Dissertations / Theses on the topic 'Chlorhexidine gluconate'

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Biomedical Technology In the Faculty of Health and Wellness Sciences At Cape Peninsula University of Technology 2013
Newly developed and commercial dental resins which are commonly used nowadays have to be tested for their antimicrobial susceptibility. The purpose of this in vitro study was to investigate the antimicrobial activity of a titanium oxide (TiO2) nano-composite which was prepared with different antibacterial substances and used as restoratives in dentistry to combat certain selected bacteria that are considered the principle causes of some tooth diseases, for example, tooth decay and to prevent unsuccessful dental restoration. The TiO2 nano-composite was prepared and divided into four groups: The first group was an untreated TiO2 nano-composite. The second group was silane-treated TiO2 nano-composite. The third group was treated TiO2 nano-composite which was combined with chlorhexidine gluconate (CHxG). The fourth group was treated TiO2 nano-composite which was combined with benzalkonium chloride (BzCl). Five of the selected bacteria were grown overnight in Petri dishes. Four of them, namely, Escherichia coli (E. coli) ATCC 11775, Staphylococcus aureus (S. aureus) ATCC 12600, Enterococcus faecalis (E. faecalis) ATCC 29212, and Pseudomonas aeruginosa (P. aeruginosa) ATCC 10145, were grown on Müller-Hinton Agar (MHA). Streptococcus mutans (S. mutans) ATCC 25175 was grown on Brain Heart Infusion (BHI) agar. All these bacteria were tested against the TiO2 nano-composite, and incubated for 24 hours at 37°C, except S. mutans, which was incubated separately and exposed to CO2. It was placed into a CO2 water-jacketed incubator in an atmosphere of 5% CO2 for 24 hours at 37°C. The obtained results showed that neither of the groups of TiO2 nano-composites, (untreated TiO2 nano-composite and treated TiO2 nano-composite) exhibited antimicrobial activity against the pathogens. Only preparations of TiO2 nano-composites at a concentration of 3 %m/m of both CHxG and BzCl showed antimicrobial activity against S. aureus. Antimicrobial activity against S. mutans, E. coli, P. aeruginosa, E. faecalis and S. aureus, were only realized at a concentration of 10 %m/m for both CHxG and BzCl..

The purpose of this study was to determine whether chlorhexidine gluconate (0.12%), used as an endodontic irrigating solution would affect the apical seal of three root canal cements. One hundred extracted human single-canal teeth were divided into 9 experimental groups of 10 teeth each, in addition to a positive and negative control group of 5 teeth each. The teeth were decoronated at the level of the cementoenamel junction, accessed, instrumented to a Master Apical File #50, irrigated with either sterile saline, 5.25% NaOCl or 0.12% chlorhexidine gluconate, and dried using paper points. Obturation was accomplished using lateral condensation and one of three endodontic sealers: Roth's 811, AH26, or Sealapex. Post-obturation apical leakage was measured at 270- and 360-day observation periods using the fluid filtration method. Using the mixed-model repeated-measures ANOVA test with Tukey's HSD multiple comparison procedure, the results showed the saline-Sealapex combination had significantly more leakage (p<0.05) than either the Peridex-Sealapex or saline-Roth's combinations at 270 days. No other significant differences were noted between any sealer-irrigant combination at 270 days. The saline-Sealapex combination had significantly more leakage than the saline-Roth's combination at 360 days. No other significant differences were noted at 360 days. Under the conditions of this study, chlorhexidine gluconate irrigant did not adversely affect the apical seal of three root canal cements at 270 and 360 days.

Thesis (M.S.D.)--Indiana University School of Dentistry, 2010.
Title from PDF t. p. (viewed July 28, 2010) Advisor(s): Mychel Vail, Chair of the Research Committee, Richard Gregory, Joseph Legan, Kenneth Spolnik, Susan Zunt. Curriculum vitae. Includes abstract. Includes bibliographical references (leaves 108-120).

Surgical site infection not only brings morbidity and mortality to patients, but it also bring substantial financial burden to the hospital and the healthcare system. To minimize the clinical consequences of surgical site infection, it is crucial that all appropriate measures for reduction of surgical site infection should be implemented. Since patient’s skin is a potential source of pathogens, normal skin flora is a common cause of surgical site infections. Preoperative skin disinfection of the surgical site with an antiseptic agent is an effective method to remove the soil and transient organisms from the skin. Currently, there are different skin antiseptics available and the most commonly used agents are povidone iodine and chlorhexidine gluconate. Although povidone iodine has a long-standing recommendation and it is widely used in various surgical procedures, it has several limitations. On the other hand, there is an increasing interest of the use of chlorhexidine in indwelling catheter placement and care, surgical hand scrubbing, as well as wound dressing. In view of this, there is a potential of replacing povidone iodine by chlorhexidine as preoperative skin antiseptic agent. As there is no existing guideline supportingthis innovative movement, this dissertation aimed to review the currently available evidence on preoperative skin preparation and to develop an evidence-based guideline of using chlorhexidine in preoperative skin preparation for reducing surgical site infection in patients undergoing general surgery. Five randomized controlled studies were identified from MEDLINE, CINAHL and PUBMED and evaluated by a critical appraisal tool, the Scottish Intercollegiate Guidelines Network. All studies reported that preoperative skin preparation with chlorhexidine is more effective than the use of povidone iodine in reducing surgical site infection. An evidence-based guideline is developed according to the guideline development process from the Scottish Intercollegiate Guideline Network. Patient characteristics, local clinical setting, organizational infrastructure and staff competency is congruent with the proposed innovation. The new protocol not only can minimize the risk of postoperative surgical site infection but also save costs. The cost-benefit analysis showed that the new protocol can help to save $675,552 to $1,097,772 (HK dollars) in six-month period after implementation. To facilitate a more comprehensive plan in actual implementation of the proposed guideline, stakeholders at administrative, managerial, and operational levels would be invited to take part in the 12-week pilot test. Surgical site infection, staff satisfaction and compliance, as well as cost and benefit ratio of the guideline would be measured in the evaluation plan. The refined guidelines would then be implemented for one year. The effectiveness of the guideline would be determined by reduction in postoperative surgical site infection, increase in staff knowledge and satisfaction, and the overall expenditure.
published_or_final_version
Nursing Studies
Master
Master of Nursing

