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Impressive confirmation of concept of preventative washing for treatment of infection using octenidine preparations

05 July 2016

A major study at the Charité hospital in Berlin found that decontaminating all intensive care patients using octenisan® preparations reduced the incidence of infection and prevented the transmission of multi-resistant bacteria.

It is not only multi-resistant Staphylococcus aureus (MRSA) that now plays a dramatically increased role as an infectious agent in intensive care units (ICU). Other bacteria that are multi-resistant to a large number of major antibiotics, so-called MDRO (for example, VRE, ESBL, Clostridium difficile) are appearing more frequently as infectious agents not just in Germany (Geffers and Gastmeier 2011; Maechler et al. 2014). All these bacteria are responsible for an increasing number of cases of disease and death in ICUs.

Many hospitals are now taking preventative measures since treatment, if it is actually successful, it is expensive and time-consuming. These measures are designed to eliminate resistant bacteria before they can cause infection, particularly in intensive care units where patients are exposed to a high risk. Nasal vestibule, skin and other parts of the body where resistant bacteria linger are treated using decontaminating procedures and preparations. The aim is to reduce the amount of bacteria such that they can no longer be transmitted to other patients or trigger further infection (for example, infections in the bloodstream or wounds) (Evans et al. 2010).

Patients are often only washed using decontaminating preparations if the presence of resistant bacteria has been proven through a swab test in advance. However, some hospitals have recently moved towards this course of action for all patients in intensive care units regardless of bacterial status. The efficacy and costeffectiveness of such preventative washing has proved impressive in recent years in major clinical trials involving chlorhexidine (Climo et al. 2013; Huang et al. 2013; Huang et al. 2014).

While chlorhexidine plays a significant role internationally, octenidine-based preparations have gained recognition in Germany. Various studies involving preparations containing octenidine in patients colonised with MRSA have already returned excellent results when used for decontamination purposes (Krishna and Gibb 2010; Tanner et al. 2012; Spencer et al. 2013). Based on its properties (Hübner et al. 2010, Koburger et al. 2010), octenidine is regarded as being on a par with chlorhexidine for this use (Siegmund-Schultze 2013).

The Charité hospital in Berlin has now conducted a large-scale study in 17 intensive care units over 25 months on the efficacy of universal decontamination in the case of almost 30,000 intensive care patients. octenisan® wash mitts and octenisan® nasal gel were used. The number of bloodstream infections was reduced by 22% in the medical ICUs (8) and at the same time 42% fewer MRSA cases were recorded. However, similar results could not be confirmed in the surgical ICUs (9). The reasons for this were diverse. Surgical interventions meant that many BSIs could not be prevented through external decontamination. The time spent by the patients in surgical intensive care units was also shorter. This is known to have a
negative impact on decontamination success (Climo et al. 2013). A further positive outcome of the preventative washing was the saving of a total of 2,945 days of isolation, which in turn, represented a considerable cost saving.

The importance of using alternatives such as octenidine, for example, is emphasised by the fact that there is often resistance to significant anti-bacterial substances such as mupirocin and chlorhexidine (Poovelikunnel et al. 2015). These substances are currently used internationally mainly for decontaminating germ carriers. However, no resistance is known to date in the case of octenidine. Consequently, the evidence-based results that have now been published mean that a valuable alternative is available for decontaminating MDRO carriers. Controlled studies still need to confirm these results.

 
 

Sources:

Climo M.W., Yokoe D.S., Warren D.K. et al. Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection. N. Engl. J. Med. 2013; 368(6); 533-42.

Evans HL, Dellit TH, Chan J, Nathens AB, Maier RV, Cuschieri J. Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients. Arch Surg. 2010;145(3):240-246. doi:10.1001/archsurg.2010.5.

Gastmeier P, Kämpf KP, Behnke M et al. An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms. J. Antimicrob. Chemother. 2016. doi:10.1093/jac/dkw170. First published May 27, 2016

Geffers C.; Gastmeier P. Nosocomial Infections and Multidrug-resistant Organisms in Germany - Epidemiological Data From KISS (The Hospital Infection Surveillance System). Dtsch Arztebl Int (2011); 108(6): 87–93

Huang S.S., Septimus E., Kleinman K. et al. Targeted versus universal decolonization to prevent ICU infection. New Engl. J. Med. 2013; 368 (24): 2255-65.

Huang S.S., Septimus E., Avery T.R. et al. Cost savings of universal colonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infect. Control Hosp. Epidemiol. 2014; 35 (S3): S23-S31.

Hübner, N.O.; Siebert, J.; Kramer, A.: Octenidine Dihydrochloride, a Modern Antiseptic for Skin, Mucous Membranes and Wounds. Skin Pharmacol Physiol. 2010 ; 23 : 244-258

Koburger, T.; Hübner, N.O.; Siebert, J.; et al: Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother. 2010 ; 65 : 1712-1719

Krishna, B.V.S.; Gibb, A.P.: Use of octenidine dihydrochloride in methicillin-resistant Staphylococcus aureus decolonisation regimes - a literature review. J. Hosp. Infect. 2010 ; 74; 199-203

Maechler F.; Pena Diaz L.A.; Schröder C. et al. Prevalence of carbapenem‑resistant organisms and other Gram‑negative MDRO in German ICUs: first results from the national nosocomial infection surveillance system (KISS). Infection (2015) 43:163–168

Poovelikunnel T., Gethin G., Humphreys H.: Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA J. Antimicrob. Chemother. 2015; 70(10): 2681-2692 first published online July 3, 2015 doi:10.1093/jac/dkv169

Spencer, C.; Orr, D.; Hallam, S.; et al: Daily bathing with octenidine on an intensive care unit is associated with a lower carriage rate of meticillin-resistant Staphylococcus aureus. J. Hosp. Infect. 2013 ; 83 : 156-159

Siegmund-Schultze N. (2013): Antiseptik auf Intensivstationen: Chlorhexidinwaschung schützt vor Nosokomialinfekten. Dtsch Arztebl 2013; 110(15): A-718

Tanner, J.; Gould, D.; Jenkins, P.; et al: A fresh look at preoperative body washing. J. Infect. Prev. 2012; 13(1): 11-15

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