Protecting Yourself from Vibrio Infection

Luv2Yak

In today's modern wound treatment medicine, hydrogen peroxide belongs back in "Cowboy Bill's Wild West Medicine Show". It's good for debridement, but as for spectrum of activity against pathogens, as well as tissue health/healing, it's grossly inferior.

For chlorhexidine, see Hibiclens (human medicine) and Nolvasan (veterinary medicine). Chlorhexidine maintains activity in the presence of organic matter (blood, debris, pus, etc.) better than iodine, povidone-iodine, Betadine. Chlorhexidine is also less harsh on soft tissue vs. iodine-based products, destroying a broader spectrum of pathogens, i.e., Gram-positive and Gram-negative bacteria, while not adversely affecting healthy soft tissue and less damaging to compromised soft tissue compared to iodine/povidone-iodine/Betadine and its generics.

My opinion after 30+ years experience in veterinary medicine with small animals, horses and food animals (beef and dairy cattle, goats/sheep and swine).

Doc Stressor

Couldn't get into Med School, huh?

That explains a lot. :rotflmao

dangskiffy

Doc Don't feed the troll. No real Imput through life expierence just cut n paste knowledge. You can call him out over and over but that's what he lives for. He's the reason there's no mercury in mercurochrome!

Billy

Luv2Yak wrote: »

My opinion after 30+ years experience in veterinary medicine with small animals, horses and food animals (beef and dairy cattle, goats/sheep and swine).

If my dog gets a cut I'll keep your advice in mind.

Keep in mind my dog drinks water out of the toilet and has been known to eat her own poop. :shrug

If I get a cut I'll stick to conventional methods recommended for humans.

Bill

Saltygatorvet

No doubt luvtoyak trolls here often, but what he has to say here isn't at all off base ( although he didn't have to do it in that way). I'm not 100% sure about betadine not having activity against gram neg bacteria. But chlor hex is a great antiseptic. It's used( in human and veterinary medicine) for scrubbing hands before surgery as well as patient presx prep. I carry betadine with me, but there is nothing wrong with chlorhex solution. Not sure how well it stands up to heat, probably better than h2o2.
That was a uncharacteristic cheap shot from Doc S. I'm also a veterinarian, and take a great deal of pride in that. I chose vet school over med school. When I applied ( 1999) , it was far easier to get into ( an American) med school than vet school in Florida. I understand, he may troll a lot, but he may know what he's talking about here

Doc Stressor

I apologize for the cheap shot. It was meant as a joke and I couldn't pass up the opening.

Saltygatorvet is correct in that it is often more difficult to get into vet school than med schools. Veterinary medicine also tends to attract truly dedicated individuals who were more than "pre-wealth" majors in college. (Sorry if I'm offending MD's here. That was also meant as a snarky academic joke. :wink)

I don't understand why Chlorohexidine is not used more often for wound treatment in people given the successful history in animals. While it is used extensively for pre-surgery skin cleansing, it is still under FDA review. I suspect that it has more to do with side effects than efficacy. The prepackaged surgical wipes with 2% cholorhex gluconate say right on the label not to use on open wounds.

I found this list of case histories of side effects: http://patientsville.com/medication/chlorhexidine_side_effects.htm#.VYqo7T_bKJc

Veterinary medicine is easier than human medicine in that animals usually don't have lawyers. (Pardon the snarky lawyer joke.)

Hydrogen peroxide is good for initial wound treatment in that it helps debride the wound. The bubbles produced from the release of oxygen break up and physically removes the bacterial film that gets introduced into a puncture wound in the marine environment. In that sense it's similar to soap and water except that it gets further into a puncture.

capt louie

Hydrogen peroxide is good for initial wound treatment in that it helps debride the wound. The bubbles produced from the release of oxygen break up and physically removes the bacterial film that gets introduced into a puncture wound in the marine environment. In that sense it's similar to soap and water except that it gets further into a puncture.

OK , now that makes sense. All part of the initial treatment steps in wound care to help protect against infection.
Followed by some choice of antibacterial ointment and covered it seems. Good info.