Central line associated bloodstream infections (CLABSIs) are one of the most fatal types of healthcare associated infections (HAIs) and their economic impact is significant. Although some studies have found no signification reduction in CLABSI rates with chlorhexidine gluconate (CHG) bathing; good evidence exists to support the use of CHG bathing as an intervention to reduce CLABSIs (Bleasdale et al., 2007; Climo et al., 2009; Climo et al., 2013; Montecalvo et al., 2012). CHG bathing performance may influence the effectiveness of the CHG bathing protocol. The purpose of this study was to determine the effect of a targeted educational approach involving simulation on the delivery by nursing assistants of a CHG bathing protocol. The study aims were (1) to compare the effectiveness of removal of simulated skin microbes by nursing assistants who receive training for a CHG bathing protocol with simulation training to simulated skin microbe removal by nursing assistants who receive training for a CHG bathing protocol without simulation training and (2) to examine the influence of a demographic factor, years of practice as a nursing assistant on the percentage of simulated microbes present following performance of bathing. Thirty nursing assitant volunteered for this study and were randomized to either the intervention group (training for a 2% CHG cloth bathing protocol with simulation training) or the control group (training for a 2% CHG cloth bathing protocol without simulation training). For aim (1) an independent t-test (inferential tests of group differences) was used to examine if there was any difference between the intervention group and the control group on the percentage of microbes remaining on the mannequin post bathing. For aim (2) a Pearson correlation was computed to assess the relationship between years of practice as a nursing assistant and the percentage of microbes remaining post bathing. Results showed no statistically significant differences between the two groups on demographc factors. For aim (1) the t-test revealed a statistically significant (p < .001) difference between the intervention group and the control group on the percentage of simulated microbes remaining on the mannequin post bathing. For aim (2) there was no correlation between the years of practice as a nursing assistant and the amount of microbes left on the mannequin post bathing (p=.709). This study provided an innovative method of assessing the percentage of simulation microbes remaining on the mannequin and made it possible to quantitatively measure bathing performance. Monitoring the compliance with CHG bathing is an important component when evaluating the effectiveness of a CHG bathing protocol. The findings of this study suggest that simulation training was an added benefit to the nursing assistants who received it, as they performed better than those who did not receive simulation training.

