA was necessary for basal-level resistance to the majority of tested antiseptics. When all three pumps were present in a single strain, an additive effect was observed in the MIC for CT. Transcriptional analysis revealed that expression of qacA and norA was significantly induced following exposure to BKC. Alarmingly, in a strain carrying qacA and norA, preexposure to BKC increased CHX tolerance. Overall, our results reveal increased antiseptic resistance in strains carrying multiple efflux pumps and indicate that preexposure to BKC, which is found in numerous daily-use products, can increase CHX tolerance. IMPORTANCE S. aureus remains a significant cause of disease within hospitals and communities. To reduce the burden of S. aureus infections, antiseptics are ubiquitously used in our daily lives. Furthermore, many antiseptic compounds are dual purpose and are found in household products. The increased abundance of antiseptic compounds has selected for S. aureus strains that carry efflux pumps that increase resistance to antiseptic compounds; however, the effect of carrying multiple pumps within S. aureus is unclear. We demonstrated that an isogenic strain carrying multiple efflux pumps had an additive resistance phenotype to cetrimide. Moreover, in a strain carrying qacA and norA, increased chlorhexidine tolerance was observed after the strain was preexposed to subinhibitory concentrations of a different common-use antiseptic. Taken together, our findings demonstrate cooperation between antiseptic resistance efflux pumps and suggest that their protective phenotype may be exacerbated by priming with subinhibitory concentrations of household antiseptics.

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Role of Antiseptics in the Prevention of Surgical Site Infections

Cited by 35 publications

References 88 publications

Pre‐ and perioperative aspects of dermatosurgery

Pre‐ and perioperative aspects of dermatosurgery

Antiseptic Agents Elicit Short-Term, Personalized and Body Site-Specific Shifts in Resident Skin Bacterial Communities

Systematic Analysis of Efflux Pump-Mediated Antiseptic Resistance in Staphylococcus aureus Suggests a Need for Greater Antiseptic Stewardship

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