Saltygatorvet

I read the chlorhex side effects. Anaphylactic reactions, ok, anxiety? Really? I scrub with it before every surgery( did it this am). I wonder if that is why I'm anxious during surgery.
I believe what's happening here is that Luvtoyak has pissed off so many people( almost everyone is seems), that anytime he posts anything, there are 100 people ready to jump on him and rip his post apart. I've had a few back and forths with ( who I believe) is him on another kayak forum, afterwards I've wanted to climb through his screen and give him the business. So I completely understand, but IN THIS CASE, he's not off base. If he hadn't posted it in a "know it all" way, it may have not immediately turned people on his ****.

Doc Stressor

I think that its probably fine to use chlorohexidine after debriding the initial wound with peroxide. But I can't recommend it because it hasn't been approved. I'm sure that lots of docs are using it off label to treat wounds.

The approval process even for using a accepted product in a new procedure is mind boggling. I spent a sabbatical year at a biotech company that applied for IND status for a new compound. I have to say that helping to write that application was the hardest thing I ever did in my scientific career. It's about potential litigation as well as innovation. You have to include a discussion of ALL the prior literature regarding potential side effects or counter indications if you want to get one through the FDA panel review. I still have access to those databases on line, which is why I won't let LuvtoYak try to snow people.

While it's fun to discuss this stuff, the purpose to this thread was to inform people on what they need to know to stay safe. I'm trying to keep things as simple and straightforward as possible.

All part of the initial treatment steps in wound care to help protect against infection. Followed by some choice of antibacterial ointment and covered it

Louie, an over the counter antibacterial ointment like bacitracin or Triple Guard (bacitracin plus neomycin) probably won't help much. Antibiotics are selective for specific kinds of bacteria and many marine species like vibrio aren't affected by them. The antibiotics used to treat those infection in the clinic are not available except by prescription. Compounds like peroxide, bleach, and chlorohex are known as antiseptics. They kill cells upon contact. They can be rougher on normal tissue than antibiotics, but they kill just about everything, which is what you want.

Saltygatorvet

Thanks Doc, it's a great thread. Good info here( I don't even know if chlorhex is available otc anyway) so for the purpose of this discussion, it's irrelevant. I carry betadine, h2o2, and bleach( I was once stung by a little yellow bait size fish I think they are called leather jackets or something like that) also hear them called skip jacks( not the tuna) and bleach helped. Bleach was all hat was on board and my only option. It did dramatically help the throbbing I felt from my finger, down my arm to the rest of my body. Probably coincidence.

Darcy

Great thread. Tx Doc
What about this stuff.
I use it on my boat for cuts.

Doc Stressor

Well, Bactine has been around forever it seems. It's a mixture of a strong detergent that can disrupt cell membranes and an anesthetic, so that it doesn't sting. The type of detergent contained in Bactine is used at higher concentrations to disinfect surfaces. It can kill most bacteria on contact. It isn't recommended for puncture wounds, but is certainly better than leaving a wound untreated.

I really can't say how it compares to the other antiseptics that we have been discussing.

Darcy

TX doc.

Moon Shadow

:thumbsup Great thread Doc. I will go out and buy Betadine. Already has the h2o2 that I bought two days ago. Can they take the heat or should they be stored in the cooler on trips? Thanks for the great report.

ripnlips

Hey Doc, Good stuff here. Thank you for sharing your knowledge. I keep peroxide in my boat at all times. I get cuts all the time out there and cannot afford to end up in the hospital for some kind of funk i got from a dirty cut.

I got a question, what about rinsing open cuts with some sort of whiskey or other type of alcohol you may happen to have on the boat?

Luv2Yak

The Claim: Hydrogen Peroxide Is a Good Treatment for Small Wounds

It is a staple in medicine cabinets everywhere, a first-line treatment for the small cuts and scrapes that a hazardous world can inflict upon our skin. But does hydrogen peroxide really make a difference?
According to most studies of its effectiveness, not really. Parents and school nurses might insist otherwise, but researchers have found that hydrogen peroxide has little ability to reduce bacteria in wounds and can actually inflame healthy skin cells that surround a cut or a scrape, increasing the amount of time wounds take to heal.
THE BOTTOM LINE
Studies show hydrogen peroxide is not a very effective treatment for small wounds.
http://www.nytimes.com/2007/06/19/health/19real.html?_r=0