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Decontamination of the surface of the donor eyeballs is part of the operational norms that eye banks advocate before preservation, and antisepsis procedures are effective, ensuring greater transplantation safety. The objective of the present study was to evaluate the antiseptic effect in reducing the microbiota of the ocular globe of donors of corneas prior to enucleation, with 5% povidone-iodine (PVP-I) and 0.05% chlorhexidine gluconate (GC), In the action times of 5, 10 and 15 minutes, as well as the susceptibility profile of the microbiota isolated from gentamicin. Thirty pairs of corneas received antiseptics, with PVP-I in the right eye and GC in the left, and for each time of action 10 pairs of eyeballs were used. Swabs were collected from the ocular surface before application of the solutions, after and at the time of preservation of the corneal tissue, to evaluate the reduction of the microbiota. After identification of the microbiota, an antibiogram test was performed with gentamicin. The data were computed and evaluated by Chi-square or Fisher's exact test, T-test and McNemar test paired, and the statistical significance level was 5% (p <0.05). In the second collection, after antisepsis, there was a reduction of 39,5% in the total of gram positive bacteria (G +), and of 76,5% in the gram negative (G-) bacteria, with no statistically significant difference (p = 0.183), which demonstrated that the bacterial elimination capacity of the antiseptics was similar. It was observed that, in the second collection, both were more effective for G-, with a statistically significant difference (p <0.001), than for G +, with no statistically significant difference (p = 0.494). In the third collection, after the residual effect of the antiseptics, there was a reduction of 99.1% of all the microorganisms. In the antibiogram test, 88% of the isolated microorganisms were sensitive to gentamicin. It was concluded that the use of antiseptics is essential for the effective decontamination of donated corneas prior to preservation. The residual time of the antiseptics increased the decontamination power of PVP-I and GC, being similar in reducing the microbiota of the ocular globe of the donor of corneas. Gentamycin contained in the cornea preservation medium complements the antisepsis of the donated tissues.
A descontaminação da superfície dos globos oculares doados são normas operacionais que os bancos de olhos preconizam antes da preservação e os procedimentos de antissepsia são eficazes, garantindo uma maior segurança ao transplante. O objetivo do presente estudo foi avaliar o efeito antisséptico na redução da microbiota do globo ocular de doadores de córneas antes da enucleação, com o povidona-iodo (PVP-I) a 5% e gluconato de clorexidina (GC) a 0,05%, nos tempos de ação de 5, 10 e 15 minutos, bem como o perfil de susceptibilidade da microbiota isolada à gentamicina. Trinta pares de córneas receberam antissépticos, sendo o PVP-I no olho direito e o GC no esquerdo, e para cada tempo de ação foram utilizados 10 pares de globos oculares. Foram colhidos swabs da superfície ocular antes da aplicação das soluções, após e no momento da preservação do tecido corneano, para avaliar a redução da microbiota. Após identificação da microbiota, foi realizado teste de antibiograma com gentamicina. Os dados foram computados e avaliados pelos testes Qui-Quadrado ou Exato de Fisher, teste T e Teste McNemar pareado, e o nível de significância estatística foi (p<0,05). Com relação aos dados obtidos na segunda coleta, após o uso de antissépticos, houve uma redução de 39,5% no total de bactérias gram positivas (G+) e de 76,5% nas gram negativas (G-), não havendo diferença estatística significativa (p=0,183), sendo semelhante a capacidade de eliminação bacteriana dos antissépticos. Observa-se que, na segunda coleta, ambos foram mais eficazes para as G-, com diferença estatisticamente significativa (p<0,001), do que para as G+, sem diferença estatisticamente significativa (p=0,494). Na terceira coleta, após o efeito residual dos antissépticos, houve redução de 99,1% de todos os micro-organismos. No teste de antibiograma, 88% dos micro-organismos isolados foram sensíveis à gentamicina. Concluiu-se que o uso de antissépticos é essencial para a efetiva descontaminação das córneas doadas antes da preservação. O tempo residual dos antissépticos aumentou o poder de descontaminação do PVP-I e GC, sendo semelhantes na redução da microbiota do globo ocular do doador de córneas. A gentamicina contida no meio de preservação de córnea complementa a antissepsia dos tecidos doados.

Thesis (M.S.)--West Virginia University, 2010.
Title from document title page. Document formatted into pages; contains v, 47 p. : col. ill. Includes abstract. Includes bibliographical references (p. 44-47).

Magister Chirurgiae Dentium - MChD (Oral Medicine and Periodontics)
Candida species are frequently isolated from oral mucosal surfaces of healthy individuals and is the most common genus responsible for up to 75% of all candidal infections. The most common problems associated management of oral candidiasis are antifungal drug resistance and side effects Natural medicine is an emerging field and is being explored to overcome drug resistance and to reduce side effects. Gymnemagenin (will be known as Gymnemic acid; GA) is a purified extract from Gymnema sylvestre, a slow growing, perennial, medicinal plant found in Central and Western India, Tropical Africa and Australia is regarded as one of the plants with potent antimicrobial and antifungal activity.

The aim of this study was to evaluate the influence of different endodontic irrigants on the cohesive and flexural strength of the root dentin. One hundred of bovine incisor roots were selected, instrumented and randomly divided into 10 experimental groups (n = 10), according to the irrigation solution used: Control - physiological solution; N1 - sodium hypochlorite 1.0%; N5 - sodium hypochlorite 5.25%; N1EDTA - sodium hypochlorite 1.0% associate to EDTA 17%; N5EDTA - sodium hypochlorite 5.25% associate to EDTA 17%; Sclx chlorhexidine gluconate solution 2.0%; Gclx - chlorhexidine gluconate gel 2.0%; SclxEDTA - chlorhexidine gluconate solution 2.0% associate to EDTA 17%; GclxEDTA - chlorhexidine gluconate gel 2.0% associate to EDTA 17% and EDTA - EDTA 17%. The roots were axially sectioned in two halves. Half of them were used for the microtensile cohesive strength test: six 1.0mm thick slices were trimmed to produce hourglass shaped samples with a test area of 1mm2. The other halves were used in a 3-point bend flexural strength by means of dentine bars with 1X1X12 mm. Each sample remained two hours in contact with the irrigant solutions, except for EDTA, which remained for five minutes. After irrigants treatment, samples were rinsed with distilled water, and tested. Specific devices for each test were used, in a universal testing machine with a load cell of 20Kgf, and a crosshead speed of 0.5 mm/minute. Date were recorded and statistically analyzed with one-way ANOVA and Tukey test. Significant reduction in the ultimate cohesive strength and flexural strength was verified only for the groups that used sodium hypochlorite irrespective of the concentration and additional solution, differing significant from the group control. The use of chlorhexidine and EDTA separately did not cause alteration in the mechanical properties of root dentine.
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, que atuou por cinco minutos. Após o tratamento com os irrigantes, procedeu-se a lavagem com água destilada, e em seguida executados os ensaios mecânicos. Foram utilizados dispositivos específicos para cada ensaio, acoplados à máquina de ensaio mecânico, utilizando célula de carga de 20Kgf, com velocidade de 0,5 mm/minuto até a fratura da amostra. Os dados obtidos foram submetidos à análise de variância e teste Tukey. Verificou-se redução significativa na resistência máxima coesiva e flexural apenas para os grupos que empregaram o hipoclorito de sódio independe da concentração e associação com outra substância, diferindo estatisticamente do grupo controle. O uso de clorexidina e EDTA isoladamente não alterou as propriedades mecânicas da dentina radicular.
Mestre em Odontologia

