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OBJECTIVE. To evaluate the effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery. DESIGN. Prospective, randomized, double-blind, placebo-controlled trial. SETTING. Pediatric intensive care unit (PICU) at a tertiary care hospital. patients. One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: chlorhexidine (n = 87) and control (n = 73). INTERVENTIONS. Oral hygiene with 0.12% chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death. RESULTS. Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months; P =. 72) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups; P =. 17). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (Pp. 46) and the incidence of VAP was 18.3% versus 15% (Pp. 57) in the chlorhexidine and the control group, respectively. There was no difference in intubation time (P =. 34), need for reintubation (P =. 37), time interval between hospitalization and nosocomial pneumonia diagnosis (P =. 63), time interval between surgery and nosocomial pneumonia diagnosis (P =. 10)...

A recontaminação do sistema de canais radiculares durante os procedimentos de preparo do espaço para núcleos metálicos fundidos deve ser evitada, sob pena de falha do tratamento endodôntico. O uso de substâncias antimicrobianas durante o procedimento pode ser interessante. O objetivo deste estudo foi avaliar o efeito do uso do gluconato de clorexidina a 2% em gel ou soro fisiológico (grupo controle), em conjunto com brocas para o preparo intrarradicular, sobre a retenção de núcleos metálicos fundidos, cimentados com fosfato de zinco ou um cimento resinoso (Panavia F). Foram utilizados 40 pré-molares inferiores humanos hígidos. Estes dentes foram tratados endodonticamente e receberam preparos intrarradiculares de 10mm de profundidade, com as brocas número 2 de um sistema de pinos pré-fabricados de fibra de carbono. Em conjunto com estas brocas foi utilizado soro fisiológico (grupos 1 e 2 - controle) ou o gluconato de clorexidina em gel a 2% (grupos 3 e 4). Os condutos foram moldados e foram obtidos padrões em resina acrílica autopolimerizável. Os dentes foram incluídos em resina epóxica e depois em resina acrílica autopolimerizável. Os padrões foram fundidos em liga de níquel-cromo e cimentados com fosfato de zinco (grupos 1 e 3) ou Panavia F (grupos 2 e 4). Os espécimes foram mantidos em 100% de umidade relativa por 72 horas e em seguida...

Este estudo avaliou a influência do uso do digluconato de clorexidina como inibidor de metaloproteinase na resistência adesiva e dureza da camada de adesivo e camada hibrida de uma resina composta à dentina humana, por meio de ensaio de microtração e nanoedentação. Os fatores de variação estudados foram dois sistemas adesivos com estratégias de aplicação distintas Adper Scotchbond Multi-Purpose (3M ESPE, St. Paul, MN, USA) e Clearfil SE Bond (Kuraray Co., Osaka, Japan), e ainda foram realizados tratamentos no substrato dentinário utilizando duas concentrações de digluconato de clorexidina sendo estas 2% e 0,2% e grupos controle sem tratamento com clorexidina. As unidades experimentais foram compostas por 48 molares humanos hígidos divididos aleatoriamente em 6 grupos (n=8). Nestes foram aplicados os procedimentos adesivos e realizados os tratamentos de superfície, com clorexidina, previamente aos procedimentos adesivos. Após esta etapa foram confeccionadas as restaurações com espessura de 5mm sobre as superfícies dentinárias. Após 24h de armazenamento em água destilada, os dentes restaurados foram cortados para a obtenção de corpos de prova em forma de palito, com secção transversal de aproximadamente 1mm2. De cada grupo foram selecionados aleatoriamente 5 palitos para o ensaio de dureza. O restante dos palitos viáveis de cada dente foram submetidos ao teste de microtração a uma velocidade de 0...

