Don’t Count on Antibacterial Products to Protect
You against MRSA
Widely used antibacterial soaps contribute to the development of
antibiotic resistant bacteria. The antibacterial agents produce
a genetic change in bacteria which enables them to become more
drug-resistant (Nature 394:531-532, 199).
Antiseptics, detergents manufacturers have started advertising
their product kills all germs including MRSA & virus. We find
this repulsive. Ordinary soap and water is adequate for most
household cleaning. Using strong chemicals to wash hands will
also dry and wash away natural skin secretions and helpful
bacteria that defend our natural protection. Excessive use of
alcohol has been shown to increase bacterial penetration into
blood because the cracks produced in skin allow bacterial entry.
Currently, no evidence suggests that use of antibacterial soap
containing provides a benefit over plain soap in reducing
bacterial counts and rate of infectious symptoms in generally
healthy persons in the household setting. Longer duration and
more extensive use might provide a suitable environment for
emergence of antimicrobial drug–resistant species in the
community setting.
UK
Study (2008) proves high bed occupancy rates or low cleanliness
score, temporary staff are not associated with higher MRSA
rates. MRSA enters a normally sterile blood stream through
either a device or intravenous cannulae, catheters or a local
site of infection."
Practical procedures like inserting urinary catheters, central
venous catheters, venipuncture and intra venous cannula create
an entry point for bacteria to enter blood circulation.
Staphylococcus has great affinity to damaged skin. Multiple
puncture sites created by staff when performing a procedure is
said to attract bacteria. Infections from the devices injection
site can be very difficult to treat and life-threatening.
Urinary catheter infections account for 40% of all hospital
infections, but U.S. hospitals do not have strategies in place
to minimize them, Catheters are used on one in four patients
post operated (surgery) patients, but as many as one third of
the days in which patients have the devices are medically
unnecessary. This issue takes on additional significance because
in July Medicare stopped paying for care of urinary tract
infections acquired while hospitalized. The average Medicare
payment for a catheter-associated urinary tract infection was
$40,347.
Intravenous cannulae is the most common practical procedure
performed in hospitals. One in every eight healthy patient and
70% of in-patients in hospital are said to have an IV Cannulae
inserted. The incidence of significant local or bloodstream
infection associated with peripheral venous cannula is said to
be higher than initially estimated.
This procedure must be performed under strict aseptic technique.
CDC new guideline recommend "No Touch Technique" and advice to
maintain sterility, the insertion site must not to be palpated
after the skin has been cleaned. Implementation of these
guidelines is difficult, especially in an emergency situation.
Most doctors and nurses use index finger to palpate vein after
the needle is inserted through skin.
Hand washing, average compliance was 48%. Non-compliance was
higher among physicians, nursing assistants and other health
care workers than among nurses and was lowest on weekends.
Non-compliance was also higher in intensive care, during
procedures that carry a high risk for contamination, and when
intensity of patient care was high. American Society of
Microbiology indicate that the rate of contaminant blood
cultures should not exceed 3%, Blood contamination rate in many
university hospitals in UK exceeds 6%
Doctors and nurses are not thought about hand washing and so are
un-aware of what effect this can have on patients. To be
effective, hands should be rubbed together vigorously with soap
and warm water for at least 30 seconds. Brief rubbing or simply
rinsing under running water is not enough. Contaminants are
stuck in oils that adhere to the skin. Agitation by rubbing
loosens the dead skin cells, and soap keeps the contaminants and
germs suspended in the water so they rinse off.
Soap does not kill the bacteria. In fact, germicidal soaps have
no added benefit and are expensive. Antiseptic soap or detergent
must remain in contact with the skin for several minutes to kill
germs and can result in excessive dry cracked skin. Antiseptic
soaps may give a false sense of security that could lead to less
vigorous washing.
Washing hands is the only best form of defence against these
bacteria and has been proved to be effective. Studies have shown
that 2% tincture of Chlorhexidine applied on skin before
catheter insertion significantly lowers catheter-related
bloodstream infection rates when compared with 10% povidone-iodine
and 70% isopropyl alcohol. 2% Chlorhexidine offers a broad
spectrum of antimicrobial activity and long-term micro
bacteriocidal action after application.
Antiseptics must remain on the skin and be allowed to air dry
before injecting the needle. Skin cleaning is often incomplete,
and many attendants still palpate with non-sterile gloves the
veni-puncture site before needle insertion. If povidone iodine
(bactericidal agent used in NHS) must be allowed to remain on
the skin for at least 1-2 minutes before cannula or catheters
are inserted.
How to Prepare skin before
Injecting Needle through Skin
Firmly swipe skin of patient using a fresh swab or soap and
water in circular fashion as shown in the diagram.
Please repeat this process 2-3 times using fresh new swab.
Never go over the centre point after you clean the peripheral
area.
Use the centre point to inject needle or insert cannula
Over enthusiastic use of stronger antiseptic solutions, alcohol,
excessive drying time may lead to damaged dry skin resulting in
cracks which attract colonization of Staphylococcus Few
publications now claim these agents may not be as safe as
reported before. CA-MRSA is resistant to all known antibiotics
and may be to various antiseptic solutions. Ordinary soap and
water is adequate for most household cleaning.
Widely used antibacterial soaps contribute to the development of
antibiotic resistant bacteria. The antibacterial agents produce
a genetic change in bacteria which enables them to become more
drug-resistant (Nature 394:531-532, 199).
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