WORTH REPEATING


“As markets grow tighter and more ex- pensive, technology is replacing labor in warehousing and distribution. Distribu- tors and manufacturers are already using several of these advanced technologies to reduce labor costs, increase throughput and maximize customer service.”


Jim Richardson, Portfolio Executive, Senior Consultant, Vizient Inc.


“Staffing ratios, lack of staff education, and lack of support from leadership all contribute to the growth of pressure injury incidence. There are also problems with assessment documentation, com- plete lack of written processes, or the failure of processes in place.”


Erica Thibault, MS, RN, CNS, APN, CWON,


Clinical Manager, and Suzanne Worden, PT, MS, CSPHA, Clinical Manager, Sizewise


“Minimizing medication errors while im- proving clinical efficiency is a top concern across the healthcare landscape. Health- care executives are constantly looking for ways to leverage technology to support this outcome.”


Thomas Utech, PharmD, Worldwide


Vice President, Global Solution Management & Marketing, Medication Management Solutions, BD.


“With respect to recall and safety notices, there’s a lot of noise out there. There are official FDA notices, preliminary vendor recalls (not yet FDA validated), MAUDE reports, vendor notices, incident reports, and more. Ultimately, I’d want a process that makes the management of safety notices and recalls more efficient, that considers all recall-related documenta- tion and that gives visibility to all related stakeholders. I envision a single technol- ogy repository (i.e., a blockchain struc- ture) for Food, Pharmacy and Medical Devices that would be the clearinghouse and source of truth for all related trans- actions.”


Michael Hardin, BMET, Senior Solutions Consultant, TractManager


“... a process challenge device (PCD) provides the best indication of sterility as- surance by providing a challenge greater than or equal to the most difficult items routinely processed (AAMI ST58, section 9.5.4.1). As such, we reference the AAMI ST58, section 9.5.4.3 recommendation to use a PCD at least daily, but preferably in every sterilization cycle.”


Jeremy Yarwood, PhD Microbiology,


Immunology & Molecular Pathology, Vice President of R&D, ASP


W


hen it comes to choosing a topical antiseptic for preoperative skin preparation that complies with


SSI prevention guidelines, the options are limited. Current guidelines from the Cen- ters for Disease Control and Prevention, Society for Healthcare Epidemiology of America, and Infectious Diseases Society of America call for an alcohol-containing preparation, based on alcohol’s highly bactericidal and rapid onset of action, along with an additive antiseptic that provides more persistent antisepsis.1-2


In the US, the


only commercially available preparations combining alcohol with an antiseptic for preoperative skin antisepsis include those with povidone iodine (PVI) or chlorhexi- dine gluconate (CHG). A study published in August 2019 by researchers from the Uni- versity of Wisconsin and the University of Texas Southwestern, however, is poised to ‘expand the playing field’ and proponents of antiseptic stewardship are likely to think the timing could not be better. The study, published in the journal Infection Control and Hospital Epidemiology, reports the results of two phase 2 trials as- sessing a novel topical skin antiseptic com- bining isopropyl alcohol with citrate, alkyl para-hydroxybenzoates, methylene blue (as a colorant), and purified water.3


In both


trials, the novel formulation matched the efficacy of the widely-used 2% CHG/70% isopropyl alcohol formulation in achieving target post-application microbial reduc- tions. Additionally, the formulation was effective even when suboptimal (shorter) application times were employed—a find- ing with practical implications for surgical practitioners given that compliance with application and dry-times have been re- ported to be as low as 24.6%.4 What makes this development notewor- thy is the context of the current antiseptic landscape, particularly as it relates to CHG. CHG is a potent antiseptic with a broad spectrum of activity and a robust body of evidence supports its efficacy in reducing certain healthcare-associated infection risk.5-8


debut in the 1950s in the UK and its use has grown exponentially ever since.9 in point: in 2013, a single regional hospital


CHG made its commercial Case


48 January 2020 • HEALTHCARE PURCHASING NEWS • hpnonline.com


in Massachusetts reported 17 different applications of CHG, excluding the long- standing application of gingival and peri- odontal antisepsis.10


While none of the SSI


guidelines preferentially recommend an additive antiseptic agent, market reports indicate 2% CHG/70% isopropyl alcohol products are among the most widely used topical skin preparations in the United States.11


There is growing concern, how- ever, surrounding the widespread use of CHG-containing products within the healthcare industry for two reasons: 1. reports of resistance/reduced suscepti- bility among clinical isolates in high-use settings, and


2. an up-tick in accounts of adverse events and allergic reactions.


CHG resistance on the rise Over the past eight to ten years, there has been increased detection of CHG resis- tance/reduced susceptibility within the acute care setting that appears to be associ- ated with increased CHG exposure.12-17


One


of the first studies to demonstrate this came from a Taiwanese hospital in which CHG had been in use for hand hygiene for over 20 years.12


The study, published in 2008,


found that between 1990 and 2005, the percentage of MRSA isolates with reduced susceptibility to CHG rose from 1.7% to 46.7%.12


Two years later, British research-


ers reported that use of CHG for MRSA decolonization in the ICU led to selection of a strain with CHG susceptibility three times lower than the other MRSA strains in the facility.13


Zhang et al reported that


the prevalence of CHG-resistant genes in the skin commensal coagulase-negative staphylococci was significantly higher in nurses than in the general population (57% vs 14%, p<0.001), which they attributed to repeated exposure to CHG in the hospital environment.14


More recently, researchers from Johns Hopkins University studied CHG sus- ceptibility in organisms causing central line-associated bloodstream infections (CLABSI) and found a 69% prevalence of reduced susceptibility.15


In units where


CHG bathing was performed, organisms causing CLABSI were significantly more


PEOPLE & OPINIONS Preoperative skin antisepsis


Is it time to expand the playing field? by Helen Johnson


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