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); The ability of Candida albicans to form biofilms on denture surfaces is a significant cofactor in the pathogenesis of denture stomatitis. In this study, we applied a differential staining approach and scanning electron microscopy (SEM) to analyse the effect of sodium hypochlorite and chlorhexidine gluconate on the viability, removal and morphology of C. albicans forming biofilms on denture acrylic using an in vitro model. Immediately after treatment, to distinguish live from dead C. albicans cells in the remaining biofilms, the specimens were stained differentially and analysed by confocal scanning laser microscopy. Moreover, morphological alterations of fungal cells were investigated using scanning electron microscopy. All disinfectant solutions killed all remaining fungal cells on the specimens. Interestingly, 4% chlorhexidine did not remove these cells from the acrylic resin surface whereas sodium hypochlorite solutions (1% and 2%) provided almost complete biofilm removal. Furthermore, treating the specimens with sodium hypochlorite induced cell morphology alterations, as seen in the residual fungal cells. Finally, according to our findings, it can be suggested that sodium hypochlorite solutions are the first choice as denture cleanser when compared with 4% chlorhexidine because those solutions not only killed C. albicans biofilms but also removed them from the heat-polymerised acrylic resin.

OBJETIVO: Analisar a ação antimicrobiana da clorexidina a 2%, do hipoclorito de sódio a 1% e do paramonoclorofenol associado ao furacin sobre S aureus, C albicans, E faecalise e P aureginosa. METODOLOGIA: Foram utilizadas 40 placas Petri. Quatro placas foram separadas como controle negativo e em 4 outras, além do meio de cultura, semearam-se os microrganismos, com o círculo de papel, para se obter o controle positivo. em 32 placas seguiu-se a colocação de 4 círculos de filtro de papel esterilizados e impregnados das substâncias testes e controle, depositados em cada quadrante das mesmas. Os grupos foram analisados por 7 dias. Para a verificação dos resultados, usaram-se os halos de inibição de crescimento bacteriano. RESULTADOS: A clorexidina 2% foi significantemente (P<0,05) mais efetiva para todas as cepas microbianas que as demais substâncias. O hipoclorito de sódio a 1% apresentou resultados intermediários. O paramonoclorofenol associado ao furacin (PMC+F) obteve os piores resultados. CONCLUSÃO: A clorexidina obteve os melhores resultados. O PMC+F apresentou os menores halos de inibição.; PURPOSE: To analyze the antimicrobial action of 2% chlorhexidine gluconate, 1% sodium hypochlorite and paramonochlorophenol were combined with furacin against strains of S. aureus...

The antimicrobial activity of irrigating solutions - Endoquil (castor oil detergent), 2% chlorhexidine gluconate solution, and 0.5% NaOCI solution - was evaluated against Gram-positive cocci (Micrococcus luteus, Staphylococcus aureus, Enterococcus faecalis, Staphylococcus epidermidis, Streptococcus mutans, and Streptococcus sobrinus), Gramnegative rods (Escherichia coli and Pseudomonas aeruginosa), and the yeast Candida albicans. Activity was evaluated using the two-layer agar diffusion technique. The base layer was obtained by pouring 10.0 ml of Muller Hinton Medium or 10.0 ml of Brain Heart Infusion agar in a Petri dish. After solidification a 5.0 ml seed layer of Muller Hinton Medium or Brain Heart Infusion agar with inoculum (106/ml) was added. Absorbent paper disks (6.0 mm in diameter) immersed in the solutions were placed at equidistant points. Plates were maintained at room temperature for 2 h for prediffusion of the solutions and incubated at 37°C for 24 h. The candle jar system was used for the Brain Heart Infusion agar plates. All tests were performed in duplicate. After incubation the medium was optimized with 0.05 g% triphenyltetrazolium chlorate gel and inhibition halos were measured. All bacterial strains were inhibited by 2.0% chlorhexidine gluconate. Endoquil was effective against Grampositive microorganisms...

The aim of this study was to evaluate the influence of chlorhexidine gluconate, sodium fluoride and sodium iodine on mutans streptococci counts in saliva of irradiated patients. Forty-five patients were separated into three experimental groups and received chlorhexidine (0.12%), sodium fluoride (0.5%) or sodium iodine (2%), which were used daily during radiotherapy and for 6 months after the conclusion of the treatment. In addition, a fourth group, composed by 15 additional oncologic patients, who did not receive the mouthwash or initial dental treatment, constituted the control group. Clinical evaluations were performed in the first visit to dental clinic, after initial dental treatment, immediately before radiotherapy, after radiotherapy and 30, 60, 90 days and 6 months after the conclusion of radiotherapy. After clinical examinations, samples of saliva were inoculated on SB20 selective agar and incubated under anaerobiosis, at 37oC for 48 h. Total mutans streptococci counts were also evaluated by using real-time PCR, through TaqMan system, with specific primers and probes for S. mutans and S. sobrinus. All preventive protocols were able to reduce significantly mutans streptococci counts, but chlorhexidine gluconate was the most effective...

