To Study and Compare the Effect of Pre-Operative Skin Preparation with Aqueous Povidone Iodine Only and in Combination with Alcoholic Chlorhexidine on Surgical Site Infection in Tertiary Care Hospital SVRRGGH, Tirupati

BACKGROUND Even the normal skin of healthy humans usually harbours a rich bacterial flora, which are usually non-pathogenic. But these organisms always have a potential to cause infection of the surgical site. The aim of surgical site preparation with antiseptics is to remove microorganisms harbouring the skin surface to a lower level. Povidine iodine (iodophors) and chlorhexidine are the agents most often used for pre-operative surgical site antisepsis. In this study, we wanted to determine the efficacy of pre-operative skin preparation with aqueous povidone iodine alone and when used in combination with alcoholic chlorhexidine for surgical site asepsis. METHODS This is a cross-sectional study. 200 patients (100 in each group) were considered for the study who were undergoing clean elective surgery. Pre-operative preparation of skin in the surgical area was done by the respective antiseptic which was planned accordingly, after such application, sterile saline swab culture was taken immediately from the site of incision during surgery. In the cases which showed growth of organisms, they were isolated from colonies and subjected to gram staining, coagulase test and antibiotic sensitivity test. The organisms thus isolated were identified by their morphological and cultural characteristics and difference in colonization rates were considered as a measure of antiseptic regimen efficacy. RESULTS The results showed that, usage of povidine iodine along with alcoholic chlorhexidine is more efficacious and showed significant reduction of colonization rates at the site of incision, in comparison to using povidone iodine alone. Postoperative wound infections were lower, when povidine iodine is used in combination with chlorhexidine is used for pre-operative surgical site preparation. CONCLUSIONS Pre-operative skin preparation with the chlorhexidine gluconate 2.5 % v/v in 70 % propanol followed by aqueous povidone-iodine solution is an ideal for broad spectrum asepsis and the post-operative wound infection rate is much lower as compared to povidone iodine alone. KEYWORDS Skin Disinfection; Chlorhexidine; Propanol; Povidone-iodine; Bacterial Colonization

Topical Application of Human Milk versus Alcohol and Povidine-Iodine on Clinical Outcomes of Umbilical Cord in Healthy Newborn: Impact of an Educational Program of Mothers’ Knowledge and Practice Regarding Umbilical Cord Care

Aim: This quasi-experimental study was conducted to evaluate the effect of an educational program of mothers` knowledge and practice about umbilical cord care; compare cord-cleansing using human milk versus alcohol 70% and povidine-iodine 10% on clinical outcomes of umbilical cord in healthy newborn. Subjects: Α total of 150 mothers who had just delivered with their newborn infants at the postnatal units at El-Fayoum University Hospital, Egypt, were recruited for this study. Tool: data was collected through а structured interview questionnaire; newborn follow-up sheet and an observation checklist. Results indicated that, before the intervention of the educational program, lake of satisfactory knowledge and practice among mothers in all groups related to cord care. The total mean scores for the immediate post/follow up tests of intervention educational program were statistically significantly higher (р<0. 001), compared to their pre-intervention of the educational program scores. Concerning newborn follow-up, there were highly statistically significant differences in umbilical cord base separation time, the sign of cord infection, bleeding continuation in mother milk group as compared with alcohol 70% and povidine-iodine 10% group. Conclusion: Educational program had а positive effect on mothers' knowledge and competency of their practice regarding umbilical cord cleansing. Topical application of mother milk on umbilical cord care leads to rapid cord separation time; diminish the umbilical cord infection as it can be used as an easy, cheap and non-invasive way for cord care. Recommendation: educational programs intervention regarding neonatal care is required during the period of antenatal visit. Researches to study the effect of newborn cord care practices on the incidence of newborn morbidity/mortality are required.

Clinical study in management of infected diabetic foot ulcers: superoxidised solution versus povidine iodine solution

Background: Diabetic foot ulcer is a one of the major challenging problem to every surgeon in day to day practice. Superoxidised solution is an effective concept in the wound management. The present study was aimed to compare the efficacy of dressings with superoxidised solution versus povidine iodine in the management of infected diabetic ulcers.Methods: This is a randomized controlled study conducted over a period of one year. In our study, total of 60 patients presenting with infected diabetic ulcers are included. Patients were randomly divided into two groups of 30 each, group A (Topical superoxidised solution dressing) and group B (Topical povidine iodine dressing). Wound was observed for decrease in size of the ulcer, granulation, tissue quality and discharge from the wound at the end of each week for two weeks.Results: In the present study, 76.67% of patients in group A and B were males and the male to female ratio was 3.2:1. The mean age in group A was 55.90±14.27 years compared to 51.50±13.18 years in group B. The mean initial ulcer area in group A was 3882±1890 mm2 compared to 3992±2000 mm2 in group B. The mean post treatment final area in group A was significantly low (1607±862 mm2) compared to group B (2351±1240 mm2; p=0.009) and the comparison of mean change in ulcer area was significantly high in group A compared to group B (2215±1060 mm2 vs 1641±856 mm2; p=0.024). The mean percentage reduction in ulcer area among patients with group A was significantly high (58.90±5.21 percent vs. 40.90±8.76 percent; p=0.024). The commonest organism isolated in group A was Escherichia coli (26.67%) and in group B, it was staphylococcus. The culture was positive in 26% of the patients in group A compared to 50% in group B (p=0.063).Conclusions: Overall, topical superoxidised solution dressing for diabetic foot ulcer accelerated the healing process resulting in faster recovery through reduction in ulcer area compared to topical povidine iodine dressing.

