Madeo Clinical Summary | ChloraPrep UK Infection Prevention & Control
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This study examined the effect of introducing a 2% chlorhexidine gluconate and 70% isopropyl alcohol applicator (ChloraPrep) on blood culture contamination rates in the emergency department and two acute medical admissions units of a UK teaching hospital over one year. The monthly blood culture contamination rates decreased significantly from 7.5% prior to ChloraPrep introduction to 2.1% after its use, with the greatest decline in the emergency department. ChloraPrep significantly reduced the incidence of blood culture contamination and hospitals could benefit from lower contamination rates in meeting infection targets.
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Madeo Clinical Summary | ChloraPrep UK Infection Prevention & Control
- 1. Reducing blood-culture contamination rates by the use of a 2% chlorhexidine solution applicator in acute admission units Madeo M, Barlow G Journal of Hospital Infection 2008; 69: 307-9 Background 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 contamination Aim 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 hospital Methods 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 micrococci Results 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 introduction Monthly blood culture of ChloraPrep contamination rates in 8 the admissions units, January to December 6 Washout 2007 (% cultures contaminated) 4 2 0 Odds ratio: 0.25 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 95% CI: 0.18-0.35; p<0.0001 n= 717 713 608 568 544 461 461 425 408 480 449 533
- 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 rate Prescribing Information contact with eyes, mucous membranes, middle ear and neural tissue. Should not be used in ChloraPrep® (PL31760/0002) & ChloraPrep with Tint (PL31760-0001) 2% chlorhexidine children under 2 months of age. Solution is flammable. Do not use with ignition sources until gluconate 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 on skin 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 of 1.5ml, 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) ChloraPrep invasive 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, Surrey effects, 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 with known hypersensitivity to these constituents. For external use only on intact skin. Avoid CHL113a Date of preparation: August 2010