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Streptococcus mutans is the main etiologic agent of dental caries, especially due to its ability to adhesion to the tooth surface. This bacterium produces glycosyltransferases that synthesize polymers of soluble and insoluble glucan from sucrose, which increases the colonization of cariogenic bacteria and promote the formation of biofilm on the surface of the teeth. Chlorhexidine is the most frequent topical antibiotic used in dentistry and is considered standard in the various dental specialties, but there are few studies on this drug at the molecular level. The aim of the present study was to investigate the antibacterial activity of chlorhexidine gluconate against in vitro planktonic and biofilm Streptococcus mutans cells in a dose- and timedependent manner. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of chlorhexidine in planktonic cells and MBC in biofilms were determined by microdilution method. Total S. mutans RNA from either planktonic cells or biofilms exposed or non-exposed (controls) to chlorhexidine were extracted, purified and reversely transcribed to cDNA. Real-time reverse transcription- PCR was used to quantify the relative levels of 16S rRNA, gtfB, gtfC and gtfD transcription of S. mutans in the presence of CHX. The activity of CHX in the initial biofilm structure for 2 and 4 h and morphological alterations in planktonic cells, under a range of CHX concentrations, was examined by Scanning Electron Microscopy (SEM). CLX MIC and MBC for planktonic cells were 2.2 mg/L and 18 mg/L, respectively, while MBC for biofilm was 800 mg/L. Planktonic cells exposed to CLX 4.5 mg/L and 9 mg/L were reduced almost by 6- and 20-fold, whereas biofilm counts were reduced (2.5-fold or more) in concentrations above 500 mg/L. In planktonic cells, exposition to CHX 4.5 mg/L increased gtfC and gtfD expression by 11-fold and 4-fold (p<0.01), respectively. In biofilm, expression of gtfB, gtfC and gtfD were reduced (<1.6-fold p<0.01) at concentrations above 500mg/L. Cell surfaces did not show any change when planktonic cells were exposed to CHX at 4.5 mg/L for 2 or 4h, but after 6 h, several wilted S. mutans cells with lost intracellular material could be observed. A decrease in the cells chain length and matrix was found when the initial biofilm was exposed from 1.1 mg/L to 4.5 mg/L of CHX, while 1200 mg/L and 2000 mg/L caused extensive precipitation of unknown material on the slide. Thus, we conclude that the CHX effects against bacteria depend on the kind of growth organization and the concentration/time of exposure to the drug. CHX may affect cell walls and intervene with mechanisms of the biofilm formation, and at sub-lethal concentrations, affect the expression of gtfs, which may exert an anticariogenic effect.
Streptococcus mutans é o principal agente etiológico da cárie dentária, especialmente devido à sua habilidade de adesão à superfície dentária. Esta bactéria produz glicosiltransferases, que sintetizam polímeros de glicano solúveis e insolúveis a partir da sacarose, que aumentam a colonização de bactérias cariogênicas e promovem a formação de biofilme dental na superfície dos dentes. A clorexidina é o antimicrobiano tópico mais utilizado na Odontologia, sendo considerado padrão nas diversas especialidades odontológicas, porém existem poucos estudos com esta droga em nível molecular. O objetivo do presente estudo foi investigar a atividade do gluconato de clorexidina em Streptococcus mutans UA159, plantônicos e organizados em biofilme, em diferentes concentrações e períodos de crescimento. A Concentração Inibitória Mínima (MIC) e a Concentração Bactericida Mínima (MBC) da clorexidina nas células plantônicas e MBC em biofilmes, foram determinadas pelo método da microdiluição. O RNA total das S. mutans plantônicos e organizados em biofilme, expostos ou não (controles) à clorexidina foram extraídos, purificados e reversamente transcritos a Cdna. O PCR quantitativo em tempo real foi utilizado para quantificar os níveis relativos de transcrição dos genes 16S rRNA, gtfB, gtfC e gtfD de S. mutans na presença ou ausência de clorexidina. A atividade da clorexidina na estrutura do biofilme inicial de 2 e 4h, e as alterações morfológicas nas células plantônicas, sobre concentrações variadas, foi examinada por Microscopia Eletrônica de Varredura (MEV). A MIC e a MBC para células plantônicas foram 2,2 mg/L e 18 mg/L, respectivamente, e a MBC para os biofilmes foi de 800 mg/. A exposição à clorexidina, nas concentrações de 4,5 mg/L e 9 mg/L, reduziu a contagem das células plantônicas por 6 e 20 vezes, respectivamente, enquanto a contagem das células do biofilme foram reduzidas (2,5 vezes ou mais) em concentrações acima de 500 mg/L. Nas células plantônicas, a exposição a 4.5 mg/L de CHX, aumentou a expressão das gtfC e gtfD por 11 e 4 vezes (p<0.01), respectivamente. Em biofilme, a expressão das gtfB, gtfC e gtfD foram reduzidas (<1,6 x, p<0.01) em concentrações acima de 500 mg/L. As superficies celulares aparentemente não mostraram modificação quando as células plantônicas foram expostas às concentrações de 4,5 mg/L por 2 ou 4h, mas depois de 6h, várias células murchas de S. mutans com material intracelular extravasado, foram observadas. Um decréscimo no comprimento das cadeias das células e também da matriz foram encontradas quando os biofilmes iniciais foram expostos a 1,1 mg/L e 4,5 mg/L de clorexidina, enquanto as concentrações de 1200 mg/L e 2000 mg/L causaram extensa precipitação de material desconhecido nas lamínulas. Assim, concluiu-se que os efeitos da clorexidina contra S. mutans dependem do tipo de organização celular, período de crescimento e concentração utilizada da droga. A clorexidina pode afetar a parece celular e interferir com mecanismos de formação do biofilme e, em concentrações subletais, reduz a expressão de algumas gtfs, o que pode exercer um efeito anticariogênico.