Frequency of Infection in Cervical Lymph Node Biopsy Site using Chlorhexidine and Povidine Iodine

Background: Lymph node are located throughout the lymphatic system, they are concentrated in certain areas of the body including head and neck. Cervical lymph nodes are lymph nodes found in the neck. Of the 800 lymph nodes in the human body, 300 are in the neck. Cervical lymph nodes are subject to several different pathological conditions including tumours, infection and inflammation.Methodology: The Povidine-iodine and chlorhexidine for preoperative skin preparation in cervical lymph node biopsy procedure were used in this study and patients were asked for follow up after a week. On follow up day their wounds were checked, assessed and withdraw all stiches and complications were recorded accordingly and analysed them. It was discussed and showed that which one of Povidine-iodine and chlorhexidine is best to use for preoperative skin preparation in cervical lymph node biopsy procedures to reduce surgical site infection and economical one.Results: Out of 150 patients, 46% (69) were males and 54% (81) were females that had cervical lymphadenopathy after skin preparation by chlorhexidine antiseptic solution showed frequency of infection in total of 150 patients 16.67% (25) were infected while the other 83.33%(125) were not infected. Out of 150 patients who were underwent cervical lymphadenopathy after using povidine iodine skin preparatory antiseptic solution, 42% (63) were males and 58% (87) were females and among those frequency of infection showed 44.67% (67) were infected while the others 55.33% (83) were not.Conclusion: Preoperative scrubbing of the patient’s skin with chlorhexidine–alcohol is better than scrubbing with povidone–iodine for preventing surgical-site infection after cervical lymph node biopsy.

Efektivitas lumatan daun sirih hijau dibandingkan dengan povidine iodine sebagai alternatif obat luka

Betel leaf can be used as an antiseptic. Its chemical contents are saponins, flavonoids, polyphenols, and essential/aetheric oil. Saponins may act as antimicrobials by damaging cytoplasmic membranes and lead to cell death. The flavonoids are thought to act by of denaturing bacterial cell proteins and damaging the cell membranes irreversibly. Medically, 10% povidone iodine could speed up wound healing. However, traditionally, a number of plants have been used to prevent inflammation and to improve wound healing. This study was aimed to determine the effectiveness of betel leaf on wound healing in rabbits. This was an experimental study with the post control only controlled group design. Samples were obtained randomly. The Mann-Whitney test showed a P-value of 0.000 on wound healing and a P-value of 1.000 on infection. Conclusion: There was a significant difference in improvement of wound healing between betel leaf and 10% povidine iodine application but there was no significant difference between them in prevention of infection.Keywords: betel leaf, incision wound, povidone iodineAbstrak: Daun sirih bisa digunakan sebagai antiseptik. Kandungan kimia dari tanaman sirih ialah saponin, flavonoid, polifenol, dan minyak atsiri. Senyawa saponin dapat bekerja sebagai antimikroba dengan merusak membran sitoplasma dan membunuh sel. Senyawa flavonoid diduga memiliki mekanisme kerja mendenaturasi protein sel bakteri dan merusak membran sel tanpa dapat diperbaiki lagi. Secara medis, untuk mempercepat penyembuhan luka bisa diolesi povidone iodine 10%, tetapi secara tradisional sejumlah tanaman telah digunakan untuk mencegah peradangan dan penyembuhan luka. Penelitian ini bertujuan untuk mengetahui efektivitas daun sirih terhadap penyembuhan luka pada kelinci. Jenis penelitian ialah eksperimental dengan post test only controlled group design. Sampel penelitian diambil secara acak (random). Hasil uji Mann-Whitney menunjukkan nilai P=0,000 pada parameter penyembuhan luka dan memiliki perbedaan bermakna sedangkan pada parameter infeksi nilai P 1,000 (P >0,05) tidak memiliki perbedaan bermakna. Simpulan: Terdapat perbedaan bermakna dalam penyembuhan luka antara aplikasi daun sirih dan povidine iodine 10% tetapi tidak dalam terjadinya infeksi. Kata kunci: daun sirih,luka insisi , povidone iodine

Uterovaginal Packing as Treatment in Primary Postpartum Hemorrhage in Patan Hospital

Aims: To study the effectiveness of uterovaginal packing in the management of primary postpartum hemorrhage (PPH).Methods: This is a retrospective study conducted in Patan hospital, Lalitpur from January 2009-2011. Patients included in the study were those with intractable hemorrhage not responding to oxytocics. Exclusion criteria included cases of PPH due to trauma. Packing was done using approximately six inches sterile gauze soaked with povidine iodine packed into the uterus from the uterine fundus up to the vaginal canal. The packing is removed after 48 hours of insertion or earlier in cases of failure to control hemorrhage.Results: There were 46 cases of uterovaginal packing for primary PPH. Uterine atony was the commonest cause of packing. Uterovaginal packing was successful in 39(84.7%) cases.Conclusion: Uterovaginal packing is safe, easy and quick procedure to manage primary PPH. It is beneficial in cases of PPH due to atony thereby conserve the uterus.