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq); INTRODUCTION: For presenting wide antibacterial activity, chlorhexidine (CHX) has been extensively used in dentistry and can be easily incorporated into the glass ionomer cement (GIC) and consequently released into the oral cavity.AIM:The aim of this study was porosity and compression strength of a GIC, that was added to different concentrations of CHX.MATERIAL AND METHOD:Specimens were prepared with GIC (Ketac Molar Esaymix) and divided into 4 groups according to the concentration of CHX: control, 0.5% and 1% and 2% (n = 10). For analysis of pores specimens were fractured with the aid of hammer and chisel surgical, so that the fracture was performed in the center of the specimens, dividing it in half and images were obtained from a scanning electron microscope (SEM) analyzed in Image J software. The compressive strength test was conducted in a mechanical testing machine (EMIC - Equipment and Testing Systems Ltd., Joseph of the Pines, PR, Brazil). Statistical analysis was performed by ANOVA, Tukey test. Significance level of 5%.RESULT:No statistically significant changes between the study groups was observed both for the number of pores as well as for the compressive strength.CONCLUSION:The use of GIC associated with CHX gluconate 1% and 2% is the best option to be used in dental practice.; INTRODUÇÃO:Por apresentar ampla atividade antibacteriana...

The purpose of this study was to assess the in vitro the antimicrobial efficacy of chlorhexidine gluconate gel as an endodontic auxiliary chemical substance compared to sodium hypochlorite (NaOCl) and chlorhexidine gluconate solution. The antimicrobial efficacy of the tested substances was evaluated using the agar diffusion test. The growth inhibition zones produced by 0.2%, 1% and 2% chlorhexidine gel were evaluated against 5 facultative anaerobic bacteria and 4 pigmented Gram-negative anaerobes, and compared to the results obtained by NaOCl and chlorhexidine solution. The largest growth inhibition zones were produced when the test bacteria were in contact with 2% chlorhexidine gluconate gel (11.79 mm), being significantly different (p<0.05) from the growth inhibition zones produced by all NaOClconcentrations, including 5.25% (9.54 mm). However, there was no statistically significant difference (p>0.05) between the growth inhibition zones obtained with equal concentrations of chlorhexidine solution and gel. The results of this study indicate that, as far as its antimicrobial properties are concerned, chlorhexidine gel has a great potential to be used as an endodontic auxiliary chemical substance.

In view of the morbidity potential of oral complications in patients with leukemia, this study evaluated the clinical and microbiological alterations that occur in the oral mucosa of children with acute lymphoblastic leukemia (ALL) undergoing antineoplastic chemotherapy and prophylactic administration of 0.12% chlorhexidine gluconate. The sample consisted of 17 children aged 2 to 12 years that underwent clinical examination of the oral mucosa for the detection of oral lesions. In addition, biological material was collected from labial and buccal mucosa for microbiological analysis. Oral mucositis was observed in only 5 (29.4%) patients. Microbiological analysis revealed a reduced number of potentially pathogenic microorganisms, such as coagulase-negative staphylococci (47%), Candida albicans (35.3%), Klebsiella pneumoniae (5.9%), enteropathogenic Escherichia coli (5.9%), and Stenotrophomonas maltophilia (5.9%). Patients with oral mucositis showed a higher frequency of coagulase-negative staphylococci (80%) when compared with patients with normal oral mucosa (33.3%). In conclusion, the results of the present study suggest that the prophylactic use of 0.12% chlorhexidine gluconate reduces the frequency of oral mucositis and oral pathogens in children with ALL. In addition...