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, os pinos foram submetidos a forças de tração até serem desalojados. Os dados obtidos foram submetidos à análise de variância. Os valores das médias obtidas, em Kgf, foram: G1 - 21,744; G2 - 17,484; G3 - 25,229 e G4 - 20,028. Não houve diferença estatisticamente significante entre os grupos (p<0,05). Um protocolo de limpeza e desinfecção, para o preparo do espaço para pinos, deve ser estabelecido e o gluconato de clorexidina em gel a 2% não afetou negativamente a retenção de núcleos metálicos fundidos neste estudo. Estes dados sugerem que esta seja uma boa substância para auxiliar no preparo do espaço para pino, porque apresenta características vantajosas para o procedimento como: baixa toxicidade, fácil manuseio, atividade antimicrobiana e ação residual
Recontamination of the root canal during post space preparation must be avoided, under penalty of endodontic treatment failure. The use of antimicrobial substances in these procedures should be of interest. The aim of this study was to evaluate the retention of cast posts and cores luted with zinc phosphate cement and a resin cement (Panavia F), when burs and the 2% chlorhexidine gluconate in gel and saline were used for post space preparation. Forty sound human inferior premolars were used in this study. These teeth were treated endodontically, and had a 10mm length post space preparation with the number 2 burs of a carbon fiber post system. In adjunction with this burs saline (G1 and G2 - control) and 2% chlorhexidine gluconate in gel (G3 and G4) were used. Impressions were taken of the canals with acrylic resin. The teeth were included into epoxy resin and then into self-cure acrylic resin. The patterns were cast in niquel-cromium alloy then luted with zinc phosphate cement (groups 1 and 3) or Panavia F (groups 2 and 4). Specimens were stored in 100% of relative humidity for 72 hours. Then, the posts were dislodged by traction forces. The recorded data was submitted to ANOVA. The values of the averages obtained in Kgf were: G1 - 21.744; G2 - 17.484; G3 - 25.229 e G4 - 20.028. There was no statistical significant difference between the groups (p<0.05). Disinfection and cleaning protocol for the post space preparation must be established and the 2% chlorhexidine gluconate in gel did not affect negatively the retention of the cast posts in this study. This data suggests that this is a good auxiliary substance in the post space preparation because it presents advantage features for the procedure as: low toxicity, easy handle, antimicrobial action and substantivity.

