Wounds Research Laboratory, Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Portugal.
Belgian Defence Medical Component, Brussels, Belgium.
J Hosp Infect. 2023 Jan;131:58-69. doi: 10.1016/j.jhin.2022.09.021. Epub 2022 Oct 8.
Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can lead to resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in-vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.
养老院中不充分的感染控制、伤口护理和口腔卫生措施给居民的生活质量带来挑战。基于焦点小组会议和文献检索的结果，本叙事综述评估了防腐剂在养老院感染管理程序中的当前和潜在作用。我们研究了耐甲氧西林金黄色葡萄球菌（MRSA；包括去定植方案）、慢性伤口护理和口腔卫生管理中的当代策略和关注点，并回顾了防腐剂使用的现有数据，重点是聚维酮碘。与洗必泰、聚六亚甲基胍和银相比，聚维酮碘具有更广泛的抗菌活性，对 MRSA 和其他存在于慢性伤口中的微生物（包括生物膜）具有快速而强大的活性。由于没有关于接触聚维酮碘后出现细菌耐药或交叉耐药的报告，因此与莫匹罗星和洗必泰相比，它可能更适合用于 MRSA 去定植，因为后两者可能导致耐药的 MRSA 菌株。聚维酮碘口腔产品对口腔病原体的疗效优于其他防腐剂，如洗必泰漱口水，这突出了聚维酮碘在口腔护理中的临床益处。此外，包括漱口水在内的聚维酮碘产品已证明对 SARS-CoV-2 具有快速的体外抗病毒活性，如果将其纳入养老院 2019 年冠状病毒控制方案中，可能有助于减少其传播。重要的是，聚维酮碘的活性不受有机物质的影响，如慢性伤口和口腔中发现的有机物质。聚维酮碘是一种有前途的防腐剂，可用于管理养老院中的感染，包括 MRSA 去定植程序、慢性伤口管理和口腔护理。
