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Risky1  
#1 Posted : 08 January 2018 11:09:39(UTC)
Rank: Forum user
Risky1

I wonder if any of you can help?

I have a situation in our maternity department with reactions by staff to Chlorhexidine. Now adverse reactions are uncommon, but known to be severe in susceptible individuals. At present I have five Midwives who have reported problems, two of them to the extent of collapsing unconscious  and the other three coughing and wheezing.

The clinicians insist on using Chlorhexidine rather than Iodine because they say it is a better broad spectrum anti-microbial. The big problem is that they spray t onto the patients skin before certain procedures. I have in the short term asked them not to and to swab the patient rather than spray, this has not been welcomed universally by all the doctors and of course still leaves the problem chemical in place, abet not sprayed.

The other problem is that there is a historical reluctance by midwives (nationally) to wear PPE, as I have also recommend that the affected persons wear face masks when this chemical is being used.  

 

There must be some other healthcare  professionals out there who have had similar problems?     

PIKEMAN  
#2 Posted : 08 January 2018 12:01:10(UTC)
Rank: Super forum user
PIKEMAN

A COSHH assessment is needed. Googling the MSDS it appears to be an irritant by inhalation and skin contact. 

Risky1  
#3 Posted : 08 January 2018 12:07:23(UTC)
Rank: Forum user
Risky1

Many thanks Pikeman,

COSHH assessments for all chemical substances completed, advice given.

Problems are Doctors practice and Midwives relictence to wear PPE 

chris.packham  
#4 Posted : 08 January 2018 12:30:14(UTC)
Rank: Super forum user
chris.packham

Take a look at epic3, the NICE approved guidance on the prevention of infection. You can find in by googling on the Internet.

If you want more on this PM me with your contact details and I will get in touch off the forum.

Chris

PIKEMAN  
#5 Posted : 08 January 2018 12:53:11(UTC)
Rank: Super forum user
PIKEMAN

This is also a problem in just about all workplaces. Either you have to use the hierarchy to prevent exposure or enforce the PPE rules. This is a function of management, make it their problem.

Edited by user 08 January 2018 12:54:00(UTC)  | Reason: Fix typos

Risky1  
#6 Posted : 09 January 2018 10:16:33(UTC)
Rank: Forum user
Risky1

Many thanks both, very helpful.

It's been very frustrating really as there seems to be very little about this on the net and what is out there is concentrated on patients and not healthcare staff.

The way forward: Report the reactions to the HSE under RIDDOR and to the MHRA.

Require the doctors to stop spraying and to swab instead. Fit test affected staff for FFP3 face masks and tell their management that it is up to them to make sure affected staff use the masks. And lastly update the Trust COSHH assessments to reflect this advice.

Kind Regards

chris.packham  
#7 Posted : 09 January 2018 12:02:26(UTC)
Rank: Super forum user
chris.packham

Chlorhexidine diacetate and chlorhexidine digluconate are both recognised by dermatologists as skin irritants and sensitizers. Patch testing is done at a concentration  of just 0.5% in water.  Chlorhexidine is also recognised as an ototoxin (i.e. if it is allowed to be absorbed into the body can migrate to the ear and cause temporary/permanent hearing loss). There is some evidence that alcohol sanitiser can be used for pre-operative skin disinfection, particularly some of the newer formulations that have been tested and been shown to have virucidal properties. 

I have various items on this in my files and would be happy to pass some of it on if you are interested.

Chris

Xavier123  
#8 Posted : 09 January 2018 12:13:13(UTC)
Rank: Super forum user
Xavier123

Originally Posted by: chris.packham Go to Quoted Post

There is some evidence that alcohol sanitiser can be used for pre-operative skin disinfection, particularly some of the newer formulations that have been tested and been shown to have virucidal properties. 

Oooo.  Was unaware of this.  PHE advice around virus control still chlorine, chlorine, chlorine - certainly outside of healthcare e.g. norovirus

Got any links to info you can throw out there?

chris.packham  
#9 Posted : 09 January 2018 12:39:21(UTC)
Rank: Super forum user
chris.packham

Here's one for starters:

American Journal of Infection Control -'Isopropyl alcohol is as efficient as chlorhexidine to prevent contamination of blood cultures, Matinez J et al, April 2017.

also try Larsson E, Bobo L, 'Effective hand degerming in the presence of blood', J.Emerg.Med. 1992

Keep in mind, however, that alcohol is quickly rendered ineffective by the presence of organic soiling. 

If you need more PM me with your contact details.

Chris

thanks 1 user thanked chris.packham for this useful post.
Xavier123 on 10/01/2018(UTC)
Risky1  
#10 Posted : 10 January 2018 13:58:07(UTC)
Rank: Forum user
Risky1

Looking at the amount of chemical preprations we have now with Chlorhexidine in it at varoius concentrations, I think the adverse reactions in workers will start to pick up. And yet it's been around since the 50s.

chris.packham  
#11 Posted : 10 January 2018 15:15:12(UTC)
Rank: Super forum user
chris.packham

You may well already have the reactions but not be aware of the reason. If you check (try 'Tools of the Trade', downloadable from the RCN website) you will find that the incidence of occupational skin disease among healthcare workers is very high. A recent study published in Contact Dermatitis (the official journal of the European Society of Contact Dermatitis) showed that 68% of the healthcare workers involved had damaged skin.

My experience over many years is that such damage is frequently attributed to excessive hand washing, glove allergy or other causes. Only rarely is patch testing carried out and this is the only way to detect an allergic contact dermatitis, so possible allergic reactions may well go undetectd.

Interestingly, the study also found that those with damaged skin tended to stop using the alcohol sanitiser and wash their hands more frequently, exactly the wrong approach! All the evidence shows that alcohol sanitisers are far less damaging to the skin than hand washing. The decision to abandon the sanitiser is probably when used on damaged skin it stings and this is assumed - erroneously - to indicate skin damage. 

Chris

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