Benefits and Uses of Chlorhexidine
Chlorhexidine has been used in more than 60 different pharmaceuticals and medical devices. Its wide application is due to its broad-spectrum efficacy, safety-profile and substantivity on the skin with low irritation. It has been found to possess a high level of antimicrobial activity and strong affinity for binding to skin and mucous membranes. At product-dependent concentrations, chlorhexidine is widely used as a disinfectant in a range of healthcare products, including topical skin disinfectants, wound and burn care products, oral care products, hand washing solutions, urology catheter lubricants, central venous catheters and needleless IV connectors.
http://chlorhexidinefacts.com/consumer-information.html

Vertigo

I'm afraid to jump in here because of all the professional knowledge being tossed around, but I must ask:

Is this Walgreens off-the-shelf chlorhexidine what we're talking about? If so, why would it still be under FDA review? The ad says it's for "skin wound & general cleansing."

http://www.walgreens.com/store/c/walgreens-antiseptic-skin-cleanser/ID=prod6051051-product

Saltygatorvet

Vertigo wrote: »

I'm afraid to jump in here because of all the professional knowledge being tossed around, but I must ask:

Is this Walgreens off-the-shelf chlorhexidine what we're talking about? If so, why would it still be under FDA review? The ad says it's for "skin wound & general cleansing."

http://www.walgreens.com/store/c/walgreens-antiseptic-skin-cleanser/ID=prod6051051-product

That's the stuff. 4% is pretty strong

Billy

Saltygatorvet wrote: »

I don't even know if chlorhex is available otc anyway) so for the purpose of this discussion, it's irrelevant.

As Vertigo posted it is available OTC and can be bought in different sizes from Amazon.

My daughter's response was she knows of no cases at St Joe in the last few years but she said in reference to sterilizing "Although, we use the chlorhexadine more than anything else in the hospital setting." She was referring to sterilization and not for wound treatments.

Like Doc stated it hasn't been approved for wounds but that doesn't mean it doesn't work.

Bill

Luv2Yak

Various formulations/products containing chlorhexidine used in veterinary medicine:

Nolvasan Skin and Wound Cleanser
Nolvasan Solution
Nolvasan-S
Nolvasan Surgical Scrub
Nolvasan Shampoo
Nolvasan Oral Cleansing Solution
Nolvasan Antiseptic Ointment
Nolvasan Otic
Nolvasan Suspension

https://www.zoetisus.com/search-results.aspx?q=Nolvasan&page=0
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Effects of Chlorhexidine Diacetate and Povidone-lodine on Wound Healing in Dogs

Veterinary Surgery
Volume 17, Issue 6, pages 291–295, November 1988

To correlate the results of an in vitro study with clinical response, the effects of 0.005 and 0.05% chlorhexidine diacetate and 0.1 and 1.0% povidone-iodine concentrations on wound healing were evaluated in five beagle dogs. Full-thickness skin wounds (2 × 2 cm) were irrigated once daily for 14 days with the antiseptic solutions or physiologic-buffered saline. Chlorhexidine diacetate 0.05% had significantly more bactericidal activity than povidone-iodine and saline, and both chlorhexidine diacetate concentrations had residual effects 6 hours after irrigation. Neither povidone-iodine nor saline had significant bactericidal activity. The percentages of unhealed wound area and wound contraction were calculated 7, 14, and 21 days after wounding. Healed wound area and contraction were similar in wounds treated with chlorhexidine diacetate and povidone-iodine. However, wounds treated with chlorhexidine diacetate had more healed wound area on days 7 and 14 and more contraction on days 7, 14, and 21 than saline-treated wounds. At the concentrations tested, chlorhexidine diacetate irrigations provided bactericidal activity and were more beneficial to wound healing than irrigations with saline alone. These results suggest that concentrations of chlorhexidine diacetate which are cytotoxic to tissue culture fibroblasts in vitro do not interfere with wound healing in vivo.

http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.1988.tb01019.x/abstract

Doc Stressor

Moon, hydrogen peroxide is very stable in an unopened dark plastic bottle. It is buffered to be slightly acidic and contains additives that increase stability and the decay rate is to the order of 1% per year. However, once a bottle is opened the stability is reduced. The concern with keeping it on the boat is that high temperature increases the rate of break down. Studies have found that for every 10 degrees over 68 degrees, the decay rate increases 1.5 fold. So it's best not to keep an open bottle of peroxide on the boat.