Introdução: A prevenção de infecções relacionadas com a assistência à saúde (IRAS) é universalmente considerada relevante para os sistemas de saúde, pois afetam tanto os pacientes quanto os profissionais da assistência. As mãos dos profissionais constituem o elo importante na cadeia de transmissão de microrganismos entre o paciente colonizado e aquele que não tem tal status. A higienização das mãos (HM) é o meio mais efetivo para minimizar o risco de transmissão e envolve a escolha de um produto eficaz e bem aceito pelo profissional. Atualmente há indicação preferencial para o uso de produto alcoólico para HM para a maioria das situações. Entretanto, na prática, outros produtos germicidas também têm sido indicados. Entre eles, o gluconato de clorexidina (GCX), que é uma biguanida catiônica que tem sua atividade antimicrobiana atribuída à invasão na membrana e posterior ruptura das membranas citoplasmáticas, resultando na precipitação do conteúdo. O GCX tem sido utilizado em situações específicas, porém ainda sem evidências que justifiquem sua indicação prioritária. Objetivo: O objetivo deste estudo é selecionar e analisar as evidências científicas para fundamentar a indicação prioritária do uso de sabonete com GCX para HM na assistência à saúde. O estudo propõe como objetivos específicos identificar as evidências científicas disponíveis referentes a HM realizada com sabão contendo GCX quanto: a associação com a redução das IRAS, a relação do uso contínuo com a seleção de microrganismos resistentes a GCX e a relação com a saúde da pele das mãos dos profissionais. Método: Trata-se de um estudo de revisão sistemática, finalizada em abril de 2017, cujo método seguiu as recomendações do Instituto Joanna Briggs (JBI) e do Systematic Review and Meta-analysis Protocols (PRISMA-P) 2015. A aplicação da estratégia PICO buscou responder os objetivos específicos. Incluiu-se como base de dados para a pesquisa: Medline, Cinahl, Lilacs, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Google Scholar e Teses como literatura cinzenta, sem restrição de linguagem e publicadas a partir de 1985. A seleção dos artigos contou com dois revisores que utilizaram instrumentos de avaliação do JBI. Análise dos dados: Este estudo gerou três revisões, uma para cada pergunta de pesquisa. A revisão relacionada a transmissão de infecção incluiu 764 artigos, 40 para leitura integral e quatro estudos incluídos na revisão, 75% dos artigos com desenho quase-experimental, nenhum artigo foi excluído pelo instrumento de avaliação JBI. Os quatro artigos não mostraram diferença significativa de taxas de infecção quando relacionados ao uso do GCX. A revisão relacionada com a seleção de microrganismos resistentes a GCX incluiu 533 artigos, 27 foram para leitura integral e 12 artigos foram selecionados, dois dos quais foram excluídos ao serem avaliados pelos critérios JBI. Entre os 10 artigos, 60 % eram estudos descritivos. A análise dos resultados dos 10 estudos científicos mostra que três não relacionam o uso do GCX com a seleção de microrganismos resistentes enquanto sete estudos sugerem que o uso contínuo pode selecionar microrganismos resistentes a este princípio ativo. A revisão relacionada com a aceitação dermatológica captou 611 artigos, 27 para leitura integral e oito artigos foram selecionados, dos quais 75% eram estudos experimentais. O estudo E6 foi excluído por não atender questão eliminatória do instrumento JBI. A análise dos resultados dos sete estudos sugere que o uso do GCX está associado à maior número de eventos de reação de pele. Conclusão: o uso do GCX para HM não mostrou impacto na redução das IRAS. Os dados sugerem que o uso indevido ou prolongado pode selecionar microrganismos resistentes à GCX e a aplicação do produto está relacionada a eventos de pele, o que pode impactar nas taxas de adesão de HM.
Introduction: The prevention of health care-related infections (HCI) is universally considered relevant for health systems, as they affect both patients and healthcare workers (HCW). In the chain of microorganism transmission the hands of HCW are an important link between the colonized patient and the one who does not have such status. Hand hygiene (HH) is the most effective method to reduce the transmission risk of infection and it involves the selection of an effective product that is well accepted by the HCW. Currently, alcohol-based products are the preferred option for HH for most situations. In practice, however, a range of other microbial products have also been recommended. Among them chlorhexidine gluconate (CHG), a cationic biguanide that has its antimicrobial activity attributed to membrane invasion, and subsequent rupture of cytoplasmic membranes, resulting in precipitation of the content. CHG has been used in specific situations, but it still has no evidence to justify its preferred recommendation. Objective: The aim of this study is to recognize and to summarize scientific evidence to support preferred recommendation of the use of CHG-based soap for hand hygiene in healthcare. The study proposes specific objectives as to identify available scientific evidence regarding CHG-containing soap for HH and determine: its association with the reduction of health care-associated infections (HAIs) transmission, the association of the routine use of CHG and selection of CHG resistant strains, and the association of CHG-based hand washing as well the integrity of HCW hand skin. Method: This is a systematic review study accomplished in April 2017, which was based on the protocol of the Institute Joanna Briggs (JBI) and the recommendations from Systematic Review and Meta- analysis Protocols (PRISMA-P) 2015. PICO strategy was applied in order to address some specific objectives. The database for the research consisted of: Medline, Cinahl, Lilacs, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Scholar Google and Theses as gray literature without language restriction and published since 1985. The studies selection was carried out by two researchers who used assessment tools from the Institute Joanna Briggs. Data analysis: This study originated three distinct reviews aiming to answer three questions derived from the main research question. The first one, regarding infection transmission included 764 articles, 40 to be entirely read and four studies to be included in the review, 75% of articles with quasi-experimental design, no studies were excluded by JBI assessment instrument. Four articles did not show any significant difference in infection rates associated to the use of CHG. The revision regarding the selection of CHG-resistant microorganisms included 533 articles, 27 to be entirely read and 12 were selected, two of which were excluded after being assessed by JBI criteria. Among 10 articles, 60% were of descriptive studies. Analysis of outcomes of 10 scientific studies showed that three of them did not relate the continuous use of CHG with the selection of resistant microorganisms while seven suggest that long-term use may select resistant strains to this active ingredient. The last one, regarding dermatological acceptance included 611 articles, 27 to be entirely read and eight were selected, being 75% of experimental studies. Study E6 was excluded because it did not address the pré-defined elimination question of JBI instrument. The analysis of outcomes of seven studies suggests that the use of CHG is associated with the higher number of skin reaction events. Conclusion: the use of CHG for HH has not shown any impact on the reduction of IRAS. Data suggest that inappropriate or long-term use of it may select CHG-resistant strains and skin events have been more frequently related to its application when compared to other products, which may have an impact on HH adherence rates.

