Surgical Leave Piece | ChloraPrep UK Infection Prevention & Control

1. “Whilst every person carries millions of bacteria
on their skin, hospitals should not be tolerant
of any infections that could be avoided”
The Public Accounts Committee, 10th November 20091
Prescribing information can be found on the back cover

2. “In most SSIs, the source of pathogens is the
endogenous flora of the patient’s skin”2
SSIs are 1 in 7 of all hospital-acquired infections are SSIs1
serious
SSIs require an average additional stay of 6.5 days
and costly
and hospital costs are doubled3
Patients with SSIs are 60% more likely to spend
time in ICU, 5 times more likely to be readmitted
to hospital and twice as likely to die4
Health-related quality of life may be significantly
impaired5
At one London Trust, the annual cost associated with
SSIs for just one surgical core area (coronary artery
bypass graft) amounted to around £500,0006
Surveillance programmes that rely only on inpatient data may hugely
underestimate the incidence and cost of SSIs7,8

3. ChloraPrep reduced SSIs by 41% compared
with povidone iodine scrub and paint9
20
p=0.004
Incidence
of SSIs in 15
clean- 16.1
contaminated 10
surgery
5
9.5
(% patients)9
0
Povidone iodine ChloraPrep
n=440 n=409
ChloraPrep was significantly more protective against both superficial
(52% reduction) and deep incisional infections (67% reduction):9
10
p=0.008
Incidence
of incisional 8
infections
8.6
6
(% patients)9
4 p=0.05
4.2
2
3.0 1.0
0
Povidone iodine Superficial incisional Deep incisional
n=440 infection infection
ChloraPrep
n=409
The number needed to treat with ChloraPrep instead of povidone iodine in
order to prevent one case of SSI was approximately 179

4. ChloraPrep was significantly more effective than
0.5% chlorhexidine/70% isopropyl alcohol10
Dressings removed 24 hours after saphenectomy contained a significantly
lower number of micro-organisms with ChloraPrep10
20
Mean p=0.007
CFU counts 15
24 hours
10
14.8
after surgery10 p=0.02
5
0.6 4.2 0.4
0
0.5% chlorhexidine/ Adhesive dressing Absorbent dressing
70% isopropyl component component
alcohol n=24
ChloraPrep n=22
Rates of SSI following saphenous vein harvest as high as 1 in 5 patients
have been reported10
At 30 days post-discharge, no ChloraPrep patient had developed
an SSI following saphenectomy10
25
Incidence of p=0.0502
superficial 20
SSI post- 20.8
discharge 15
(% patients)10
10
5
0
0
0.5% chlorhexidine/ ChloraPrep
70% isopropyl alcohol n=22
n=24

5. ChloraPrep provides broad spectrum, rapid,
residual and persistent antimicrobial activity
ChloraPrep is effective against a broad range of micro-organisms
including MRSA, VRE, Clostridium difficile, coagulase negative
staphylococci and most viruses and fungi11-13
Optimal agent ChloraPrep
for pre-surgical
skin antisepsis12
Rapid ChloraPrep has good activity levels
within 30 seconds;14 povidone
iodine takes 2-3 minutes to reach
full effect11
Persistent ChloraPrep is effective for at least
48 hours.14,15 0.5% chlorhexidine13
and iodophors have been shown
to have a much shorter duration
of activity16
Practical Unlike povidone iodine,
ChloraPrep is not inactivated in
the presence of blood12

6. ChloraPrep is an easy to apply, sterile,
skin antisepsis system
ChloraPrep is the only 2% chlorhexidine / 70% isopropyl
alcohol licensed for cutaneous antisepsis prior to invasive
procedures in the UK17
Sterile solution is maintained in a glass
ampoule prior to activation, obviating
concerns about contamination18
In line with ANTT™, the operator’s
hands do not come into contact with
the patient’s skin, preventing cross
contamination18
The foam sponge controls flow to
prevent splashing/pooling while gently
helping to expose bacteria in the lower
cell layers
A back and forth prep was used in all the phase III
efficacy studies of ChloraPrep applicators19

