ALCOHOL-BASED CHLORHEXIDINE HANDRUB SOLUTION OF · PDF fileALCOHOL-BASED CHLORHEXIDINE HANDRUB...

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


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


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%


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.


Handwashing …an action of the past(except when hands are soiled)

Alcohol-basedhand rub isstandard of care


TIME FACTOR = major obstacle for hand hygiene

handwashinghand antisepsis

1 to 1.5 min

alcohol-basedhandrub

15 to 20 sec


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


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).


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


� 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.


The solution complies with EuropeanStandards (EN 1500)9 after only 15 seconds

of contact which is the fastest time everreached by a skin disinfectant


➨ 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.


➨ 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.


Figures since the beginningof the campaign.

0

20000

40000

60000

80000

100000

120000

14000019

93

1994

1995

1996

1997

1998

1999

2000

2001

bottles


❏ 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.


✦ Available to publichospitals in Switzerland(Individual contractsduring 2003.

✦ Swiss registration: 2003.

� European Registration ≈≈≈≈2005.

✦ And then….. ?


Alcohol-basedhand rub

Before and after any patient contactBefore and after glove use


� 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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ALCOHOL-BASED CHLORHEXIDINE HANDRUB SOLUTION OF · PDF fileALCOHOL-BASED CHLORHEXIDINE HANDRUB...

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