Mario, it's best to drink the whiskey and use a recommended antiseptic for treating wounds. Alcohol kills bacteria by denaturing proteins and at high concentrations disrupting cell membranes. The efficacy as a disinfectant is greatest around 70% alcohol, which is 140 proof booze. Hand sanitizers typically contain about 40-60% (80-120 proof) alcohol. While this concentration is fine for surface sterilization of the skin, it doesn't work as well in a wet wound environment. It takes 10-15 seconds if exposure to high concentrations of alcohol to kill bacteria and alcohol is rapidly diluted by body fluids inside of a wound. If all you have on board is booze, it's probably better to use it to clean out a wound rather than to leave it untreated. But I don't know if I'd want anybody pouring that cheap Captain Morgan most people seem to drink around here into my wound.

Let me be up front about Chlorhexidine. I'm not an MD (although I've trained them at several universities), so I can't give medical advice. I've tried to be careful in this thread to only try to explain treatments that have been recommended by medical professionals. Chlorhexidine has many properties (effective residual antimicrobial activity and good stability), but it has only been approved for specific applications.

According to the FDA Committee on Drugs: "The FDA requires that substantial evidence resulting from adequate and well-controlled investigations demonstrate that a drug will have the effect it purports or is represented to have under the conditions or use prescribed, recommended, or suggested in the proposed labeling. Once the FDA determines that a drug is safe and effective the manufacturer can only advertise or promote the drug for the indication approved by the FDA, and all promotion must be based on information that was submitted for review."

Medical doctors are permitted to use approved drugs for treatments other than where they have been specifically approved. But it would not be responsible for me (or a veterinarian or vet tech) to recommend the use of a drug off label. Most over the counter chlorhexidine solutions specifically warn against using the stuff in open wounds. That's because it has not been certified for safety in that application in humans.

It's one thing to use a drug in a clinical situation where professionals do follow ups and can deal with rare adverse side effects. It different when people are treating themselves.

Vertigo

I'm even more confused now. Doc Stressor says:
"Chlorhexidine has many properties (effective residual antimicrobial activity and good stability), but it has only been approved for specific applications."

Yet the product description from Walgreens says:

"Skin Wound & General Skin Cleansing:

Thoroughly Rinse the Area to be Cleaned with Water
Apply the Minimum Amount of Product Necessary to Cover the Skin or Wound Area & Wash Gently
Rinse Again Thoroughly"

Is or is not the Walgreen product safe and appropriate to use on wounds? I'm stocking up my first aid kit soon and would really like too know.

Doc Stressor

I'm trying to avoid confusion, which is why I don't like this technical argument in this thread.

Here is what the Walgreen's label says:

For external use only.
Do not use

• If You Are Allergic to Chlorhexidine Gluconate or Any Other Ingredients
• In Contact with Meninges
• In the Genital Area
• As a Preoperative Skin Preparation of the Head or Face

When using this product

• Keep out of eyes, ears & mouth. May cause serious & permanent eye injury if placed or kept in the eye during surgical procedures or may cause deafness when instilled in the middle ear through perforated eardrums.
• If solution should contact these areas, rinse out promptly & thoroughly with water.
• Wounds which involve more than the superficial layers of the skin should not be routinely treated.
• Repeated general skin cleansing of large body areas should not be done except when the underlying condition makes it necessary to reduce the bacterial population of the skin.

Chlorhexidine has been cleared by the FDA for 3 uses: as a pre-surgical skin cleanser (except for spinal anesthesia), for coating invasive medical devices such as catheters, and for wound dressing pads. It has also been cleared for use at much lower concentrations for dental application. The purpose of a wound dressing pad is to draw fluids away from an open wound such as a burn or skin ulcer. The purpose of the chlorhexidine is to prevent bacteria from growing in the fluid contained in the pad, not to treat the wound. Covering a wound with a pad is not the same as pouring 4% chlorhexidine gluconate into an open wound.

This is what the NIH has to say about chlorhexidine solution:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bdb6a012-37e5-4664-84a3-134bea284744

Click on the Warning section and read for yourself.

In order to get FDA approval for wound disinfection, data from controlled clinical trials would be required. Conducting these trials in this country would be prohibitively expensive for a drug that is not covered by a patent.

All I can do at this point is to suggest that everybody decide for themselves which antiseptics to use.

