Healthcare-associated infections (HCAIs) are described as “infections occurring in a health- care setting, that were not present prior to a patient entering that care setting” [Guest, 2020]. They pose a serious risk to patients and can cause significant harm to those affected. Unfortunately they are common, and for every 20 hospitalised patients, at least one person will acquire a preventable HCAI [Hacque, 2018].
Critically ill patients in Intensive Care Units (ICU) are particularly vulnerable to the impact of HCAI. It’s estimated that between 9% to 37% of those admitted to ICU have an HCAI [Hacque, 2018].These patients have a worse outcome in terms of mortality and length of stay than those without an HCAI. They are also more severely ill on admission [Nuvials, 2015].
HCAIs are caused by a wide range of microorganisms, some of which are carried by patients. 25% to 30% of the UK population is positive for skin or nasal carriage of Staphylococcus [Jeans, 2018], which may present a higher risk of subsequent infections.
There is evidence that preventive washing with an antimicrobial body wash reduces the likelihood of some HCAIs occurring [Gastmeier, 2016; Spencer, 2013; Messler, 2019]. A number of ICUs are using octenidine impregnated wash mitts for the routine skin cleansing of all patients. This replaces washing with a disposable bowl, soap and towels.
Octenidine dihydrochloride (usually referred to as octenidine) is a synthetic antimicrobial molecule which is highly effective within a short contact time at low concentrations even in the presence of possible interfering substances, such as blood or mucin [Malanovic, 2020]. It has a broad spectrum of antimicrobial activity against (multidrug-resistant) Gram-positive and Gram-negative bacteria and fungi. In addition, octenidine is the only antiseptic that remains active locally for up to 48 hours [Malanovic 2020]. To date, no antimicrobial resistance has been reported in clinical isolates, even though octenidine has been routinely used for topical application for over 3 decades for skin, mucous membrane and wound antisepsis [Vejzovic, 2022].
There is significant evidence which suggests the use of octenidine in ICUs can help lower the rate of HCAIs [Gastmeier, 2016; Spencer, 2013; Messler, 2019]. Clinical studies examining the use of an octenidine based antimicrobial body wash in ICU found a 76% reduction in the acquisition of multi-drug resistant organisms [Spencer, 2013]. There was a significant reduction in ICU-acquired blood-stream infections and MRSA in medical ICUs after using an octenidine-based antimicrobial for decontamination [Gastmeier, 2016]. Nosocomial incidence density of 7.55 (pre-intervention) was reduced to 2.61 (post-intervention) per 1000 patient days [Messler, 2019]. This led to a significant reduction in nosocomial infections from 13 cases to 1 case after intervention [Messler, 2019].
Given that up to 3.5% of patients who acquire an HCAI die as a result of their infection [Guest, 2020], a universal decontamination policy in ICU should receive serious consideration.
References
Gastmeier P, Kämpf KP, Behnke M, Geffers C, Schwab F. An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms. J Antimicrob Chemother. 2016;71(9):2569-2576.
Guest JF, Keating T, Gould D, et al. Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England BMJ Open 2020;10:e033367. doi: 10.1136/bmjopen-2019-033367
Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections – an overview. Infect Drug Resist. 2018;11:2321-2333.
Jeans E, Holleyman R, Tate D, Reed M, Malviya A. Methicillin sensitive staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty. J Infect. 2018;77(5):405-409.
Malanovic N, Ön A, Pabst G, Zellner A, Lohner K. Octenidine: Novel insights into the detailed killing mechanism of Gram-negative bacteria at a cellular and molecular level. Int J Antimicrob Agents. 2020;56(5):106146. doi:10.1016/j.ijantimicag.2020.106146
Messler S, Klare I, Wappler F, et al. Reduction of nosocomial bloodstream infections and nosocomial vancomycin-resistant Enterococcus faecium on an intensive care unit after introduction of antiseptic octenidine-based bathing. J Hosp Infect. 2019;101(3):264-271.
Nuvials X, Palomar M, Alvarez-Lerma F, et al. Health-care associated infections. Patient characteristics and influence on the clinical outcome of patients admitted to icu. envin-helics registry data. Intensive Care Med Exp. 2015;3(Suppl 1):A82. Published 2015 Oct 1.
Spencer C, Orr D, Hallam S, Tillmanns E. 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(2):156-159.
Vejzovic D, Iftic A, Ön A, Semeraro EF, Malanovic N. Octenidine’s Efficacy: A Matter of Interpretation or the Influence of Experimental Setups?. Antibiotics (Basel). 2022;11(11):1665. Published 2022 Nov 19. doi:10.3390/antibiotics11111665
