Bad Day For Bugs In Britain As DH Launches New HCAI Offensive

A single patient use skin disinfection system that has saved many lives and millions of dollars in the United States is just one of many clinical developments that have today been recommended for widespread use in the NHS in a seminal set of clinical recommendations. The Department of Health has today published the much-awaited epic2 guidelines, a key tool in the battle against healthcare-associated infections, which calls for NHS staff to implement a number of new initiatives in infection control, including the use of a stronger skin-preparation to reduce some of the 6000 catheter-related bloodstream infections (BSIs) in the NHS every year.

The practice of employing a single patient use 2% chlorhexidine gluconate/70% isopropyl alcohol skin preparation system, replacing the common practice of using a 0.5% chlorhexidine solution, has already proved highly successful, both in the UK and in the US.

Speaking at a recent symposium, Microbiologist and Director for Acute Medicine at the University of Birmingham, Professor Tom Elliott, drew attention to the need to focus on key developments in skin antisepsis.

"In the 1870's, Joseph Lister introduced carbolic acid spray which effectively reduced surgical infection rates - have we moved on since then?

"Hospitals are still using antiseptics, such as iodine, which have reduced residual activity and are adversely affected by organic matter, such as blood. Chlorhexidine in isopropyl alcohol, by contrast, works rapidly and has comparatively good residual activity, especially in the 2% chlorhexidine formation."

Professor Tom Elliott continued: "Why therefore do hospitals still use 0.5% chlorhexidine or 10% povidone-iodine?"

A number of health organisations - including the Royal Berkshire Hospital - have already seen a reduction in catheter-related bloodstream infections (BSIs). In the US, where it has been used for over five years, the Brookdale University Medical Centre in New York reduced BSIs by 48% saving an estimated $3 million annually**. The England and Wales National Blood Service*** has also seen a significant drop in contamination rates.

Mike Fairbourn, Commercial Director of Enturia UK, manufacturers of ChloraPrep®, the only sterile non-touch skin antiseptic systems containing 2% chlorhexidine gluconate and 70% isopropyl alcohol licensed for use in the NHS, has been anticipating the publication of epic2.

"For a few years now hand washing and dirty hospitals have dominated the media and policy environment.В  The publication of epic2 should turn the spotlight on what is an essential part of infection control - skin disinfection prior to inserting catheters, a major cause of bloodstream infections.

"Epic2 recommendations arise from a systematic and expert review of all the available scientific evidence and there is little doubt that implementation will save many lives".

ChloraPrep® One-Step 3mL skin preparation system is available in the UK. Enturia Ltd. plans to introduce the full line of additional applicators designed for a wide range of medical procedures in the near future. Enturia, Ltd, based in Reigate, is the wholly-owned subsidiary of US-based Enturia Incorporated, ChloraPrep's® manufacturer. ChloraPrep® is distributed in the UK by Insight Health, Wembley, London.

For further information, readers should visit www.enturia.co.uk

** Garcia R et al. Manag Infect Control 2003: 10: 42-9
*** Evaluation and routine performance of a 'best practice' donor arm disinfection procedure: ChloraPrep - C P McDonald, C Biggs, B Lees, N Beckman, J Kellington, G Evans

Prof Tom Elliot FRCPath

Tom Elliott is currently Consultant Clinical Microbiologist at the Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, appointed in 1987, and Clinical Director for Acute Medicine, University Hospital Birmingham NHS Foundation Trust.

Previously to this, he was Consultant Clinical Microbiologist and Reader in Bacteriology at the Royal Victoria Infirmary, Newcastle-upon-Tyne.

He has been a member of several editorial boards for scientific journals including currently the Journal of Hospital Infection and the Journal of Antimicrobial Agents. He is also an advisor to the British National Formulary on antibiotics and has published over 290 scientific articles on various infections ranging from urinary tract infections to catheter-related sepsis.