When 2% chlorhexidine isn't 2%! Implications on MRSA decolonization guidelines

Farthing, Kathryn; Wares, Karen D; Siani, Harsha

doi:10.1016/j.jhin.2022.06.006

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…However, technology transfer should be accompanied by regulatory strengthening. Therefore, NRAs should be included in any future access collaborative partnerships, whether national or supranational, to ensure sustained compliance with WHO Good Manufacturing Practices and with adequate quality specifications,5 7 for example, correct chlorhexidine concentration,8 or water of adequate quality to avoid contamination with Gram-negative bacteria 9. The latter is particularly important for chlorhexidine.…”

Section: Lessons Learntmentioning

confidence: 99%

Collaborative partnerships as a solution for poor access to essential antimicrobial medicines: what can we learn from the chlorhexidine gel example?

Tack

Ravinetto

Allegaert

2022

bmjpo

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Section: Lessons Learntmentioning

confidence: 99%

Collaborative partnerships as a solution for poor access to essential antimicrobial medicines: what can we learn from the chlorhexidine gel example?

Tack

Ravinetto

Allegaert

2022

bmjpo

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Bacterial Contamination of Antiseptics, Disinfectants, and Hand Hygiene Products Used in Healthcare Settings in Low- and Middle-Income Countries—A Systematic Review

Lompo

Agbobli

Heroes

et al. 2023

Hygiene

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We conducted a systematic review of healthcare-associated outbreaks and cross-sectional surveys related to the contamination of antiseptics, disinfectants, and hand hygiene products in healthcare settings in low- and middle-income countries (PROSPERO CRD42021266271). Risk of bias was assessed by selected items of the ORION and MICRO checklists. From 1977 onwards, 13 outbreaks and 25 cross-sectional surveys were found: 20 from Asia and 13 from Africa. Products most associated with outbreaks were water-based chlorhexidine, chlorhexidine-quaternary ammonium compound combinations (7/13), and liquid soap products (4/13). Enterobacterales (including multidrug-resistant Enterobacter cloacae, Klebsiella pneumoniae, and Serratia marcescens) and non-fermentative Gram-negative rods were found in 5 and 7 outbreaks and in 34.1% and 42.6% of 164 isolates, respectively, from cross-sectional surveys. Risk factors included preparation (place, utensils, or tap water high and incorrect dilutions), containers (reused, recycled, or inadequate reprocessing), and practices (topping-up or too long use). Potential biases were microbiological methods (neutralizers) and incomplete description of products’ identity, selection, and denominators. External validity was compromised by low representativeness for remote rural settings and low-income countries in sub-Saharan Africa. Outstanding issues were water quality, biofilm control, field-adapted containers and reprocessing, in-country production, healthcare providers’ practices, and the role of bar soap. A list of “best practices” to mitigate product contamination was compiled.

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Bacterial Contamination of Antiseptics, Disinfectants and Hand Hygiene Products in Healthcare Facilities in High-Income Countries: A Scoping Review

Lompo

Heroes

Agbobli

et al. 2023

Hygiene

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This scoping review addresses bacterial contamination of antiseptics, low-level disinfectants, and hand hygiene products in healthcare settings in high-income countries. Over 70 years, 114 articles were found: 68 outbreaks, 13 pseudo-outbreaks and 33 cross-sectional surveys. Outbreaks affected median 29 (1–151) patients, extended for 26 (1–156) weeks and had a case fatality of 0.0% (0.0–60.0%). Most (72.8%) (pseudo-)outbreaks were caused by water-based chlorhexidine (CHG), quaternary ammonium compounds (QUAT) and the combination CHG–QUAT. Contaminating bacteria were nonfermentative Gram-negative rods (87.6% (pseudo-)outbreaks), mainly Burkholderia cepacia, Pseudomonas aeruginosa and Achromobacter spp.) and Enterobacterales (29.6%, 24/81), mostly Serratia spp.). Risk factors were at the level of the bacteria (natural resistance to CHG and QUAT), containers (design and functioning, presence of cork and cotton, biofilm formation), preparation (nonsterile water, overdilution) and practices (too long expiry dates, inappropriate container reprocessing, topping up of containers and deviation from procedures). Transmission occurred through direct contact (antiseptics), contact with semicritical items (disinfectants) and were handborne (soaps). During recent decades, reports of soap contaminated with Enterobacterales emerged and nationwide outbreaks of intrinsically contaminated CHG occurred. Outstanding issues comprise intrinsic contamination, implementation of antiseptic stewardship, the role of unit doses and sterile products, transmission studies, biofilm control and understanding healthcare providers’ perceptions.

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When 2% chlorhexidine isn't 2%! Implications on MRSA decolonization guidelines

Cited by 3 publications

References 4 publications

Collaborative partnerships as a solution for poor access to essential antimicrobial medicines: what can we learn from the chlorhexidine gel example?

Collaborative partnerships as a solution for poor access to essential antimicrobial medicines: what can we learn from the chlorhexidine gel example?

Bacterial Contamination of Antiseptics, Disinfectants, and Hand Hygiene Products Used in Healthcare Settings in Low- and Middle-Income Countries—A Systematic Review

Bacterial Contamination of Antiseptics, Disinfectants and Hand Hygiene Products in Healthcare Facilities in High-Income Countries: A Scoping Review

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