References

Almajano MP, Carbό J, Lόpez Jiménez JA, Gordon JM Antioxidant and antimicrobial activities of tea infusions. Food Chemistry. 2008; 108:(1)55-63

Anderson MJ, Horn ME, Lin YC, Parks PJ, Peterson ML Efficacy of concurrent application of chlorhexidine gluconate and povidone iodine against six nosocomial pathogens. Am J Infect Control. 2010; 38:(10)826-31

Animalcare. Product Safety Data Sheet Vetasept Povidone-iodine Surgical Scrub. 2014. http://www.animalcare.co.uk/FileDepository/documents/hygiene/antiseptics/vetasept%20povidone-iodine%20surgical%20scrub.pdf ([Accessed 02 March 2015])

Anita P, Sivasamy S, Madan Kumar PD, Nanda Balan I, Ethiraj S In vitro activity of Camellia sinensis extract against cariogenic microorganisms. J Basic Clin Pharm. 2014; 6:(1)35-9

Archana S, Abraham J Comparative analysis of antimicrobial activity of leaf extracts from fresh green tea, commercial green tea and black tea on pathogens. Journal of Applied Pharmaceutical Science. 2011; 1:(8)149-52

Art G. Comparison of the safety and efficacy of two topical antiseptic products: chlorhexidine gluconate + isopropyl alcohol and povidone-iodine + isopropyl alcohol. The Journal of the Association for Vascular Access. 2007; 12:(3)156-63

Aspinall V. Clinical Procedures in Veterinary Nursing, 3rd. Gloucester: Elsevier; 2014

Atlas RM, Snyder JW Handbook of Media for Clinical Microbiology, 2nd ed. Florida: Taylor and Francis Group; 2006

Bowers L. Aseptic skin preparation: reducing the risk of surgical site infection. The Veterinary Nurse. 2012; 3:(9)544-51

Bowlt K, Gasson J Preoperative infection control. Companion Animal. 2013; 18:(2)22-7

Cho Y-S, Schiller NL, Oh KH Cellular responses and proteomic analysis of Escherichia coli exposed to green tea polyphenols. Current Microbiology. 2007; 55:(6)501-6

Culligan PJ, Kubik K, Murphy M, Blackwell L, Snyder J A randomized trial that compared povidone-iodine and chlorhexidine as antiseptics for vaginal hysterectomy. American Journal of Obstetrics and Gynaecology. 2005; 192:(2)422-5

Cushnie TP, Lamb AJ Antimicrobial activity of flavonoids. International Journal of Antimicrobial Agents. 2005; 26:(5)343-356

Darouiche RO, Wall MJ, Itani KM Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010; 362:(1)18-26

Denton G Disinfection, Sterilization, and Preservation, 5th. In: Block SS (ed). Philadelphia: Lippincott Williams and Wilkins; 2001

Desrochers A, St-Jean G, Anderson DE, Rogers DP, Gengappa MM Comparative evaluation of two surgical scrub preparations in cattle. Vet Surg. 1996; 25:(4)336-41

Driscoll AJ, Bhat N, Karron RA, O'Brien KL, Murdoch DR Disk diffusion bioassays for the detection of antibiotic activity in body fluids: applications for the pneumonia etiology research for child health project. Clin Infect Dis. 2012; 54:(2)S159-S164

Durani P, Leaper D Povidone-iodine: use in hand disinfection, skin preparation and antiseptic irrigation. Int Wound J.. 2008; 5:(3)376-87

Eugster S, Schawalder P, Gaschen F, Boerlin P A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg. 2004; 33:(5)542-50

Evans LK, Knowles TG, Werrett G, Holt PE The efficacy of chlorhexidine gluconate in canine skin preparation – practice survey and clinical trials.. J Small Anim Pract. 2009; 50:(9)458-65

Field A. Discovering Statistics Using IBM SPSS Statistics, 3rd. London: Sage Publications Ltd; 2009