O presente estudo avaliou in situ a influência de fatores da dieta associado ao uso de clorexidina na cor e na rugosidade superficial de diferentes resinas compostas (Z250® - 3M-ESPE e Filtek Supreme® - 3M-ESPE). Foram confeccionados 112 corpos-de-prova (6,0x2,0mm) que foram polidos com disco abrasivos Super Snap® (Shofu). O estudo foi constituído por duas fases de 5 dias cada, com um período de washout de 9 dias entre elas. Os corpos-de-prova de cada um dos materiais foram divididos entre 14 voluntários e montados em dispositivo palatino, na região dos pré-molares e molares superiores e instalados nos participantes para a realização dos bochechos e da ingestão do chá em cada uma das fases do experimento. De acordo com sorteio aleatório, metade dos voluntários utilizou, na primeira fase do experimento, solução de gluconato de clorexidina 0,12% (S1) e a outra metade dos voluntários realizou os bochechos com uma solução placebo (S2), de mesma composição da solução original, porém sem adição de gluconato de clorexidina 0,12%. Os bochechos foram realizados 2 vezes ao dia, por 1 minuto, durante 5 dias. Todos os voluntários, após o bochecho com gluconato de clorexidina 0,12% ou placebo ingeriram 200 mL de chá em ambas as fases. Na segunda fase do experimento, os corpos-de-prova foram substituídos por outros e os voluntários foram cruzados quanto à solução, de modo que todos usaram ambas às soluções. As leituras de cor, obtidas através de um colorímetro, e a rugosidade superficial, obtida por meio de um rugosímetro, foram realizadas imediatamente antes da fixação do espécime no aparelho intra-bucal e após 24 horas do término do período experimental. Os dados foram submetidos ao teste ANOVA e Tukey (p≤0,05). Os resultados mostraram que: a) a solução S1obteve maiores médias de alteração de cor (ΔE*) que S2 enquanto que para os outros fatores e interações não houve diferença estatisticamente significante para esta variável; b) todos os fatores e respectivas interações, exceto a interação Solução x Material, sofreram variação de luminosidade (L*) significante estatisticamente; c) todos os fatores e respectivas interações, exceto a interação Material x Tempo, sofreram variação do parâmetro a* significantes estatisticamente; d) o fator Solução quando analisado isoladamente e a interação Tempo x Solução não obtiveram resultados estatisticamente diferentes para o parâmetro b* e; e) para a rugosidade superficial (Ra) apenas o fator Tempo foi estatisticamente significante. Conclui-se que: houve uma maior alteração de cor da resina composta quando se utiliza soluções a base de Clorexidina 0,12%; as resinas estudadas não influenciaram no comportamento da cor quando associado à Clorexidina 0,12% e chá preto; para os parâmetros L* a* e b* os fatores Solução, Material e Tempo tiveram efeito significante, exceto o fator Solução para o parâmetro b*; a utilização de Clorexidina durante 5 dias não influenciou na rugosidade superficial dos materiais estudados e; o tempo teve influencia sobre o aumento da rugosidade superficial.
This in situ study evaluated the influence of dietary factors in association with chlorhexidine on the color change (ΔE*) of two composites resins (Z250® - 3M-ESPE and Filtek Supreme® - 3M-ESPE). 112 discs (6.0x2.0mm) were fabricated and polished with Super Snap® discs (Shofu). The specimens were divided among 14 volunteers, and fitted onto intraoral devices and placed in the maxillary premolar and molar positions. Palatal intra-oral acrylic resin appliances were made for each volunteers in the experiment. In each appliance, two specimen of each materials was randomly fixed. This study was composed of two phases of 5 days each, with a washout period of 9 days between them. In the first phase, half of the volunteers chosen by random draw, used a 0.12% chlorhexidine solution (S1) and the other half used a placebo solution (S2). The mouthwashes were performed 2 times a day, for 1 min. each, for 5 days. In the second phase of the experiment, the specimens were replaced by others and the volunteers were crossed on the outcome. In both phases, after mouthwashes with S1 or S2, all volunteers ingested 200 mL of black tea for 10 minutes. The color change of all specimens before and after of the experimental period was measured by a colorimeter and the data were analyzed by two-way analysis of variance (ANOVA) and Tukey´s test (&alpha=.05). Subsequently, the surface roughness (Ra) of the specimens was evaluated using a profilometer, and the data were compared by two-way ANOVA followed by a Tukey multiple comparations test (α=.05). According to ANOVA: a) the S1 solution had the highest means of color change (ΔE*) that S2, while for the others factors and interactions no have statistically significant difference for this variable; b) all the factors and their interactions had significant statistically changes in lightness (L*), except for the Solution x Material interaction; c) all the factores and their interactions had significant statistically changes in parameter a*, except for the Material x Time interaction; d) the solution factor and Time x Solution interaction no had statistica different for the parameter b* and; e) for surface roughness (Ra) only the time factor was statistically significant. It was concluded that: there was an increase in color change of composite resin when using Chlorhexidine 0.12%; the resin did not influence on the color when associated with Chlorhexidine 0.12% and black tea; for parameters L * a * b * Solution, Material and Time factors had significant effect, except for the Solution factor for the parameter b *; the use of chlorhexidine for 5 days did not influence the surface roughness of the materials studied; and the time had a significant influence on increased surface roughness.

