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Breaking skin – breaking bad practice

It is time to add a new campaign in the drive to tackle antibiotic resistance, infections and sepsis and raise patient awareness.

  • There is little doubt that the continuous ‘handwashing’ campaigns have highlighted the risk of cross infection or the simple transfer of an organism from one person to another. I might be tempting fate to suggest that large hospital based outbreaks of infections such as c difficile is a thing of the past.
  • I would have to commend Ron and the work of Sepsis UK in improving the early recognition of sepsis and the rapid treatment that has saved lives and will continue to do so.
  • I am a supporter of the antibiotic guardian program and feel sure that it will improve the use of antibiotics going forward.

When we break the skin, we break the natural barrier between the bugs on the outside and the susceptible inside. We may convert a normal commensal into an annoying superficial infection or a deadly pathogen.

Every day, thousands of healthcare professionals deliberately break the skin. This may be the few seconds to administer a simple injection or a minute to take a blood sample to the longer term break necessary for an intravenous cannula or a surgical procedure.

We understand the need for the immediate action from 70% alcohol and the longer term requirement of antiseptics such as chlorhexidine which seem to bind to the skin. We understand that lower concentrations of chlorhexidine (for example 0.5%) may be effective for shorter time periods such as 6 hours, where higher concentrations (for example 2%)may be effective for longer, perhaps 48 hours. And we understand that chlorhexidine is superior to iodine containing solutions. We have some robust clinical evidence showing this.

The application of a product prior to an invasive procedure to reduce the risk of infection is clearly a medicinal purpose and requires the use of a medicinal product – check the RCS/MHRA joint statement if you are not sure of this. And you can also check their advice on the addition of a skin staining dye. The MHRA sets the standards, reviews the evidence and manufacturing and grants marketing authorisation in order to protect patient safety. Think of it as a stamp of approval. We have guidance from the DH, NICE, EPIC and other bodies so it is not as if we don’t know what to use and what to do. But this is a strange market place where any company can produce an antiseptic product with similar contents as a licensed medicine and introduce it. It is up to the healthcare professionals to recognise what is and what is not licensed and what is appropriate use and what is not. All professional bodies have offered very clear advice on the use of unlicensed or off-label use.

In my opinion, however, this area remains a mess of confusion and misinterpretation where unsatisfactory clinical practice is commonplace.

Perhaps patients are the key. If a healthcare professional is going to break your skin – ask them what they are going to use before that procedure to reduce the risk of infection. Make sure that the product is appropriately licensed and ask to see the label or the package insert. Just ask the healthcare professional to show you where it says that it is a suitable product to be used in that manner.

So here is the missing link in the campaigns to reduce infections and fight against antibiotic resistance.

Let’s call it breaking skin- breaking bad practice

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About markmandc (267 Articles)
A pharmacist with experience working in secondary care, primary care, community pharmacy and general practice.

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