INF ECT ION PR EVENT ION & CONT ROL
150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0
145 118 89 72 Surgical Skin prep 13 Theatre One Figure 1: Results of BSRMA tests over 1st week
4000 3750 3500 3250 3000 2750 2500 2250 2000 1750 1500 1250 1000 750 500 250 0
13 2 Theatre Two 4
In 2017 the United States Centre for Disease Control (US CDC), published the long-awaited update to its 1999 guidance on prevention of surgical site infections.18 According to the new recommendations, the preparation of skin prior to surgery is now considered to be a single issue with a two-stage procedure. Stage 1 is to ensure that the patient pre-operatively showers, and Stage 2 is to use a skin disinfectant to clear the skin edges and surrounding area of bacterial load immediately prior to incision. One of the skin disinfectants
Wash only
70% Alcohol Gel 72% Alcohol liquid Clinsept
5th Generation Si Quat 3,491
recommended is Chlorhexidine Gluconate (CHG) in 70% alcohol, despite the clear evidence that this is affected by the ionic charge from soaps, a message that the authors missed, even though it is stated definitively by the WHO.19
Figure 3a and 1,582 1,452 1,264 1,261 1,241 1,378 1,282 606 362 222 246 243 Pre wash 218 46 Post wash Figure 2: Comaparison test over time
2000 1900 1800 1700 1600 1500 1400 1300 1200 1100 1000 900 800 700 600 500 400 300 200 100 0
1,9711,989 1,798 1,725 1,672 1,596 1,646 1,532 1,650 1,453
2% CHG in 70% Alcohol 0.5% CHG in 70% Alcohol 7.5% Pl in 70% Alcohol 70% Alcohol
5th Generation Si Quat 1,6851,651
1,582 163 48 46 5 mins post treatment 1 hour post treatment 382 15
3b use the BSRMA test to determine CFU counts on the skin around surgical wounds over a four hour period after application of CHG as compared to a 5th generation SiQuat when either anionic or cationic soaps are used. These results again clearly show the benefit of using persistent technologies over non persistent technologies. Although the US CDC do recommend the skin disinfectant chemicals to be used in the operating room, there is no mention of the type of soap that should be used for the pre-operative shower. 5th generation SiQuats can be used anywhere that standard non persistent, or standard Quats can be used.
Family doctor’s surgery 1,056
Swab samples were taken from six separate high touch, high risk surfaces, in a GP Practice. Prior to testing, standard cleaning was performed daily and all high touch surfaces were cleaned with “all-purpose” disinfectant wipes. After the initial testing, a 5th generation SiQuat was introduced and applied once every 30 days. Standard cleaning was performed daily using only a mild detergent (no disinfectant) to remove surface dust, dirt and debris. (See Figure 4)
788 605 429 318 222 202 61 Pre Treatment 69 15 5 mins post 1 hour post 11 2 hours past 7 4 hours past Figure 3a: Comparison of average CFU counts: skin surgical prep after anionic soap OCTOBER 2020
In the home For many years, there has been an understanding that that food chopping boards were less contaminated if wood is chosen as the material instead of plastic. The following are the results of BSRMA testing on these types of chopping boards. (Figure 5)
WWW.CLINICALSERVICESJOURNAL.COM l 23
Pre clean Post clean Pre start of operating list
Pre start of operating list 4 days post treatment
to a much more pathogenic Bacillus cereus is also of cause of great concern.16
Again,
because hospitals do not routinely test surfaces for numbers or species of bacteria (and if they do, they rarely publish the results), we have no way of knowing how this negative effect on hands is affecting the surfaces in hospitals.
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Average bacterial CFU counts per cm2 Average bacterial CFU counts per cm2
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