Antiseptic and CA-MRSA

Six Bacteria are among the biggest threats infectious diseases physicians (Medical profession) face today are:

Enterococcus faecium
Staphylococcus aureus,
Klebsiella species
Acinetobacter baumannii
Pseudomonas aeruginosa
Enterobacter species

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.

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