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Reducing blood-culture contamination rates by the use of a2% chlorhexidine solution applicator in acute admission unitsMad...
The observed decline was most marked in the A&E department                                              15   Blood culture...
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Madeo Clinical Summary | ChloraPrep UK Infection Prevention & Control


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Madeo Clinical Summary | ChloraPrep UK Infection Prevention & Control

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Madeo Clinical Summary | ChloraPrep UK Infection Prevention & Control

  1. 1. Reducing blood-culture contamination rates by the use of a2% chlorhexidine solution applicator in acute admission unitsMadeo M, Barlow GJournal of Hospital Infection 2008; 69: 307-9Background While blood culture is invaluable in the diagnosis of serious infection, contamination with non-significant skin flora is relatively common and is associated with substantial healthcare costs The consequences are not trivial. For example, patients may receive unnecessary antibiotics that may in turn result in avoidable adverse effects such as Clostridium difficile-associated diarrhoea (CDAD). Performance management targets for both MRSA bacteraemia and CDAD may be inappropriately jeopardised Thorough skin preparation is often neglected by medical staff and it is likely to be implicated in many cases of blood culture contaminationAim To examine the effect of introducing a 2% chlorhexidine gluconate in 70% isopropyl alcohol applicator (ChloraPrep) on blood culture contamination rates in the admission units of a 1500-bed UK teaching hospitalMethods The year-long study was performed in the accident and emergency department and two acute medical admissions units of the hospital The monthly total contamination rates were compared before and after introduction of ChloraPrep by logistic regression analysis Blood cultures were deemed contaminated if they grew coagulase-negative staphylococci, diphtheroids, propionibacteria or micrococciResults The ChloraPrep applicator significantly reduced the incidence of blood culture contamination from 7.5% prior to its introduction to 2.1% (p<0.0001) in the four months after implementation, excluding August as a ‘washout’ month 10 Prior to introduction of ChloraPrep Following introductionMonthly blood culture of ChloraPrepcontamination rates in 8the admissions units,January to December 6 Washout2007(% cultures contaminated) 4 2 0Odds ratio: 0.25 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec95% CI: 0.18-0.35; p<0.0001 n= 717 713 608 568 544 461 461 425 408 480 449 533
  2. 2. The observed decline was most marked in the A&E department 15 Blood culture A&E AMAU 1 AMAU 2 (unselected acute (acute respiratory, contamination medical patients) infection and elderly rates in each of the medicine) admissions units 10 11.5% (% cultures contaminated) 5 6.6% 3.9% 2.6% 1.7% 1.8% 0 Before introduction n= 1361 797 1545 577 1166 496 of ChloraPrep Following the introduction of ChloraPrep Conclusion With the potential to significantly reduce blood culture contamination rates, hospital trusts could find the ChloraPrep applicator useful in achieving their hospital-acquired infection performance management targets The cost of ChloraPrep is likely to be readily absorbed by savings associated with a lower blood culture contamination ratePrescribing Information contact with eyes, mucous membranes, middle ear and neural tissue. Should not be used inChloraPrep® (PL31760/0002) & ChloraPrep with Tint (PL31760-0001) 2% chlorhexidine children under 2 months of age. Solution is flammable. Do not use with ignition sources untilgluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Indication: Disinfection of dry, do not allow to pool, and remove soaked materials before use. Over-vigorous use onskin prior to invasive medical procedures. Dosage & administration: ChloraPrep – 0.67ml, fragile or sensitive skin or repeated use may lead to local skin reactions. At the first sign of1.5ml, 3ml, 10.5ml, 26ml; ChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on local skin reaction, application should be stopped. Per applicator costs (ex VAT) ChloraPrepinvasive procedure being undertaken. Applicator squeezed to break ampoule and release – 0.67ml (SEPP) - 30p; 1.5ml (FREPP) - 55p; 3ml - 85p; 10.5ml - £2.92; 26ml - £6.50.antiseptic solution onto sponge. Solution applied by gently pressing sponge against skin and ChloraPrep with Tint – 3ml - 89p; 10.5ml - £3.07; 26ml - £6.83. Legal category: GSL.moving back and forth for 30 seconds. The area covered should be allowed to air dry. Side Marketing Authorisation Holder: CareFusion UK 244 Ltd, 43 London Road, Reigate, Surreyeffects, precautions & contra-indications: Very rarely allergic or skin reactions reported RH2 9PW, UK. Date of preparation: July 2010.with chlorhexidine, isopropyl alcohol and Sunset Yellow. Contra-indicated for patients withknown hypersensitivity to these constituents. For external use only on intact skin. Avoid CHL113a Date of preparation: August 2010