Luv2Yak

HIBICLENS/Molnlycke Health Care (Chlorhexidine Gluconate solution 4.0% w/v) Antiseptic/Antimicrobial Skin Cleanser is an FDA Approved Drug Product – see below:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
[email protected]
FDA Approved Drug Products

Drug Name(s) HIBICLENS
FDA Application No. (NDA) 017768
Active Ingredient(s) CHLORHEXIDINE GLUCONATE
Company MOLNLYCKE HLTH

View the label approved on 06/30/2014 (PDF)11 for HIBICLENS, NDA no. 017768

Uses
- antimicrobial skin cleanser helps reduce bacteria that can potentially cause disease
- for skin wound and general skin cleansing
- surgical hand scrub
- healthcare personnel hand wash

Directions
- skin wound and general skin cleansing. Thoroughly rinse the the area to be cleansed with water. Apply the minimum amount of the product necessary to cover the skin or wound area and wash gently. Rinse thoroughly.

https://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#labelinfo
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Also of interest: Purdue Products, manufacturer of Betadine products makes Betasept Surgical Scrub (chlorhexidine gluconate 4%):

Betasept® Antiseptic Surgical Scrub

chlorhexidine gluconate 4% provides rapid antiseptic action with a persistent antimicrobial effect against a wide range of microorganisms.
Chlorhexidine gluconate 4% in a highly viscous base for surgical hand scrubbing, healthcare personnel hand-washing, preoperative patient prepping, and general skin degerming. Produces a good lather, with a pleasant fragrance.

[PDF]Betadine ® Family of Products
www.betadine.com/pdf/D8208-BHF.pdf

jlh49

Not to let any stone stay unturned, how about Vetericyn (Wound & Infection Treatment)? I bought a spray bottle from a Feed Store & use it on a regular basis.

Heading to Crystal River to scallop during August 16 - 21, 2015, & was planning to bring Betadine Surgical Scrub (Not solution).

With the information provided on this thread, have not made a final call on what to bring.

Thanks!

Saltygatorvet

I just noticed in Docs wallgreen label, do not get into contact w meninges? My god, I hope no one with a bottle of Walgreens antiseptic is going anywhere near meninges. If that's the case your toast

Luv2Yak

jlh49 wrote: »

Not to let any stone stay unturned, how about Vetericyn (Wound & Infection Treatment)? I bought a spray bottle from a Feed Store & use it on a regular basis.

Heading to Crystal River to scallop during August 16 - 21, 2015, & was planning to bring Betadine Surgical Scrub (Not solution).

With the information provided on this thread, have not made a final call on what to bring.

Thanks!

In my opinion Vetericyn products are excellent (but expensive).

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Why can’t you use Puracyn on an animal and Vetericyn on a human?

Even though the formulas are based on the same technology, as the company in compliance with FDA regulations and International guidance, we cannot endorse, promote or communicate off label use in any of our products in adherence to regulatory requirements.

http://vetericyn.com/technology/faq.php

- - - - - - - - - - - - - - - - - - - - - - - - - -
Innovacyn is the manufacturer of Puracyn (human) and Vetericyn (animal) products.

See http://www.innovacyn.com/#/science/overview/products

Luv2Yak

Doc Stressor wrote: »

...I'm not an MD (although I've trained them at several universities), so I can't give medical advice...

“So cleaning the wound with peroxide, which kills on contact, and Betadine, which provides some residual protection is the way to go.”

- Doc Stressor, Post #1, Protecting Yourself from Vibrio Infection

Sounds like medical advice to me.

Jim311

Since I work in animal health I can state that while these chlorhex solutions and ointments are generally only labeled as disinfectants they are widely used off label by veterinarians to treat wounds. Its a cheap and effective disinfectant. I've seen it help heal some ghastly wounds on horses that have been badly lacerated by wire fences and such. I can't comment on its effectiveness against vibrio though. Ha.

Billy

Luv2Yak wrote: »

“So cleaning the wound with peroxide, which kills on contact, and Betadine, which provides some residual protection is the way to go.”

- Doc Stressor, Post #1, Protecting Yourself from Vibrio Infection

Sounds like medical advice to me.

He is giving scientific advice.

Do I have to mention again that my dog eats poop and drinks from the toilet bowl? So what works for an animal works for a human?

So a vet's advice is medical advice for humans? I mean...that's what you are promoting. If you aren't a medical doctor trained in treating vibrio infections you have no more credence than anyone else on this forum. Not that we don't want to hear your opinion, not a cut and paste, but don't be condescending...course that might be tough for you to do.

Bill