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 20091

Prescribing information can be found on the back cover

Surveillance programmes that rely only on inpatient data may hugely underestimate the incidence and cost of SSIs7,8

1 in 7 of all hospital-acquired infections are SSIs1

SSIs require an average additional stay of 6.5 days 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 impaired5

SSIs are serious and costly

“ In most SSIs, the source of pathogens is the endogenous flora of the patient’s skin”2

At one London Trust, the annual cost associated with SSIs for just one surgical core area (coronary artery bypass graft) amounted to around £500,0006

Povidone iodinen=440

Incidence of SSIs in clean-contaminated surgery (% patients)9

20

15

10

5

0

p=0.004

16.1

9.5

ChloraPrepn=409

Povidone iodine n=440

ChloraPrep n=409

Superficial incisional infection

Deep incisional infection

Incidence of incisional infections(% patients)9

10

8

6

4

2

0

p=0.008

p=0.05

3.0

8.6

4.21.0

ChloraPrep reduced SSIs by 41% compared with povidone iodine scrub and paint9

ChloraPrep was significantly more protective against both superficial (52% reduction) and deep incisional infections (67% reduction):9

The number needed to treat with ChloraPrep instead of povidone iodine in order to prevent one case of SSI was approximately 179

At 30 days post-discharge, no ChloraPrep patient had developed an SSI following saphenectomy10

Incidence of superficial SSI post-discharge (% patients)10

25

20

15

10

5

0

p=0.0502

20.8

0

0.5% chlorhexidine/ 70% isopropyl alcohol

n=24

ChloraPrepn=22

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

0.5% chlorhexidine/ 70% isopropyl alcohol n=24

ChloraPrep n=22

Adhesive dressing component

Absorbent dressing component

Mean CFU counts 24 hours after surgery10

20

15

10

5

0

p=0.007

p=0.02

0.40.6

14.8

4.2

Rates of SSI following saphenous vein harvest as high as 1 in 5 patients have been reported10

ChloraPrep provides broad spectrum, rapid, residual and persistent antimicrobial activity

ChloraPrep is effective against a broad range of micro-organisms including MRSA, VRE, Clostridium difficile, coagulase negative staphylococci and most viruses and fungi11-13

ChloraPrep has good activity levels within 30 seconds;14 povidone iodine takes 2-3 minutes to reach full effect11

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 activity16

Unlike povidone iodine, ChloraPrep is not inactivated in the presence of blood12

Rapid

Persistent

Practical

Optimal agent for pre-surgical skin antisepsis12

ChloraPrep

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 layers

Sterile solution is maintained in a glass ampoule prior to activation, obviating concerns about contamination18

ChloraPrep is an easy to apply, sterile, skin antisepsis system

ChloraPrep is the only 2% chlorhexidine / 70% isopropyl alcohol licensed for cutaneous antisepsis prior to invasive procedures in the UK17

A back and forth prep was used in all the phase III efficacy studies of ChloraPrep applicators19

Using ChloraPrep surgical applicators

Pinch the lever to release the solution. You will hear a ‘pop’ as the ampoule breaks.

Starting at the incision site, gently press the applicator against the skin until the solution soaks the sponge.

Apply using repeated up and down, back and forth strokes for at least 30 seconds, before working outwards towards the periphery.

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.

1. Pinch 2. Apply 3. Dry

Leave the area to dry completely before applying sterile drapes. Do not blot or wipe away. Discard the applicator after a single use.

Important safety point:Do not drape or use ignition source until the solution has completely dried.

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.

3ml tinted

Coverage area: 15 cm x 15 cm

NHS list price per applicator: £0.89 (ex. VAT and delivery)

NHS supply chain order code: MRB494

10.5ml tinted




26ml tinted




3ml clear




10.5ml clear




26ml clear




Range of surgical applicatorsLicensed, sterile, single use, ANTT™, latex free applicators available in the UK

Prescribing InformationChloraPrep® (PL31760/0002) & ChloraPrep with Tint (PL31760-0001) 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Indication: Disinfection of skin prior to invasive medical procedures. Dosage & administration: ChloraPrep – 0.67ml, 1.5ml, 3ml, 10.5ml, 26ml; ChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on invasive procedure being undertaken. Applicator squeezed to break ampoule and release antiseptic solution onto sponge. Solution applied by gently pressing sponge against skin and moving back and forth for 30 seconds. The area covered should be allowed to air dry. Side effects, precautions & contra-indications: Very rarely allergic or skin reactions reported with chlorhexidine, isopropyl alcohol and Sunset Yellow. Contra-indicated for patients with known hypersensitivity to these constituents. For external use

only on intact skin. Avoid contact with eyes, mucous membranes, middle ear and neural tissue. Should not be used in children under 2 months of age. Solution is flammable. Do not use with ignition sources until dry, do not allow to pool, and remove soaked materials before use. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin reactions. At the first sign of local skin reaction, application should be stopped. Per applicator costs (ex VAT) ChloraPrep – 0.67ml (SEPP) - 30p; 1.5ml (FREPP) - 55p; 3ml - 85p; 10.5ml - £2.92; 26ml - £6.50. ChloraPrep with Tint – 3ml - 89p; 10.5ml - £3.07; 26ml - £6.83. Legal category: GSL. Marketing Authorisation Holder: CareFusion UK 244 Ltd, 43 London Road, Reigate, Surrey RH2 9PW, UK. Date of preparation: July 2010.

CHL104a Date of preparation: August 2010

For customer services and all other enquiries: Please telephone: 0800 0437 546 Email: [email protected] or visit: www.chloraprep.co.uk

Health & Medicine

Surgical Leave Piece | ChloraPrep UK Infection Prevention & Control