Infection prevention
screening should be considered, particularly as it has shown to be more cost effective.18
MSSA decolonisation in elective hip and knee arthroplasty One of the largest case series in the literature detailing the effects of MSSA screening and decolonisation demonstrated a significant improvement in MSSA following the introduction of screening and decontamination. 12,910 hip and knee arthroplasties were performed during the study at Northumbria Healthcare NHS Foundation Trust (2007 to 2014).7 The aims of the study were to determine if
MSSA screening and decolonisation reduced MSSA periprosthetic joint infection (PJI) rate in primary joint replacement and to determine the cost effectiveness of such a programme. MSSA is a common isolate in PJI and colonisation is a proven risk factor for subsequent infection. PJI is a catastrophic and potentially life-threatening complication following arthroplasty and is associated with significant additional costs to the NHS, estimated at £21,937 per case. All MSSA positive patients attending for elective arthroplasty were prescribed octenisan body wash and a nasal ointment to use for five days prior to surgery, and five days after. Infection data was collected prospectively and compared with a control group. The regime was shown to be effective in reducing rates of PJI by up to 60%, leading researchers to conclude that: “the decolonisation programme was a significant factor in the threefold reduction of MSSA.” The programme also resulted in significant
financial savings when compared to the cost of prevented infections. There was an estimated
total cost benefit of £1,031,039 over the course of the study.7
Octenidine dihydrochloride Topically applied antiseptics are often regarded as causing no antimicrobial resistance due to their unspecific mode of action. This assumption has been challenged in recent years and there have been reports of clinical resistance to chlorhexidine. This has raised concerns among healthcare professionals about its use as a preventative measure.19 Octenidine dihydrochloride (usually referred
to as octenidine) is a promising alternative agent which could be more effective against Gram-negative organisms.20
To date, no
antimicrobial resistance has been reported in clinical isolates, even though octenidine has been routinely used for topical application for over three decades for skin, mucous membrane and wound antisepsis.19 Octenidine is a synthetic antimicrobial molecule which is highly effective within a short contact time at low concentrations, even in the presence of possible interfering substances such as blood or mucin.11
It has
a broad spectrum of antimicrobial activity against (multidrug-resistant) Gram-positive and Gram-negative bacteria and fungi. In addition, octenidine is the only antiseptic that remains active locally for up to 48 hours.11
This ability
to form a long-term persistent residue has a biocidal effect against microorganisms (re-) emerging, e.g., from sebaceous glands or hair follicles after disinfection.12
have an effect on microorganisms that are sheltered within biofilms.12 A number of studies have evaluated
the efficacy of decontamination with an octenidine-based antimicrobial. A large-scale trial conducted by Jeans et al reported a 60% reduction in periprosthetic joint infections following arthroplasty, after a five-day decontamination regime which included octenisan wash lotion.7 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.14 In a study investigating the efficacy and
safety of octenidine, patients positive for MRSA underwent a decontamination regime using octenidine-based products. Total decontamination was observed in 67% of patients. None of the patients experienced side-effects or secondary symptoms such as skin irritation or allergic reactions during the course of the study. The researchers concluded “with a favourable safety and tolerability profile, octenidine-based products represent a good choice in multifaceted MRSA decontamination regimes, which are necessary to curb the increasing problem of severe infections.”21 Octenidine is also available for topical
intranasal application and, in a study of 1255 patients, was found to reduce the prevalence of MRSA colonisation by 58% when used in conjunction with antimicrobial washing.21
It Octenidine may even
is clinically useful to have an alternative to mupirocin, where resistance is reported to be as high as 81%.22
A study of topical intranasal
octenidine showed no reduction in MRSA efficacy over an eight-month period of use.21 In conclusion, antiseptic body washing is a useful tool to help reduce dermal microorganisms as potential pathogens on the skin and trials with antiseptic agents suggest a reduction of nosocomial infection rates,23
including SSIs. Octenidine is a promising
antimicrobial which can play a key role in pre- operative decontamination regimes.
CSJ
References 1. Leaper D. An overview of surgical site infection Review. Wounds UK, EWMA Special, 2015 p 14-19
2. Falconer R, Ramsay G, Hudson J, Watson A; Highland Colorectal SSI Group. Reducing surgical site infection rates in colorectal surgery - a quality improvement approach to implementing a comprehensive bundle. Colorectal Dis. 2021;23(11):2999-3007. doi:10.1111/codi.15875
3. UK Health Security Agency, Surveillance of surgical site infections in NHS hospitals in England April 2021 to March 2022. Published
34
www.clinicalservicesjournal.com I July 2023
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