Fitzpatrick N, Solano MA Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg. 2010; 39:(4)460-74

Hardy Diagnostics. Mueller-Hinton Media. https://catalog.hardydiagnostics.com/cp_prod/Content/hugo/MuellerHintonMed.htm ([Accessed 03 February 2015])

Hedalgo E, Dominguez C Mechanisms underlying chlorhexidine-induced cytotoxicity. Toxicology in Vitro. 2001; 15:271-6

Hemani ML, Lepor H Skin preparation for the prevention of surgical site infection: which agent is best?. Reviews in Urology. 2009; 11:(4)190-5

Global Salm-Surv.. 2002. http://www.who.int/ihr/lyon/surveillance/ihr_astsalmonella_2010_en.pdf ([Accessed 05 February 2015])

Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. 2013. http://www.microbelibrary.org/component/resource/laboratory-test/3189-kirby-bauer-disk-diffusion-susceptibility-test-protocol ([Accessed 08 February 2015])

Hutchinson T BSAVA Manual of Canine and Feline Surgical Principles: A Foundation Manual. In: Baines S, Lipscomb V, Hutchinson T (eds). Gloucester: British Small Animal Veterinary Association; 2012

Jarral OA, McCormack DJ, Ibrahim S, Shipolini AR Should surgeons scrub with chlorhexidine prior to surgery?. Interactive Cardiovascular and Thoracic Surgery. 2011; 12:(6)1017-21

Guiding Principles for Preparing and Undertaking Aseptic Surgery. 2010. http://www.lasa.co.uk/PDF/LASA_Guiding_Principles_Aseptic_Surgery_2010.2.pdf ([Accessed 24 February 2015])

Kampf G, Kramer A Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clinical Microbiology Reviews. 2004; 17:(4)863-93

Knights CB, Mateus A, Baines SJ Current British veterinary attitudes to the use of perioperative antimicrobials in small animal surgery. Vet Rec. 2012; 170:(25)646-54

Koburger T, Hübner N-O, Braun M, Siebert J, Kramer A Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother. 2010; 65:(8)1712-9

Kumar A, Kumar A, Thakur P Antibacterial activity of green tea(Camellia sinensis) extracts against various bacteria isolated from environmental sources. Recent Research in Science and Technology. 2012; 4:(1)19-23

Kunkle CM, Marchan J, Safadi S, Whitman S, Chmait RH Chlorhexidine gluconate versus povidone iodine at cesarean delivery: a randomised clinical trial. The Journal of Maternal-Fetal and Neonatal Medicine. 2014; 18:E1-E5

Ling LT, Schneider T, Peoples AJ A new antibiotic kills pathogens without detectable resistance. Nature. 2015; 517:455-9

Macias JH, Arreguin V, Munoz JM, Alvarez JA, Mosqueda JL, Macias AE Chlorhexidine is a better antiseptic than povidone-iodine and sodium hypochlorite because of its substantive effect. Am J Infect Control. 2013; 41:(7)634-7

McHugh D, Young A, Johnson J BSAVA Textbook of Veterinary Nursing, 5th. In: Cooper B, Mulineaux E, Turner L (eds). Gloucester: British Small Animal Veterinary Association;

Meyer W, Neurand K Comparison of skin pH in domesticated and laboratory mammals. Arch Dermatol Res. 1991; 283:(1)16-8

Montevecchi M, Dorigo A, Cricca M, Checchi L Comparison of the antibacterial activity of an ozonated oil with chlorhexidine digluconate and povidone-iodine. mixed-citation>A disk diffusion test. The New Microbiologica. 2013; 36:(3)289-302

Orpet H, Welsh P Handbook of Veterinary Nursing, 2nd ed. Chichester: Wiley-Blackwell; 2010

Osuna DJ, DeYoung DJ, Walker RL Comparison of an antimicrobials adhesive drape and povidone-iodine preoperative skin preparation in dogs. VetSurg. 2010; 21:(6)458-62