7. Using ChloraPrep surgical applicators
1. Pinch 2. Apply 3. Dry
Pinch the lever to release the Starting at the incision site, Leave the area to dry
solution. You will hear a ‘pop’ gently press the applicator completely before applying
as the ampoule breaks. against the skin until the sterile drapes. Do not blot
solution soaks the sponge. or wipe away. Discard the
applicator after a single use.
Apply using repeated up and
down, back and forth strokes Important safety point:
for at least 30 seconds, before Do not drape or use ignition
working outwards towards the source until the solution has
periphery. completely dried.
The 26ml applicator contains
two swabs. Where applicable,
the swabs can be moistened
by pressing against the soaked
sponge and then used to clean
the umbilicus.
References: 1. House of Commons Public Accounts Committee. Reducing Healthcare Associated Infection in
Hospitals in England.10 November 2009. London: The Stationery Office Limited. 2. Murkin CE. Br J Nurs 2009; 18:
665-9. 3. Edwards PS et al. Cochrane DB Syst Rev 2008. DOI:10.1002/14651858.CD003949.pub2. 4. Kirkland KB
et al. Infect Control Hosp Epidemiol 1999; 20: 725-30. 5. Whitehouse JD et al. Infect Control Hosp Epidemiol 2002;
23: 183-9. 6. Frampton L. Clin Services J 2008; June edition. 7. Tanner J et al. J Hosp Infect 2009; 72: 243-50.
8. Ward VP et al. J Hosp Infect 2008; 70: 166-73. 9. Darouiche R et al. New Engl J Med 2010; 362: 18-26. 10. Casey
AL et al. Poster presented at ECCMID, Barcelona, Spain, April 2008 11. Crosby CT, Mares AK. J Vasc Access Devices
2001; Spring: 26-31. 12. Florman S, Nichols RL. Am J Infect Dis 2007; 3: 51-61 13. Data on file, CareFusion Ltd.
14. Hibbard JS. J Infus Nurs 2005; 28: 194-207. 15. Garcia R et al. Abstracts of the IDSA 40th Annual Meeting 2002;
Abs 418. 16. Fletcher N et al. J Bone Joint Surg Am 2007; 89: 1605-18. 17. UK PL 31760/0001. 18. McDonald CP.
Vox Sanguinis 2001; 80: 135-41. 19. Richardson D. J Assoc Vasc Access 2006; 11: 215-21.

8. Range of surgical applicators
Licensed, sterile, single use, ANTT™, latex free applicators available in the UK
Coverage area: 15 cm x 15 cm
3ml
NHS list price per applicator: £0.85 (ex. VAT and delivery)
clear
NHS supply chain order code: MRB306
Coverage area: 25 cm x 30 cm
10.5ml
NHS list price per applicator: £2.92 (ex. VAT and delivery)
clear
NHS supply chain order code: MRB304
Coverage area: 50 cm x 50 cm
26ml
NHS list price per applicator: £6.50 (ex. VAT and delivery)
clear
NHS supply chain order code: MRB305
Coverage area: 15 cm x 15 cm
3ml
NHS list price per applicator: £0.89 (ex. VAT and delivery)
tinted
NHS supply chain order code: MRB494
Coverage area: 25 cm x 30 cm
10.5ml
NHS list price per applicator: £3.07 (ex. VAT and delivery)
tinted
NHS supply chain order code: MRB495
Coverage area: 50 cm x 50 cm
26ml
NHS list price per applicator: £6.83 (ex. VAT and delivery)
tinted
NHS supply chain order code: MRB496
For customer services and all other enquiries:
Please telephone: 0800 0437 546
Email: enquiries@chloraprep.co.uk
or visit: www.chloraprep.co.uk
Prescribing Information only on intact skin. Avoid contact with eyes, mucous membranes, middle ear
ChloraPrep® (PL31760/0002) & ChloraPrep with Tint (PL31760-0001) 2% and neural tissue. Should not be used in children under 2 months of age.
chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Solution is flammable. Do not use with ignition sources until dry, do not allow
Indication: Disinfection of skin prior to invasive medical procedures. to pool, and remove soaked materials before use. Over-vigorous use on
Dosage & administration: ChloraPrep – 0.67ml, 1.5ml, 3ml, 10.5ml, 26ml; fragile or sensitive skin or repeated use may lead to local skin reactions. At
ChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on invasive the first sign of local skin reaction, application should be stopped. Per
procedure being undertaken. Applicator squeezed to break ampoule and applicator costs (ex VAT) ChloraPrep – 0.67ml (SEPP) - 30p; 1.5ml (FREPP)
release antiseptic solution onto sponge. Solution applied by gently pressing - 55p; 3ml - 85p; 10.5ml - £2.92; 26ml - £6.50. ChloraPrep with Tint – 3ml -
sponge against skin and moving back and forth for 30 seconds. The area 89p; 10.5ml - £3.07; 26ml - £6.83. Legal category: GSL. Marketing
covered should be allowed to air dry. Side effects, precautions & Authorisation Holder: CareFusion UK 244 Ltd, 43 London Road, Reigate,
contra-indications: Very rarely allergic or skin reactions reported with Surrey RH2 9PW, UK. Date of preparation: July 2010.
chlorhexidine, isopropyl alcohol and Sunset Yellow. Contra-indicated for
patients with known hypersensitivity to these constituents. For external use CHL104a Date of preparation: August 2010