alcohol-based chlorhexidine handrub solution of · pdf filealcohol-based chlorhexidine handrub...
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 1
ALCOHOL-BASED CHLORHEXIDINE HANDRUBSOLUTION OF THE HUG
W.Griffiths*, P.Eggimann#, D. Pittet0, P. Bonnabry* Pharmacy*,Medical Intensive Care#, Infection Control Program0
September 13th, 2002 Lugano Switzerland
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 2
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 3
In UK, nosocomial infections may beresponsible for > 5’000 deaths/year
BMJ 2.12.2000
Nosocomial infections
Every year in the US,preventable hospital-acquired diseases,
including nosocomial infections,are responsible for 44’000-98’000 deaths
Kohn Institute of Medicine 1999
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 4
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 5
10,810,0
6,1
0%
2%
4%
6%
8%
10%
12%
Large Intermediate Small
Sax Arch Intern Med 02 (in press)
1999 Swiss NI Prevalence Study
Hospital size
Nosocomial infections14%
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 6
ALCOOL BASED HANDRUB✔ Improves compliance.✔ Superior to traditional handwashing with ordinary or
antiseptic soaps.✔ Requires less time.✔ Acts faster.✔ Less irritating to the skin.
Used in the only programme that reported a sustainedimprovement in hand hygiene compliance associated withdecreased infection rates. (Pittet et al)2.
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 7
Handwashing …an action of the past(except when hands are soiled)
Alcohol-basedhand rub isstandard of care
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 8
TIME FACTOR = major obstacle for hand hygiene
handwashinghand antisepsis
1 to 1.5 min
alcohol-basedhandrub
15 to 20 sec
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 9
Hands of Dr. B. after 1 week of ID consultationservice using handwashing or hand antisepsis with (un)medicated soap only
Hands of Dr. B.after 1 week of IDconsultation serviceusing alcohol-basedhand rub only
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 10
1954: Patent registration forChlorhexidine (CHX).
1960: Development of antisepticsoap solutions. (HibiscubR).
1960-1974: British Medical Journal:Use of alcoholic solutions for handdisinfection3,4,5,6,7.
1975:Development of a solution atthe Cantonal Hospital of Fribourg(HCF): Isopropanol (IP) +CHX.
1979: Introduction of the HCFformulation in the UniversityHospitals of Geneva (HUG).
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 11
1984: A study confirms the efficacyof 0.5% CHX + IP. (Médecine etMaladies Infectieuse)8.
1995: Beginning of the HUG campaignby the Infection Control Unit(UPCI)of Professor.D.Pittet.
2000: Paper in the Lancet2
describing the successful outcomeof Pittet’s campaign.
2001: 132’000 bottles produced bythe HUG
2002: Industrial manufacturingagreement.
2002: The first batch supplied inA il
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 12
� ISOPROPANOL 75% :• Rapidity of action : immediate.• No residual activity.� CHLORHEXIDINE 0.5% :• Rapidity of action: intermediary.• Persistant effect.� EMOLLIENT :• Improves cutaneous tolerance.� NO PERFUME :• Only 2 cases of allergy recorded over the
last 5 years.
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 13
The solution complies with EuropeanStandards (EN 1500)9 after only 15 seconds
of contact which is the fastest time everreached by a skin disinfectant
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 14
➨ Small bottle designed tofit in the pocket.
➨ Cap conceived so thatthere was no fingercontact with the solution.
➨ Cartoon-type messageprinted on one side ofthe bottle.
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 15
➨ Since 1995: A3 posters « TalkingW alls » were displayed in 250strategic areas to rem ind staff of theim portance of hand disinfection
➨ Cartoons were also printed on thehandrub bottles.
➨ The objectives are described in detailat www.hopisafe.ch
➨ The operation was successful:
50% reduction of prevalence ofnosocom ial infections (16.9% in 1994to 9.9% in 1998)8.
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 16
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 17
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 18
Figures since the beginningof the campaign.
0
20000
40000
60000
80000
100000
120000
14000019
93
1994
1995
1996
1997
1998
1999
2000
2001
bottles
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 19
❏ The second most supplied product by the HUG pharmacy after100ml IV bags of 0.9%NaCl. > 130’000 bottles.
❏ It was necessary to outsource its production in order to sell it. Weare not allowed to sell it ourselves, being a public hospital.
❏ An industrial manufacturing partnership was concluded at theend of 2001 with B.Braun Ltd..
❏ The product will be shortly on the market at low cost.
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 20
✦ Available to publichospitals in Switzerland(Individual contractsduring 2003.
✦ Swiss registration: 2003.
� European Registration ≈≈≈≈2005.
✦ And then….. ?
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 21
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 22
Alcohol-basedhand rub
Before and after any patient contactBefore and after glove use
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 23
� Pittet D et al. Compliance with Handwashing in a Teaching Hospital. Ann Intern Med 1999; 130:126-130. Pittet D et al. Effectiveness of a hospital-wide programme to improve
compliance with hand hygiene Lancet. 2000;46:43-49. Lowbury EJL, Lilly HA. and Bull JP. Brit Med J. 1960;2:1039 Lowbury EJL, Lilly HA. and Bull JP. Brit Med J. 1964;2: 231� Lowbury EJL, Lilly HA. and Bull JP. Brit Med J. 1964;2: 531� Lilly H.A. and Lowbury EJL. Brit Med J. 1971;3:674 Lowbury EJL, Lilly HA, Ayliffe GAI. Pre-operative disinfection of surgeons hands
: use of alcoholic solutions and effect of gloves on skin flora. Brit Med J.1974;4:369-372
� Gevaudan MJ, Gulian C, Mallet MN. Etude de l ’efficacite d ’une solutionalcoolique de Chlorhexidine 0,5% pour antisepsie des mains. Médecines etMaladies Infectieuses 1984; (14) 3:94-101
� CEN (European committee for Standardisation). EN 1500 Chemical disinfectantsand antiseptics- hygienic handrub, Brussels, Belgium.
� Michaud RN et al. Application of glove-hand model for multi-parametermeasurements of skin- degerming activity. J Clin Microbiol 1976;3:406-413
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William Griffiths Pharmacie des HUG, Lugano, sept. 2002 24
Download atwww.hcuge.ch/Pharmacie/ens/conferences.htm