Transcript Chlorhexidine Wash Cloths

CHLORHEXIDINE
WASH CLOTHS
By Sarah Ewart
Presentation Layout
This presentation will cover the following topics:
Product Overview
Uses
Surgical Site Infections
When to use the wipes.
Competitors
Cost analysis
Questions and issues that commonly arise.
Product Overview
Clinell Chlorhexidine Wash Cloths are
a rinse-free, non-alcoholic antiseptic
body cleansing solution.
Containing 2% Chlorhexidine Gluconate BP, as well as skin conditioners and
moisturisers. The chlorhexidine being the only active ingredient.
Designed to be used on skin to kill all the bacterial skin flora.
Developed in conjunction with a major University teaching Hospital in London
The Royal free.
Clinell Chlorhexidine Wash Cloths
(Wipe Size: 20 x 30cm) 12 packs of 4 cloths – seen here in desk top tray
Product Overview
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Comes in a desk ready tray of 12 packs
Ideal for keeping on the nurses desk during clinic or in ITU
4 large wipes
30 x 20cm and very thick, enough for a whole body cleanse
Can be heated for more comfortable bathing
Store in a Clinell warmer or heat in a microwave
Cares for skin
Contains skin conditioners and moisturisers
Natural green tea fragrance.
Chlorhexidine
Chlorhexidine is a biocide that is being
recommended by many guidelines.
Chlorhexidine is a cationic biguanide which means it is positively charged
molecule. This property is what allows it to stick to the skin for long periods
and gives the patient a sticky sensation on application.
First established as an antimicrobial agent in 1954.
It exists as acetate (diacetate), gluconate, and hydrochloride salts.
Efficacy
Broad spectrum activity
- Gram positive
- Gram negative non-sporing bacteria
- Yeast
- Selective enveloped viruses such as HIV
How it Works
Due to the binding of the CHG cationic
molecules to the negatively charged
components of the bacterial cell wall.
Works differently with different
concentrations.
At low concentrations
Exerts a bacteriostatic effect by causing an alteration of the bacterial cell
osmotic equilibrium resulting in leakage of potassium and phosphorus,
inhibiting growth.
At high concentrations
Rapidly bactericidal, the result of precipitation of the bacterial cell cytoplasmic
contents.
Uses
Two main uses:
Bed bathing of ITU patients
This should be done on a daily basis. This will
reduce the incidence of blood stream infections
(BSIs).
Presurgical patient bathing
This should be done the morning or the night
before the surgery. This will reduce the
incidence of surgical site infections (SSIs).
How it Works
Because it is cationic (positively charged)
it sticks to the skin leaving a residual
coating of chlorhexidine.
The chlorhexidine will kill the bacterial skin flora.
It will be effective for many hours as it sticks to the skin for over 6 hours giving a
protective coating barrier effect.
Should be used with care being taken to avoid the eyes and areas of disrupted
skin integrity.
ITU Patients
Intensive Therapy Unit (ITU) patients have many invasive procedures per
day with many skin penetrations occurring daily.
Therefore they are at a higher risk of blood stream infections from their own
skin flora.
By reducing patient’s skin microbes such as: MRSA, VRE, Acinetobacter etc.
It prevents these microbes being introduced by the needle into the bloodstream.
Therefore this product will reduce the incidence of blood stream infection (BSIs).
Surgical Site Infections (SSIs)
A surgical site infection (SSI) is a type of healthcare-associated infection in
which a wound infection occurs after an invasive (surgical) procedure.
SSIs have been shown to compose up
to 20% of all of healthcare-associated
infections.
At least 5% of patients undergoing a
surgical procedure develop an SSI.
Surgical Site Infections (SSIs)
An SSI may range from a spontaneously limited wound discharge
within 7–10 days after an operation to a life-threatening postoperative
complication, such as a sternal infection after open heart surgery.
Most SSIs are caused by contamination of an incision with microorganisms
from the patient’s own body during surgery.
Surgical Site Infections (SSIs)
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Infection caused by microorganisms from an outside source
following surgery is less common.
The majority of SSIs are preventable. Measures can be taken
in the pre-, intra- and postoperative phases of care to reduce
risk of infection.
They are associated with considerable morbidity and
extended hospital stay.
Considerable financial burden to healthcare providers.
Patients who develop an SSI are also "twice as likely to die."
Source of Surgical Site Infections (SSIs)
Most SSIs come from bacteria already found on a patient's skin (skin flora).
Multi-drug resistant organisms such as MRSA, VRE, and Acinetobacter are just
some of the SSI-causing pathogens that can be found on a patient's skin.
Chlorhexidine will eradicate all bacteria on a patients skin
(unless resistance has occurred).