Owens CD, Stoessel K Surgical site infections: epidemiology, microbiology and prevention.. J Hospital Infect. 2008; 70:(s2)3-10

Parija SC. Textbook of Microbiology and Immunology.India: Elsevier; 2009

Pelligand C. Nursing the Feline Patient. In: Scmeltzer LE, Norsworthy GD (eds). United Kingdom: Wiley-Blackwell; 2012

Reichman DE, Greenberg JA Reducing surgical site infections: a review. Reviews in Obstetrics and Gynaecology. 2009; 2:(4)212-21

Reygaert WC. The antimicrobial possibilities of green tea. Frontiers in Microbiology. 2014; 5:1-8

Rutter JD, Angiulo K, Macinga DR Measuring residual activity of topical antimicrobials: is the residual activity of chlorhexidine an artefact of laboratory methods?. J Hosp Infect. 2014; 88:(2)113-5

Sharif A, Almansoori A, Fowler M, Elkamel A, Kamal A Design of an energy hub based on natural gas and renewable energy sources. International Journal of Energy Research. 38:(3)363-73

Sharma A, Gupta S, Sarethy IP, Dang S, Gabrani R Green tea extract: possible mechanism and antibacterial activity on skin pathogens. Food Chemistry. 2012; 135:(2)672-5

Silva BM, Palmeira-de-Oliveria A, Palmeira-de-Oliveria R, Martinez-de-Oliveria J, Duarte AP Tea (Camellia sinensis (L)): a putative antimicrobial in sexually transmitted infections. In: Mendez-Vilas A. Spain: Formatex Research Center; 2013

Singh BN, Shankar S, Srivastava RK Green tea catechin, epigallocatechin-3-gallate (EGCG): Mechanisms, perspectives and clinical applications. Biochemical Pharmacology. 2011; 82:(12)1807-21

Sogawa Y, Kobayashi H, Kajiura T, Nishihara Y Comparison of residual antimicrobial activity of chlorhexidine-containing antiseptics: an express report. Journal of Healthcare-associated Infection. 2010; 2-6

Tiwari RP, Bharti SK, Kaur HD, Dikshit GS, Hoondal GS Synergistic antimicrobial activity of tea and antibiotics. Indian Journal of Medical Research. 2004; 122-4

Turk R. Prospective evaluation of the epidemiology and microbiology of surgical site infections.: MSc, University of Guelph; 2013

Turk R, Singh A, Weese JS Prospective surgical site infection surveillance in dogs. Vet Surg. 2015; 44:(1)2-8

Uckay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D Preventing surgical site infections. Expert Review of Anti-Infective Therapy. 2010; 8:(6)657-70

Verwilghen D, Singh A Fighting surgical site infections in small animals. Vet Clin North Am Small Anim Pract. 2014; 45:(2)243-76

Vetbact. Veterinary Bacteriology: Information about Important Bacteria. 2015. http://www.vetbact.org/vetbact/?startpage=1 ([Accessed 03 March 2015])

Wang Y, Ma S Recent advances in inhibitors of bacterial fatty acid synthesis type II (FASII) system enzymes as potential antimicrobial agents. ChemMedChem. 2013; 8:(10)1589-1608

Weaver D, Jean G, Steiner A Bovine Surgery and Lameness, 2nd ed. Oxford: Blackwell Publishing Ltd; 2005

Wilson DG, Hartmann F, Carter VR, Klohnen A, MacWilliams PS Comparison of three preoperative skin preparation techniques in ponies. Equine Vet J. 2011; 23:(9)462-5

Wolcott RD, Gontcharova V, Sun Y, Zischackau A, Dowd SE Bacterial diversity in surgical site infections: not just aerobic cocci anymore. J Wound Care. 2009; 18:(8)317-23

Yassen RT, Bakkir LK, Mustaffa RM In vitro and in vivo study of green and black tea antimicrobial activity on methicillin resistant staphylococcus aureus. Basrah Journal of Veterinary Research. 2011; 10:(2)1-104

An in vitro investigation into the efficacies of chlorhexidine gluconate, povidone iodine and green tea (Camellia sinensis) to prevent surgical site infection in animals

02 October 2016
Research
14 mins read
02 October 2016
Volume 7 · Issue 8

Abstract

Background:

Surgical site infections are common in veterinary practice; their prevention is based on the preoperative use of topical antimicrobials at the surgical site to reduce resident bacteria to sub-pathogenic levels.

