Infection prevention Conclusion
With a single-use human waste disposal system, a large portion of the human required actions are eliminated due to a completely touchless macerator system and an eliminated risk of cross-contamination from reusable products. Many healthcare organisations and governing bodies advocate for single-use products to be used in healthcare, removing the possibility of cross-infection from incorrectly cleaned or compromised reusable products. The Vernacare single-use human waste disposal system helps tackle these issues.
References 1. Guest, J. Keating, T. Gould, D. Wigglesworth, N. (2020) Modelling the annual NHS costs and outcomes attributable to healthcare- associated infections in England. The BMJ. Jan 22;10(1):e033367. Doi:10.1136/bmj- open-2019-033367
2. Giraldi, G. et al. (2019). Excess length of hospital stay due to healthcare acquired infections: methodologies evaluation. Ann lg 2019 Sept- Oct;31 (5):507-516.
3. World Health Organization. (2021). Key facts and figures World Hand Hygiene Day 2021. (Key facts and figures [
who.int])
Letter to the editor
To the editor, Having read the recent highlights from the recent Infection Prevention & Control conference in Birmingham, published in the June edition of the CSJ, it is important to highlight some further evidence. Concerning the authors´ summary which advises that skin preparation should be with 2% alcoholic Chlorhexidine as a strong recommendation in the WHO guidelines, please note that both the WHO and NICE do not recommend a concentration of Chlorhexidine to be used for pre-operative skin preparation. The WHO global guideline states “The panel recommends alcohol-based antiseptic solutions based on CHG for surgical site skin preparation in patients undergoing surgical procedures.1 It is also important to note that following WHO review of the evidence, the “GDG did not feel comfortable to include a statement about the concentration of the antiseptic compound in the recommendation.”1 In England, NICE guideline [NG125} Surgical site infections: prevention and treatment, Antiseptic Skin Preparation states “First choice unless contraindicated or the surgical site is next to a mucous membrane, Alcohol – based solution of Chlorhexidine”.2
Intrinsic contamination of antiseptics, especially alcohol based, is very rare. Often concern is raised that bacterial spores can survive in alcohol, but a study conducted by
Steinhauer et al., looking at the potential of alcohol-based antiseptics becoming contaminated with spores found that alcohol-based solutions and primary packaging of such bottles do not become contaminated with spores. Appropriate production according to Good Manufacturing Practice (cGMP) ensures safety of such solutions.3
Skin
antisepsis products are available in single use bottles to minimise contamination in use. Prevention of extrinsic contamination is also very important. Regardless of the method of application for pre-operative skin antisepsis, whether via a gallipot or applicator, it is essential that good hand hygiene and aseptic non touch technique is followed. The OneTogether Surgical Skin Preparation Quality Improvement Resource highlights the need to take care not to contaminate the cap or inside neck of the bottle with your hands and ensure the unused solution is not returned to the bottle.4 The OneTogether resource also highlights best practice to prevent the risk of pooling stating that “the solution must be allowed to dry on the skin before drapes are fixed and the incision is made” along with “the risk of fire associated with alcohol-based solutions can be prevented by allowing skin to completely dry after application, and removing alcohol pooled e.g. in umbilicus, or body hair.”4 Therefore if good practice is followed here, bottled solutions shouldn’t
present increased fire risk in the operating theatre. The Healthcare sector is increasingly taking into account the environmental impact of its activities. Several areas for improvement have been identified by healthcare establishments, including energy and water consumption as well as greenhouse gas emissions. Within the operating theatres themselves, teams are assessing the carbon footprint of the various surgeries and adopting good practices to minimise waste production. Plastic waste is a global concern because of its cumulative nature, and targets aimed at reducing the quantities of plastic placed on the market have been set by many governments and leading organisations. For example, the bottles in which pre-operative skin preparations are provided in are, for the most part, recyclable. However, only single-material plastic packaging is generally accepted by reprocessing companies and can be recycled. The environmental impact of packaging is therefore a multifactorial assessment over its entire life cycle, taking into account in particular the ratio of product to packaging weight and its recyclability.
Vanessa Pouget Clinical Affairs Manager Ecolab Healthcare Correspondence:
vanessa.pouget@ecolab.com
References 1. WHO Global Guidelines for the Prevention of Surgical Site Infection, 2018. 2. NICE guideline [NG125] Surgical site infections: prevention and treatement. 3 .Steinhauer et al. (2013) Hygienic safety of alcohol-based hand disinfectants and skin antiseptics, GMS Hygiene and Infections Control, 8 (2); 1-10 4. OneTogether Surgical Skin Preparation Quality Impreovement Resource, 2017.
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4. Tri-County Healthcare. (2018). Gross! Hand hygiene and other germy facts. (Gross! Hand hygiene and other germy facts - Tri Living Well [
tchc.org]]
5. Covin, B . et al. (2012). Frequency of Patient Contact with Health Care Personnel and Visitors: Implications for Infection Prevention. The Joint Commission Journal on Quality and Patient Safety. Volume 38. Issue 12. Pp 560-565.
CSJ
6. World Health Organization. (2022). Decontamination and reprocessing of medical devices for health-care facilities (Decontamination and reprocessing of medical devices for health care facilities: aide-memoire (
who.int)
7. Centers for Disease Control and Prevention (2023). Infection Prevention and Control Recommendations for Hospitalised Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in US Hospitals. (Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S.
8. NHS England. (2023). National Infection Prevention and Control Manual (NIPCM) for England. (NHS England, Chapter 1: Standard infection control precautions [SICPs]) 9. World Health Organization. (2022).
About the author
As global marketing communications executive at Vernacare, Lydia Heap, works across the business’s core specialties to provide customers, and end-users, with vital information to help to prevent infections, promote effective clinical waste management, and educate on the benefits of Vernacare’s single-use surgical solutions.
Transmission- based precautions for the prevention and control of infections. (Transmission-based precautions for the prevention and control of infections: aide- memoire (
who.int)
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