DECONTAMINATION


patient washing. The study showed a 76% reduction in the acquisition of multi-drug resistant organisms.19 To investigate the effect of universal decontamination with octenidine on the incidence of ICU-acquired bloodstream infections (BSI) and MDR organisms (MDRO) a total of 12,855 medical ICU patients were included in a study. A significant reduction in ICU-acquired blood-stream infections and MRSA in medical ICUs was observed after implementation of an octenidine-based antimicrobial for decontamination.20


The


researchers highlighted the ‘significant effect on the reduction of ICU-acquired BSI in medical ICUs.’.20


Octenidine is a broad-spectrum antimicrobial and, to date, has not shown any descrease in antimicrobial efficacy to multi-resistant bacteria21


and there have


been no reports of the development of resistance to octenidine.22


Octenidine has


a residual antimicrobial effect on the skin, which lasts for at least 24 hours, which may result in a better preventative outcome.23


A


randomised trial of 60 participants compared the effects of using soap or an octenidine based antimicrobial on colony forming units (CFUs) for up to six hours. Octenidine was found to be more effective than soap in reducing CFUs on the skin of healthy volunteers.24


The recent pandemic has once again highlighted the importance of robust infection prevention strategies in all clinical settings, including intensive care units (ICU). Minimising the risks of patients acquiring a healthcare associated infection should be integral to these strategies, and decontamination offers a useful tool.


References 1. Bearman GM, Munro C, Sessler CN, Wenzel RP. Infection control and the prevention of nosocomial infections in the intensive care unit. Semin Respir Crit Care Med. 2006;27(3):310-324. doi:10.1055/s-2006-945534


2. National Institute for Health and Care Excellence (NICE). Healthcare associated infections: prevention and control in primary and community care, Clinical guideline [CG139], 2017. https://www.nice.org.uk/ guidance/cg139


3. NICE, Infection prevention and control Quality Standard [QS61], April 2014 www.nice.org.uk/ guidance/qs61


4. Guest JF, Keating T, Gould D, et al Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England BMJ Open 2020;10:e033367. doi: 10.1136/ bmjopen-2019-033367


5. Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections - an overview. Infect Drug Resist. 2018;11:2321-2333.


6. Nuvials X, Palomar M, Alvarez-Lerma F, et al. Health- care associated infections. Patient characteristics and influence on the clinical outcome of patients


DECEMBER 2021


admitted to icu. envin-helics registry data. Intensive Care Med Exp. 2015;3(Suppl 1):A82. Published 2015 Oct 1.


7. Jeans E, Holleyman R, Tate D, Reed M, Malviya A. Methicillin sensitive Staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty. J Infect. 2018;77(5):405-409.


8. Nuffield Trust, Healthcare-associated infections, 2021, https://www.nuffieldtrust.org.uk/resource/ healthcare-associated-infections accessed 271021


9. Duszyńska W, Adamik B, Lentka-Bera K, et al. Effect of universal chlorhexidine decolonisation on the infection rate in intensive care patients. Anaesthesiol Intensive Ther. 2017;49(1):28-33


10. Huang SS, Septimus E, Avery TR, et al. Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infect Control Hosp Epidemiol. 2014;35 Suppl 3:S23-S31.


11. Humphreys H. Can we do better in controlling and preventing methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU)?. Eur J Clin Microbiol Infect Dis. 2008;27(6):409-413


12. Robotham JV, Graves N, Cookson BD, et al. Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation. BMJ. 2011;343:d5694.


13. Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis. 2003;36(3):281-285


14. Edgeworth JD. Has decolonization played a central role in the decline in UK methicillin- resistant Staphylococcus aureus transmission? A focus on evidence from intensive care. J Antimicrob Chemother. 2011;66 Suppl 2:ii41-ii47. doi:10.1093/jac/dkq325


15. Johnson R, Jameson SS, Sanders RD, et al. Reducing surgical site infection in arthroplasty of the lower limb: A multi-disciplinary approach. Bone Joint Res. 2013;2(3):58-65.


16. van Rijen MM, Bode LG, Baak DA, Kluytmans JA, Vos MC. Reduced costs for Staphylococcus aureus carriers treated prophylactically with mupirocin and chlorhexidine in cardiothoracic and orthopaedic surgery. PLoS One. 2012;7(8):e43065


17. Bradley CW, Wilkinson MA, Garvey MI. The Effect of Universal Decolonization With Screening in Critical Care to Reduce MRSA Across an Entire Hospital. Infect Control Hosp Epidemiol. 2017;38(4):430-435. doi:10.1017/ice.2017.4


18. Messler S, Klare I, Wappler F, et al. Reduction of nosocomial bloodstream infections and nosocomial vancomycin-resistant Enterococcus faecium on an intensive care unit after introduction of antiseptic octenidine-based bathing. J Hosp Infect. 2019;101(3):264-271.


19. Spencer C, Orr D, Hallam S, Tillmanns E. Daily bathing with octenidine on an intensive care unit is associated with a lower carriage rate of meticillin- resistant Staphylococcus aureus. J Hosp Infect. 2013;83(2):156-159.


20. Gastmeier P, Kämpf KP, Behnke M, Geffers C, Schwab F. An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms. J Antimicrob Chemother. 2016;71(9):2569-2576.


21. Hübner NO, Siebert J, Kramer A. Octenidine dihydrochloride, a modern antiseptic for skin, mucous membranes and wounds. Skin Pharmacol Physiol. 2010;23(5):244-58. doi: 10.1159/000314699. Epub 2010 May 18. PMID: 20484966.


22. Lachapelle JM. A comparison of the irritant and allergenic properties of antiseptics. Eur J Dermatol 2014;24:3–9.


23. Brill FHH, Radischat N, Goroncy-Bermes P, Siebert J. Residual antiseptic efficacy of octenidine dihydrochloride versus chlorhexidine gluconate in alcoholic solutions. Antimicrob Resist Infect Control. 2015;4(Suppl 1):P33. Published 2015 Jun 16. doi:10.1186/2047-2994-4-S1-P33


24. Tanner J, Gould D, Jenkins P, Hilliam R, Mistry N, Walsh S. A fresh look at preoperative body washing. J Infect Prev. 2012;13(1):11-15


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