Transcript of "Surgical Leave Piece | ChloraPrep UK Infection Prevention & Control"
“Whilst every person carries millions of bacteria on their skin, hospitals should not be tolerant of any infections that could be avoided” The Public Accounts Committee, 10th November 20091Prescribing information can be found on the back cover
“In most SSIs, the source of pathogens is the endogenous flora of the patient’s skin”2SSIs are 1 in 7 of all hospital-acquired infections are SSIs1serious SSIs require an average additional stay of 6.5 daysand costly and hospital costs are doubled3 Patients with SSIs are 60% more likely to spend time in ICU, 5 times more likely to be readmitted to hospital and twice as likely to die4 Health-related quality of life may be significantly impaired5At one London Trust, the annual cost associated withSSIs for just one surgical core area (coronary arterybypass graft) amounted to around £500,0006Surveillance programmes that rely only on inpatient data may hugelyunderestimate the incidence and cost of SSIs7,8
ChloraPrep reduced SSIs by 41% compared with povidone iodine scrub and paint9 20 p=0.004Incidenceof SSIs in 15clean- 16.1contaminated 10surgery 5 9.5(% patients)9 0 Povidone iodine ChloraPrep n=440 n=409 ChloraPrep was significantly more protective against both superficial (52% reduction) and deep incisional infections (67% reduction):9 10 p=0.008Incidenceof incisional 8infections 8.6 6(% patients)9 4 p=0.05 4.2 2 3.0 1.0 0 Povidone iodine Superficial incisional Deep incisional n=440 infection infection ChloraPrep n=409 The number needed to treat with ChloraPrep instead of povidone iodine in order to prevent one case of SSI was approximately 179
ChloraPrep was significantly more effective than 0.5% chlorhexidine/70% isopropyl alcohol10 Dressings removed 24 hours after saphenectomy contained a significantly lower number of micro-organisms with ChloraPrep10 20Mean p=0.007CFU counts 1524 hours 10 14.8after surgery10 p=0.02 5 0.6 4.2 0.4 0 0.5% chlorhexidine/ Adhesive dressing Absorbent dressing 70% isopropyl component component alcohol n=24 ChloraPrep n=22 Rates of SSI following saphenous vein harvest as high as 1 in 5 patients have been reported10 At 30 days post-discharge, no ChloraPrep patient had developed an SSI following saphenectomy10 25Incidence of p=0.0502superficial 20SSI post- 20.8discharge 15(% patients)10 10 5 0 0 0.5% chlorhexidine/ ChloraPrep 70% isopropyl alcohol n=22 n=24
ChloraPrep provides broad spectrum, rapid,residual and persistent antimicrobial activityChloraPrep is effective against a broad range of micro-organismsincluding MRSA, VRE, Clostridium difficile, coagulase negativestaphylococci and most viruses and fungi11-13Optimal agent ChloraPrepfor pre-surgicalskin antisepsis12Rapid ChloraPrep has good activity levels within 30 seconds;14 povidone iodine takes 2-3 minutes to reach full effect11Persistent ChloraPrep is effective for at least 48 hours.14,15 0.5% chlorhexidine13 and iodophors have been shown to have a much shorter duration of activity16Practical Unlike povidone iodine, ChloraPrep is not inactivated in the presence of blood12
ChloraPrep is an easy to apply, sterile,skin antisepsis systemChloraPrep is the only 2% chlorhexidine / 70% isopropylalcohol licensed for cutaneous antisepsis prior to invasiveprocedures in the UK17 Sterile solution is maintained in a glass ampoule prior to activation, obviating concerns about contamination18 In line with ANTT™, the operator’s hands do not come into contact with the patient’s skin, preventing cross contamination18 The foam sponge controls flow to prevent splashing/pooling while gently helping to expose bacteria in the lower cell layersA back and forth prep was used in all the phase IIIefficacy studies of ChloraPrep applicators19