Respiratory assistance devices bypass essential host defenses and allow these pathogens direct access to the lower respiratory tract and hinder these defense systems to effectively clear respiratory pathogens (1). Mechanical ventilation in the presence of dental plaque with respiratory pathogens has the potential to lead to ventilator-associated pneumonia (VAP). Ventilator-associated pneumonia is the leading cause of morbidity and mortality in intensive care units. VAP influences increasing need for medical treatment and hospital length of stay (LOS) (2-4). Lower respiratory tract infections (LRTI) have been found to be the most expensive site per infection with 13% of all infections accounting for 29% of the total recorded cost (5). The purpose of this systematic review is to perform a comprehensive literature search to identify published randomized clinical trials relating to the efficacy of chlorhexidine gluconate (CHX) oral rinse in preventing VAP. CHX has been identified as the "gold standard" to reduce the number of microorganisms. This review also addresses the importance of oral health and the increased risk of respiratory infections from colonization by harmful pathogens within the oral mucosa. Clinical trials relating to the hypothesis in question were evaluated using Consolidated Standards of Reporting Trials (CONSORT) checklist for validity. Quality and strength of each randomized clinical trial were evaluated based on the requirements of the Agency for Healthcare Research and Quality (AHRQ). Nine bibliographic databases, from 1965-2012 were used to conduct the literature inquiry. Ten studies included populations greater than or equal to 18 years of age and admitted to the intensive care unit receiving mechanical ventilation. The patients were, ventilated due to either trauma, undergoing elective cardiothoracic surgery, or from some other form of surgery, at risk for VAP. In one study, CHX oral rinse decreased microbial colonization of the respiratory tract and hospital-acquired pneumonia (HAP) in patients who underwent open-heart surgery and were intubated less than 24 hours. Yet the difference was not significant in patients intubated more than 24 hours who had a higher amount of bacterial colonization (6). Modulation of oropharyngeal colonization by the use of oral chlorhexidine has reduced the number of ICU-acquired HAP in selected patient populations such as those undergoing coronary bypass grafting, but its routine use is not recommended until more data become available (7). Findings from several studies suggest a significant decrease in the incidence of total nosocomial respiratory infections and systemic antibiotic use in patients who underwent open heart and used a CHX oral rinse as compared with ventilator patients who did not use the rinse; there was also a 65% decrease (13% vs. 4%) in the overall nosocomial infection rate in the chlorhexidine group (7,8,9). Using 2% chlorhexidine solution presents the strongest evidence for decreasing VAP (10,11). From Scannapieco and colleagues' study we can conclude that twice daily is not necessarily better than once daily, but maybe a four times daily regimen with 2% instead of 0.12% CHX does make a difference in reducing the incidence of VAP (12).

Indiana University-Purdue University Indianapolis (IUPUI)
The purpose of this study was to investigate the antibacterial efficacy of 0.12-percent and 2.0-percent chlorhexidine gluconate (CHX) on eliminating Enterococcus faecalis from dentinal tubules, and whether this antibacterial effect was enhanced by heat. To date there have been no published articles that describe the heating of 2.0-percent CHX and its antimicrobial efficacy and clinical relevance towards E. faecalis within dentinal tubules in root canal systems. Ninety-five human extracted, single rooted, maxillary, anterior teeth were used to prepare dentin disk specimens. After proper sterilization, a 2.5-mm ISO-sized diameter lumen was prepared, and then the canals were filled with brain-heart infusion (BHI) broth infected with E. faecalis. The BHI was removed and the specimens in equally divided groups were rinsed with sterile saline and filled with saline, or 0.12 percent CHX or 2.0 percent CHX at ambient temperature (24°C) or experimental temperature (46°C) and incubated at oral temperature (37°C) or the experimental temperature (46°C), respectively. The specimens were frozen to -70˚C and pulverized in liquid nitrogen. Serial dilutions were prepared of 1:100 and 1:1000 and spiral plated on BHI agar plates in duplicate. They were incubated, and the number of bacterial colonies was recorded 24 hours later for data analysis. A two-way analysis of variance (ANOVA), with factors for solution, solution temperature, and the solution-by-temperature interaction was used to determine antibacterial efficacy. Pair-wise comparisons between groups were examined for significance using the Fisher’s Protected Least Significant Differences Method. The E. faecalis CFU were log-transformed to satisfy the assumptions required for the ANOVA. The results of this investigation demonstrated no statistically significant difference with the addition of heat to either test irrigation solution regarding the elimination of E. faecalis from dentinal tubules within the root canal system. There was a statistically significant difference in the antibacterial efficacy of CHX against E. faecalis in comparison with the concentration tested. A higher concentration of 2.0-percent CHX demonstrated a significantly higher antibacterial efficacy against E. faecalis compared with 0.12-percent CHX, and likewise with the saline control. It can be concluded that the use of a higher concentration of 2.0-percent CHX is advantageous as a final irrigation solution after copious amounts of NaOCl and EDTA have been utilized for effective antimicrobial efficacy and substantivity.