INTRODUCTION: For presenting wide antibacterial activity, chlorhexidine (CHX) has been extensively used in dentistry and can be easily incorporated into the glass ionomer cement (GIC) and consequently released into the oral cavity. AIM: The aim of this study was porosity and compression strength of a GIC, that was added to different concentrations of CHX. MATERIAL AND METHOD: Specimens were prepared with GIC (Ketac Molar Esaymix) and divided into 4 groups according to the concentration of CHX: control, 0.5% and 1% and 2% (n = 10). For analysis of pores specimens were fractured with the aid of hammer and chisel surgical, so that the fracture was performed in the center of the specimens, dividing it in half and images were obtained from a scanning electron microscope (SEM) analyzed in Image J software. The compressive strength test was conducted in a mechanical testing machine (EMIC - Equipment and Testing Systems Ltd., Joseph of the Pines, PR, Brazil). Statistical analysis was performed by ANOVA, Tukey test. Significance level of 5%. RESULT: No statistically significant changes between the study groups was observed both for the number of pores as well as for the compressive strength. CONCLUSION: The use of GIC associated with CHX gluconate 1% and 2% is the best option to be used in dental practice.

PURPOSE: To analyze the antimicrobial action of 2% chlorhexidine gluconate, 1% sodium hypochlorite and paramonochlorophenol were combined with furacin against strains of S. aureus, C. albicans, E. faecalis and P. aureginosa. METHODS: Forty Petri plates were used. Four plates were separated from the others and used as a negative control. Four other plates were used a positive control. The other 32 plates were treated with four circles of sterilized filter paper impregnated with the test and control substances. The groups of plates were analyzed after an experiment time of seven days by the measuring the inhibition halos. RESULTS: Two percent chlorhexidine gave the largest inhibition zones, and the difference in size between its inhibition zones and the compound with the next largest inhibition zone, 1% sodium hypochlorite, was statistically significant. The 1% sodium hypochlorite also had significantly larger inhibition zones than the control group and PMC+F. CONCLUSION: Two percent chlorhexidine gluconate gave the best results, while PMC+F showed the weakest antibacterial activity.

Chlorhexidine gluconate is a bisguanide germicide currently available with 70% isopropanol (Hibistat, Hibitane) or a detergent (Hibiclens, Hibiscrub) for preoperative skin preparation. As these solvents are toxic to the cornea, we investigated the safety and efficacy of aqueous chlorhexidine solutions for ophthalmic use. Chlorhexidine in Tris-glycine buffer was evaluated for retardation of epithelial regeneration after experimental corneal abrasion in rabbits. Irrigant concentrations of 2.0 and 4.0% chlorhexidine significantly slowed the healing rate (0.546 and 0.076 mm/h, respectively) compared with saline controls (0.938 mm/h). Irrigant concentrations of less than or equal to 1% did not statistically delay healing (P greater than 0.4). In a separate group of animals, the right conjunctivae of pigmented rabbits were inoculated with Staphylococcus epidermidis (approximately 10(7) organisms per eye) and irrigated with 40 microliters of aqueous chlorhexidine in concentrations of 0.1, 0.5, and 1.0%; the left eyes were irrigated with saline or left untreated. Quantitative conjunctival cultures were obtained, and the total number of organisms recovered per eye was calculated. All chlorhexidine-treated eyes showed significant reduction in organisms compared with either untreated or saline-irrigated control eyes (P less than 0.001). In vitro antimicrobial susceptibility testing demonstrated chlorhexidine in concentrations of 0.1 to 4% to be highly active against a variety of gram-positive and gram-negative bacterial pathogens by disk diffusion and broth diffusion assays. Topical aqueous chlorhexidine may be an alternate agent for preoperative conjunctival antisepsis.