Using ChloraPrep surgical applicators1. Pinch 2. Apply 3. DryPinch the lever to release the Starting at the incision site, Leave the area to drysolution. You will hear a ‘pop’ gently press the applicator completely before applyingas the ampoule breaks. against the skin until the sterile drapes. Do not blot solution soaks the sponge. or wipe away. Discard the applicator after a single use. Apply using repeated up and down, back and forth strokes Important safety point: for at least 30 seconds, before Do not drape or use ignition working outwards towards the source until the solution has periphery. completely dried. The 26ml applicator contains two swabs. Where applicable, the swabs can be moistened by pressing against the soaked sponge and then used to clean the umbilicus. References: 1. House of Commons Public Accounts Committee. Reducing Healthcare Associated Infection in Hospitals in England.10 November 2009. London: The Stationery Office Limited. 2. Murkin CE. Br J Nurs 2009; 18: 665-9. 3. Edwards PS et al. Cochrane DB Syst Rev 2008. DOI:10.1002/14651858.CD003949.pub2. 4. Kirkland KB et al. Infect Control Hosp Epidemiol 1999; 20: 725-30. 5. Whitehouse JD et al. Infect Control Hosp Epidemiol 2002; 23: 183-9. 6. Frampton L. Clin Services J 2008; June edition. 7. Tanner J et al. J Hosp Infect 2009; 72: 243-50. 8. Ward VP et al. J Hosp Infect 2008; 70: 166-73. 9. Darouiche R et al. New Engl J Med 2010; 362: 18-26. 10. Casey AL et al. Poster presented at ECCMID, Barcelona, Spain, April 2008 11. Crosby CT, Mares AK. J Vasc Access Devices 2001; Spring: 26-31. 12. Florman S, Nichols RL. Am J Infect Dis 2007; 3: 51-61 13. Data on file, CareFusion Ltd. 14. Hibbard JS. J Infus Nurs 2005; 28: 194-207. 15. Garcia R et al. Abstracts of the IDSA 40th Annual Meeting 2002; Abs 418. 16. Fletcher N et al. J Bone Joint Surg Am 2007; 89: 1605-18. 17. UK PL 31760/0001. 18. McDonald CP. Vox Sanguinis 2001; 80: 135-41. 19. Richardson D. J Assoc Vasc Access 2006; 11: 215-21.
Range of surgical applicators Licensed, sterile, single use, ANTT™, latex free applicators available in the UK Coverage area: 15 cm x 15 cm 3ml NHS list price per applicator: £0.85 (ex. VAT and delivery) clear NHS supply chain order code: MRB306 Coverage area: 25 cm x 30 cm 10.5ml NHS list price per applicator: £2.92 (ex. VAT and delivery) clear NHS supply chain order code: MRB304 Coverage area: 50 cm x 50 cm 26ml NHS list price per applicator: £6.50 (ex. VAT and delivery) clear NHS supply chain order code: MRB305 Coverage area: 15 cm x 15 cm 3ml NHS list price per applicator: £0.89 (ex. VAT and delivery) tinted NHS supply chain order code: MRB494 Coverage area: 25 cm x 30 cm 10.5ml NHS list price per applicator: £3.07 (ex. VAT and delivery) tinted NHS supply chain order code: MRB495 Coverage area: 50 cm x 50 cm 26ml NHS list price per applicator: £6.83 (ex. VAT and delivery) tinted NHS supply chain order code: MRB496For customer services and all other enquiries:Please telephone: 0800 0437 546Email: firstname.lastname@example.org visit: www.chloraprep.co.ukPrescribing Information only on intact skin. Avoid contact with eyes, mucous membranes, middle earChloraPrep® (PL31760/0002) & ChloraPrep with Tint (PL31760-0001) 2% and neural tissue. Should not be used in children under 2 months of age.chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Solution is flammable. Do not use with ignition sources until dry, do not allowIndication: Disinfection of skin prior to invasive medical procedures. to pool, and remove soaked materials before use. Over-vigorous use onDosage & administration: ChloraPrep – 0.67ml, 1.5ml, 3ml, 10.5ml, 26ml; fragile or sensitive skin or repeated use may lead to local skin reactions. AtChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on invasive the first sign of local skin reaction, application should be stopped. Perprocedure being undertaken. Applicator squeezed to break ampoule and applicator costs (ex VAT) ChloraPrep – 0.67ml (SEPP) - 30p; 1.5ml (FREPP)release antiseptic solution onto sponge. Solution applied by gently pressing - 55p; 3ml - 85p; 10.5ml - £2.92; 26ml - £6.50. ChloraPrep with Tint – 3ml -sponge against skin and moving back and forth for 30 seconds. The area 89p; 10.5ml - £3.07; 26ml - £6.83. Legal category: GSL. Marketingcovered should be allowed to air dry. Side effects, precautions & Authorisation Holder: CareFusion UK 244 Ltd, 43 London Road, Reigate,contra-indications: Very rarely allergic or skin reactions reported with Surrey RH2 9PW, UK. Date of preparation: July 2010.chlorhexidine, isopropyl alcohol and Sunset Yellow. Contra-indicated forpatients with known hypersensitivity to these constituents. For external use CHL104a Date of preparation: August 2010