MRSA and SSIs
Staphylococcus aureus is recognised
as a major cause of SSIs.
S. aureus bacteria accounts for 44% of all SSIs.
Of all SSIs caused by S. aureus, 60% were
methicillin-resistant (MRSA).
And this means just over a quarter of all SSIs
(26%) were caused by MRSA.
How to Reduce SSIs
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Preoperative phase
Intraoperative phase
Postoperative phase
Preoperative Phase
NICE guidelines (UK)
Advise patients to shower or have a bath (or help patients to shower, bath or
bed bath), either the night before the operative day
CDC guidelines (USA)
Require patients to shower or bathe with an antiseptic agent on at least the
night before the operative day.
Comfort Vs. Clinell
Comfort
Clinell
2 or 6 Wipes
4 Wipes
Size 19x19cm
Size 30x20cm – 66% bigger
Cost in the UK (2 wipe pack)
Cost in the UK
£1.49 (£0.74 per wipe)
Cost in the UK (6 wipe pack)
£2.88 (£0.48 per wipe)
£0.93 (£0.23 per wipe)
Summary
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Clinell has 66% larger wipes than Comfort.
Clinell is 52% cheaper per wipe than the cheapest
Comfort wipe (6 pack).
Clinell is 69% cheaper per wipe than the 2 pack Comfort.
These prices are based on UK hospital purchase prices.
4% CHG Bottles
Many hospitals use these for washing patients.
Give 1 bottle to each patient
Use the bottle on the ward/ITU
Bottle on its own more expensive £1.18 compared to £0.93 for Clinell.
Compliance is less with bottles – wipes much easier.
Papers show coverage with bottle wash not great with large gaps evident.
Dilution issue.
In hospital wipes offer large cost saving due to quicker bathing process – see
cost comparison sheet.
Questions and Issues
Q Is there any evidence it works?
Show them the journals which you can get on
request from GAMA.
The data is mainly from the USA and quite a bit
has been published on SAGE Comfort wipes.
In effect we are a cheaper improved version of
SAGE.
We also have data confirming that the
formulations in Clinell and SAGE are identical.
Questions and Issues
cloths only have 2% the
Q Your
bottles are 4% - surely yours
is not as effective?
Most of the evidence published is on 2% CHG
look at the 2% CHG & 70% IPA wipes in EPIC
guidelines.
Also some journals have shown cloths containing
2% CHG actually leave more residual CHG on
skin than 4% bottles.
Also 4% CHG bottles applications have shown
gaps in coverage – using a cloth these gaps are
absent.
Show journal by Edmiston, American College
Surgeons, 2008.
Questions and Issues
not just wash on the morning of surgery, what is the point of also doing it the
Q Why
night before?
CHG surface activity is enhanced following multiple
applications – cumulative effect. In the USA most
practitioners recommend 2 – 5 separate
applications before surgery.
Questions and Issues
Q Do you offer any literature to go with the product
One of the most important aspects about using the wipes is they need to used be used
correctly and patient compliance has to be high.
We provide custom leaflets to be given to the patient in preadmission clinic to help with
compliance and correct procedure.
Questions and Issues
Q What about CHG sensitivity?
Some patients can be allergic, (as any
disinfectants such as alcohol), but it is rare –
discontinue use if occurs.
Understand that sensitivity is not the same as
Resistance:
Sensitivity is the patient having an allergic
Reaction to the chlorhexidine.
Resistance is the bacteria being able to survive
Chlorhexidine application.
Questions and Issues
Q You have 4 wipes but the studies were done ton the sage 6 pack?
Our wipes are 30x20cm much larger than sage and an
independent laboratory has said
‘In practicable terms, both the Clinell & Comfort Wash
Cloths should be considered essentially equivalent and
Interchangeable.
Questions and Issues
Q Can it be used in neonates?
CHG is poorly absorbed through intact skin in
adults but can be absorbed in neonates through to
young adults (3 months – 17 years).
Recent study of 100 neonatal ICU in the US found
that CHG is frequently used (>50%) for CVC,
PICC, Umbilical line insertions, and CVC
maintenance and less frequently (<10%) for
MRSA decolonisation and routine bathing.
Although used safely across USA CHG is not
currently recommended by FDA in infants less
than 2 months of age.
Questions and Issues
Q What about CHG resistance?
Resistance to chlorhexidine among gram-positive
bacterial species is rather uncommon. Gram
positive cause the majority of Hospital Acquired
Infections.
Most studies showing resistance have use minimum
inhibitory concentrations and not the high level
concentration in our product.
Important to note that a reduced susceptibility to CHG
does not translate into diminished antimicrobial
effectiveness when the biocide is used at the
appropriate concentration.
Questions?