A gloved-hand wash method was used to compare the antimicrobial effect of chlorhexidine gluconate alcohol emollient hand wash (HIBISTAT) with that of 70% isopropyl alcohol on the normal flora of the hands (81 subjects) under conditions designed to mimic use by surgeons. Results of the immediate postwash effects on the bacterial counts for all 3 tests days showed that chlorhexidine significantly reduced the normal flora of the hands. When compared with the base line bacterial counts, there was 85, 96, and 98% reduction with chlorhexidine treatment and 84, 93, and 90% reduction with alcohol treatment on days 1,2, and 5, respectively. The difference between chlorhexidine and alcohol treatments was not statistically significant on days 1 and 2, but was significant on day 5 (P less than 0.01). For delayed postwash bacterial counts (for persistent antimicrobial effects), the overall log means were 4.9943 and 5.4684 for chlorhexidine and alcohol treatments, respectively. The difference between the two treatments was significant (P less than 0.01). After the chlorhexidien treatment, there was no significant growth of bacteria over a period of 6 h when compared with the base line bacterial counts.

AIM—The management of suppurative keratitis due to filamentous fungi presents severe problems in tropical countries. The aim was to demonstrate the efficacy of chlorhexidine 0.2% drops as an inexpensive antimicrobial agent, which could be widely distributed for fungal keratitis.
METHODS—Successive patients presenting to the Chittagong Eye Institute and Training Complex with corneal ulcers were admitted to the trial when fungal hyphae had been seen on microscopy. They were randomised to drop treatment with chlorhexidine gluconate 0.2% or the standard local treatment natamycin 2.5%. The diameters, depths, and other features of the ulcers were measured and photographed at regular intervals. The outcome measures were healing at 21 days and presence or absence of toxicity. If there was not a favourable response at 5 days, "treatment failure" was recorded and the treatment was changed to one or more of three options, which included econazole 1% in the latter part of the trial.
RESULTS—71 patients were recruited to the trial, of which 35 were randomised to chlorhexidine and 36 to natamycin. One allocated to natamycin grew bacteria and therefore was excluded from the analysis. None of the severe ulcers was fully healed at 21 days of treatment...

O objetivo desse estudo foi avaliar a influência de diferentes irrigantes endodônticos na resistência coesiva e flexural da dentina radicular. Cem raízes de incisivos bovinos foram selecionadas, instrumentadas e divididas aleatoriamente em 10 grupos experimentais (n= 10), de acordo com a substância irrigadora utilizada: Controle - solução fisiológica; N1 - hipoclorito de sódio a 1,0%; N5 - hipoclorito de sódio a 5,25% ; N1EDTA - hipoclorito de sódio a 1,0% associado à EDTA a 17%; N5EDTA - hipoclorito de sódio a 5,25% associado à EDTA a 17%; Sclx - solução de gluconato de clorexidina a 2,0%; Gclx - gel de gluconato clorexidina a 2,0%; SclxEDTA - solução de gluconato clorexidina 2,0% associado à EDTA a 17%; GclxEDTA - gel de gluconato clorexidina a 2,0% associado à EDTA a 17% e EDTA - EDTA a 17%. As raízes foram axialmente seccionadas em duas metades. Uma metade foi utilizada para ensaio de microtração, da qual foram obtidas seis fatias de 1,0mm de espessura que receberam constrições na face externa, determinando área de teste de 1mm2. A outra metade foi utilizada no ensaio de flexão de 3-pontos, da qual foi extraída uma barra de dentina com dimensões de 1X1X12 mm. Cada amostra permaneceu duas horas em contato com a substância irrigante endodôntica com exceção do EDTA...

The efficacy of the fluoride-chlorhexidine association in the prevention of gingivitis and caries has been advocated for a number of years5,7,14. The objective of the association of these therapeutic agents is a synergistic action. The aim of the present study was to determine the substantivity of chlorhexidine associated or not to sodium fluoride at different intervals of time, in vitro. Bovine enamel surfaces were treated with 0.12% chlorhexidine gluconate (Periogard® - Colgate®) or 0.05% sodium fluoride with 0.12% chlorhexidine (Duplak® - Dentsply®) solutions for one minute. Fragments were placed in distilled water and samples were collected at intervals of 5, 30 and 360 minutes and analyzed by spectrophotometry in the visible ultraviolet region. Substantivity was evaluated by the measurement of chlorhexidine desorption from the treated slabs. The mean values obtained were statistically analyzed by Student's t-test. The results showed that the concentration of chlorhexidine decreased when it was used in association with sodium fluoride. The difference between the groups was statistically significant (p < 0.05). These in vitro results suggest that the association between sodium fluoride and chlorhexidine in the studied concentrations appears to have no beneficial effect because of the decrease in the substantivity of chlorhexidine.

