THE WOUND HEALING EFFECT OF CHLORHEXIDINE 0.

05% IN THE
TREATMENT OF SCHOOLCHILDREN WITH VULNUS LACERATUM

The effectiveness of topical application of chlorhexidine 0.05% on vulnus laceratum

with Pseudomonas aeruginosa

Soeherwin Mangundjaja and Abdul Muthalib

Department of Microbiology Faculty of Dentistry Universitas Indonesia

ABSTRACT
Microorganism are widely scattered in nature and are found as normal flora in the skin. It
can be hazardous to human especially children who have tissue injuries while playing
that can be contaminated by various microorganisms from the soil. For this purpose we
do research about the implementation of infection control in the elementary school .The
bacterial compositions from fifteen tissue injuries before and after topical application by
chlorhexidinc 0.05% and the percentages of isolates shown Pseudomonas aeruginosa in
a high number. As a result of the treatment with topical application of chlorhexidine
0.05%, there were not any Pseudomonas aeruginosa and other bacteria found on the
Vulnus laceratum. Therefore it can be concluded that chlorhexidine 0.05% can be
accepted to eliminate the growth of Pseudomonas aeruginosa on Vulnus laceratum.

Key words: Wound healing-Chlorhexidine 0.05% - Vulnus laceratum

INTRODUCTION

The tissues of a wound is not only found during medical treatment conducted by
the surgeon in his private practice, hospital and Puskesmas, but also involves people in
their daily lives. One of the wounds found in the people especially in wounds on children
caused by falling down injury.
The first step is to close the wound to avoid any bacterial contamination which
might also have effects on the healing process.
Close the wound with topical application medicine with the intention to expedite
the healing process and decrease the hurt feeling.
The healing process on wounds constitute one of many attractive biomedical
symptoms which constitute the character of living creatures, thereby the healing process
of such a wound is not a process which deviates from the complex process of biology.
We agree that there are several ways to expedite the process of healing wounds,
among other things by applying oral medicine as well as topical.
Chlorhexidine 0.05% is one of the medicines which can be used in a topical
manner on the outer tissue of the body.
The aim of this research is to know the healing process speed of a wound with
chlorhexidine 0.05% against bacteria contained in wounds in primary schoolchildren.
L1TERATURE STUDY

Wound healing constitute e an occurrence which cannot stand on its own but it
constitutes a series of Ccomplex biological process. New wounds within 24 . hours will
give an acute infection reaction around the wound and infected cell especially leucocyte
neutrophils emigrate of the blood vein into the blood clotted.
Several day later around the area of the wound, there will be a fibroblast cell and
blood clotted will be replaced by granulated tissue consisting of new proliferated blood
veins fibroblast cell and chronic infected cell. Thereafter the wound will be bridged by
granulated tissue slowly followed by collagen process and epithelial process during the
end of the first week 1,2,3.
The use of antimicrobial agent to eliminate microorganism causing infectious
diseases has been discussed for a number of years. One agent of anti microbial widely
used to reduce the bacterial load in the mouth is chlorhexidine. Chlorhexidine has
potential to reduce salivary levels of mutans streptococci and caries activity levels of
mutans streptococci in plaque4,5.
Chemically it consts of 1.6-bis-p chlorophenylbiguanidohexane. It ha s a broad
anti microbial spectrum and generally more effective against gram-positive tthan against
gram-negative bacteria, some species of Pseudomomnas aeruginosa and Proteus being
less susceptible . It is inactive against bacterial spores at room temperature.
Chlorhexidine inhibits some viruses and is active against some fungi. Chlorhexidine is
bacterial and act as a detergent by damaging the cell membrane 6.
This study was to examine the effectiveness of topical application of
chlorhexidine 0.05% on vulnus laceratum with Pseudomonas aeruginosa on
schoolchildren .

MATERIAL AND METHODS

Fifteen schoolchildren who had just experienced from tissue injuries participated
in this study. The analyzed unit was bacterial load of Pseudomonas aeruginosa on vulnus
laceratum.
All subjects were monitored during school hours, whether any of them had
experienced an accident by falling to the ground and getting tissue injuries.

Bacterial examination

1. Samples were taken by wetted cotton sterile of NaCl 0.9% to swab the vulnus
laceratum and then the swab were pooled in 0.5 ml of reduced transport
medium fluid(RTF), dispersed by a vortex mixer for 30 seconds, is then
diluted serially 10-fold. An aliquot of 0.1 ml of dilute was plate on blood agar
medium and incubated in anaerobic chamber at 370 Celsius degree for 3 X 24
hours.
After 3 days of incubation appropriate plates with 10 – 100 colonies were
selected and all colonies were transferred in fresh blood agar medium for
repeating streaked to obtain pure culture.

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 2. The vulnus laceratum covered by cotton and drops of chlorhexidine 0.05%
solution.
3. After one hour samples were taken same as above item No 1.
4. Isolated were examined for colony and cellular morphology , gram staining
characteristics and biochemical test.

Colony Forming Units of Pseudomonas aeruginosa and other bacteria were

recorded.

Table I. The effectiveness of the topical application of chlorhexidine 0.05% on vulnus

laceratum with Pseudomonas aeruginosa.