Aim

Chlorhexidine gluconate (CHG) and povidone iodine (PI) are the most popular options for preoperative skin preparation in veterinary practice, however increasing bacterial resistance to CHG and PI have been reported; therefore investigation into alternative antimicrobials such as Camellia sinensis (green tea: GT) is required.

Method

The Kirby-Bauer disk diffusion method was used to test the antibacterial activity of four dilutions of CHG, PI and GT on the normal flora of animal skin, represented by S. aureus, S. intermedius, S. uberis and S. pyogenes. Zones of inhibition (ZOI) were measured to assess antimicrobial action. Kruskal-Wallis analyses with Mann-Whitney post-hoc tests determined differences in efficacy between the dilutions of antimicrobials for each bacterium tested.

Results

All antimicrobials inhibited bacterial growth, CHG was more efficacious than PI and GT (p<0.0001; mean CHG: 24.02± 2.05 mm; mean PI: 4.46±1.35 mm; mean GT: 2.90mm±2.60mm). Although GT produced smaller ZOIs than PI, no significant differences in efficacy existed (p>0.05).

Conclusion

The results suggest that CHG is the best antimicrobial for preoperative skin preparation. GT did produce an antibacterial effect on three of the four bacteria, although this was inferior to the existing veterinary products used. Therefore GT in the formulation tested is not recommended for use as a veterinary antimicrobial.

Surgical site infections (SSIs) are a type of iatrogenic infection occurring in wounds postoperatively, which can be a potentially life-threatening surgical complication within human and veterinary medicine (Eugster et al, 2004; Cho et al, 2007; Hemani and Lepor, 2009). SSIs can result in pain, delayed healing and wound breakdown and, because preventable, could be deemed ‘unavoidable suffering’ (Jennings and Berdory, 2010). Therefore effective SSI prevention is essential to maintain the health and welfare of surgical patients.

It is widely believed that the patient's skin is the main source of surgical wound contamination, with Staphylococci and Streptococci bacterial species most frequently cultured from veterinary SSIs (Darouiche et al, 2010; Hutchinson, 2012). These species represent the normal bacteria of the skin and are usually non-pathogenic, but can cause infection when they enter a wound (Bowers, 2012). SSIs account for 15% of human nosocomial infections, prolong hospitalisation and increase morbidity and mortality, in turn increasing the cost of surgery in humans (Durani and Leaper, 2008; Reichman and Greenberg, 2009). Veterinary SSI incidence occurs at an estimated 3% in surgical patients (Fitzpatrick and Solano, 2010; Turk et al, 2015) with livestock surgery that often occurs outside the surgical environment in situ increasing SSI risk >30% (Weaver et al, 2005; Verwilghen and Singh, 2014). Investigations into the microbiology of SSIs have demonstrated wide bacterial diversity (Owens and Stoessel, 2008; Wolcott et al., 2009; Turk et al, 2015); causal bacteria implicated include Staphylococci species (74%), with Staphylococcus aureus and coagulasenegative Staphylococci most commonly reported (Owens and Stoessel, 2008; Turk et al, 2015).

Register now to continue reading

Thank you for visiting The Veterinary Nurse and reading some of our peer-reviewed content for veterinary professionals. To continue reading this article, please register today.

Register
Or continue by

Signing in with your registered email address

antimicrobial resistance
green tea
surgical site infection
Veterinary nursing