The efficacy of the fluoride-chlorhexidine association in the prevention of gingivitis and caries has been advocated for a number of years5,7,14. The objective of the association of these therapeutic agents is a synergistic action. The aim of the present study was to determine the substantivity of chlorhexidine associated or not to sodium fluoride at different intervals of time, in vitro. Bovine enamel surfaces were treated with 0.12% chlorhexidine gluconate (Periogard® - Colgate®) or 0.05% sodium fluoride with 0.12% chlorhexidine (Duplak® - Dentsply®) solutions for one minute. Fragments were placed in distilled water and samples were collected at intervals of 5, 30 and 360 minutes and analyzed by spectrophotometry in the visible ultraviolet region. Substantivity was evaluated by the measurement of chlorhexidine desorption from the treated slabs. The mean values obtained were statistically analyzed by Student's t-test. The results showed that the concentration of chlorhexidine decreased when it was used in association with sodium fluoride. The difference between the groups was statistically significant (p < 0.05). These in vitro results suggest that the association between sodium fluoride and chlorhexidine in the studied concentrations appears to have no beneficial effect because of the decrease in the substantivity of chlorhexidine.; A efetividade da associação fluoreto-clorexidina na prevenção da gengivite e da cárie vem sendo defendida há alguns anos5...

The scrubbing of hands and forearms using antiseptic agents has been the standard pre-operative procedure to prevent surgical site infection. With the introduction of antiseptic agents, the need to use brushes for pre-operative disinfection has been questioned and it has been recommended that the procedure be abandoned due to the injuries it may cause to the skin. With the purpose to provide the foundations for the efficacy of pre-operative asepsis without using brushes or sponges, the objective of this study was to evaluate three methods of pre-operative asepsis using an antimicrobial agent containing chlorhexidine gluconate - CHG 2%; hand-scrubbing with brush (HSB), hand-scrubbing with sponge (HSS), and hand-rubbing with the antiseptic agent (HRA) only. A comparative crossover study was carried with 29 healthcare providers. Antimicrobial efficacy was measured using the glove-juice method before and after each tested method. Statistical analyses showed there were no significant differences regarding the number of colony-forming units when comparing HRA, HSB, and HSS techniques (p=0.148), which theoretically disregards the need to continue using brushes or sponges for hand asepsis.; La desinfección quirúrgica de manos y antebrazos es un procedimiento que integra las actividades prequirúrgicas como medida de prevención contra infección del sitio quirúrgico. Con el advenimiento de la antisepsia desinfectante...

Background. Nosocomial infections are risk factors related to intrahospital mortality. Among other factors, these infections are strongly associated with invasive devices. In pediatric patients, the central venous catheter (CVC) is one of the most frequently related device-associated bloodstream infections. The aim of this study was to evaluate the efficacy and safety of a chlorhexidine-gluconate impregnated patch (CHGp) in reducing infections related to CVC in pediatric patients. Methods. We conducted a systematic review and meta-analysis. An electronic search of the literature (Medline, EMBASE, Lilacs and the Cochrane Library Plus) from 1966 to December 2010 was carried out for clinical trials comparing the CHGp vs. standard case management for prevention of catheter tip colonization (CTC); bloodstream infections (BSI) were retrieved. Results. Only two clinical trials were found with a total of 850 participants. Patients randomized to the CHGp group showed a lower incidence of CTC than the control group (14% vs. 25%), relative risk [RR]: 0.61, 95% confidence interval [CI 95% (0.45, 0.81)], p = 0.001), with a number needed to treat of 11. BSI showed a RR: 1.14, ([CI 95% (0.57, 2.28)], p = 0.71). Adverse events were found mainly in the CHGp group and were described as local skin reactions in 5.6% (RR 8.17 [95% CI: 1.19-56.14]...