Topical application of Chlorhexidine 0.05%

Bacterial composition of individual samples.
Case
Before treatment After treatment
Case 1 Pseudomonas aeruginosa 35.8%
Staphylococcus albus 34.0%
Corynebacterium 20.8% Negative
Gram-positive rod 3.8%
Case 2 Pseudomonas aeruginosa 50.0%
Micrococcus 12.0% Negative
Streptococcus spp 37.5%
Case 3 Pseudomonas aeruginosa 28.8%
Propionibacterium 5.2% Negative
Streptococcus spp 65.0%
Case 4 Pseudomonas aeruginosa 24.9%
Actinomyces spp 17.6% Negative
Staphylococcus albus 57.5%
Case 5 Pseudomonas spp 84.4%
Diptheroids spp 3.0% Unidentified *)
Staphylococcus albus 12.5%
Case 6 Pseudomonas spp 23.8%
Streptococcus spp 34.8% Negative
Micrococcus 41.1%
Case 7 Pseudomonas aeruginosa 39.0%
Staphylococcus aureus 29.9% Negative
Fusobacterium spp 31.1%
Case 8 Pseudomonas aeruginosa 41.2%
Haemophilus spp 32.9% Negative
Unidentified 25.8%
Case 9 Pseudomonas aeruginosa 28.8%
Streptococcus spp 1.3%
Staphylococcus spp 0.6% Gram – positive rods *)
Unidentified 69.3%

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Case 10 Pseudomonas aeruginosa 50.0%
Propionibacterium spp 25.0% Negative
Streptococcus spp 25.0%
Case 11 Pseudomonas spp 40.9%
Diptheroids spp 10.8% Negative
Actinomyces spp 48.3%
Case 12 Pseudomonas aeruginosa 56.1%
Staphylococcus albus 34.0% Negative
Streptococcus spp 18.9%
Case 13 Pseudomonas aeruginosa 75.0% Negative
Micrococcus 24.9%
Case 14 Pseudomonas spp 37.7%
Staphylococcus aureus 35.9% Negative
Streptococcus spp 26.3%
Case 15 Pseudomonas aeruginosa 49.0%
Streptococcus spp 39.2% Gram-positive rods *)
Corynebacterium 11.8%

* ) Contamination

A total of 15 samples from bacterial load on vulnus laceratum showed that CFU
of Pseudomonas aeruginosa e higher number than other bacteria grew on the blood agar
medium, The microbial compositions before and after- topical application by
chlorhexidine 0.05% and the percentages of isolates are summarized in table 1.
All culture positive cases contained more than two species. The lost isolates are
expressed unidentified or gram-stain characteristic and cellular shapes.

DISCUSSION

As a result of the treatment with topical application of chlorhexidine, there were

not any Pseudomonas aeruginosa and other bacteria found on the vulnus laceratum ,
therefore chlorhexidine can be accepted to delay bacterial growth with the predicate
bactericidal.
All subjects stated that the wounds suffered were healed and did not hurt any
more. Chlorhexidine in this case was effective toward the bacteria gram-negative
Pseudomonas aeruginosa . Pseudomonas aeruginosa is found in the nature, such bacteria
is an opportunistic bacteria if the situation is advantageous it will grow causing infection.
This bacteria is a research parameter because this bacteria is found in nature, thereby
causing the wound to be contaminated by this bacteria. To know the effectiveness of
this topical medicine , a topical method has been conducted on this wound by applying
several milliliter of chlorhexidine which came to the conclusion that no bacterial growth
was found and that the disappearance of hurt feelings within a short time frame.

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CONCLUSION

Local application with chlorhexidine 0.5% is a bactericidal effect toward the

Pseudomonas aeruginosa bacteria and the other bacteria on schoolchildren with vulnus
lareratum.
The healing process on wounds that are applied locally chlorhexidine become
more expeditious.

ACKNOWLEDGEMENTS

I Would like to thank PT Minorock Mandiri which has supported the research
from the first beginning And also to the Schoolchildren of Sekolah Dasar Negeri
Pangkalan Jati Kabupaten Bogor who have participated in this research.

REFERENCES

1. Shafer WG.,Hine MK.,Levy BM. A Text Book of Oral Pathology

4th l Tokyo: W.B Saunders Co, 1983 :594 - 601
2. Oshima Y., ,Saito, Motegi, Matsumoto T, Abc S, Shibayama Y. The
therapeutic result of Solcoseryl in gastro-dudenal ulcers and ulcerative
stomatitis of Behceet’s disease.
Clin Gastroenterology 1961 ;9:31-8
3. Roll W. .C1inical experience with a method to promote the healing in maxillo
facial surgery.
Chirurg 1963,34: 247-50
4. Soehenwin Mangundjaja et al .Effectiveness of mouthwash containing
Chlorhexidine 0.2% on salivary levels of mutans streptococci. 2000 .
Unpublished
5. Soeherwin Mangundjaja .Effectiveness of mouthwash containing
Cchlorhexidine 0.2% on caries activity of mutans streptococci in plaque
2000. Unpublished
6. Norman et al 1986..Pseudobacterium associated with contaminated skin
cleansing agent.
Lancet 1986. 1209

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Disajikan pada Pertemuan Ilmiah Tahunan PERMI 27- 28 Juni 2000

Denpasar Bali