Dermatitis in staff with probable cause Chlorhexidine

[Margaret Gleeson]

Hello all
I have had a couple of staff who are apparently sensitive to Chlorhexidine products.
Dermatology review is difficult to access in the NT so my question is what do other ICP recommend for hand hygiene in this case. I realise you can’t endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889| e…margaret.gleeson@nt.gov.au | http://www.nt.gov.au/health

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[Jennifer Benjamin]

Triclosan products are generally well tolerated and still has antimicrobial properties
Jen Benjamin
Infection Control Consultant
Melbourne Pathology
M: 0402 000 590
“We take it personally”
This message and any files transmitted with it may contain privileged and confidential information intended only for the use of the addressee named above. If you are not the intended recipient of this message you must not disseminate, copy or take any action in reliance on it. If you have received this message in error, please notify the sender immediately.

________________________________

Hello all

I have had a couple of staff who are apparently sensitive to Chlorhexidine products.

Dermatology review is difficult to access in the NT so my question is what do other ICP recommend for hand hygiene in this case. I realise you can’t endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889| e…margaret.gleeson@nt.gov.au | http://www.nt.gov.au/health

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[Cath Murphy]

Dear Margaret

A dermatology consult is as you recognise ideal and probably idealistic.

Next course of action for me would be extensive review of the affected
individual’s technique, non-clinical hand care (ie. domestic products and
other harsh chemicals and moisturisers)and evaluation of HCW skin according
to a valid scale/ criteria – see WHO 2009 HH Guidelines for such a tool) –
just to rule out causes other than the CHG reaction.

I would also consider review of gloves and glove use ? inappropriate use or
over use (common in non-clinical staff such as delivers of meals)

If still no joy I would connect with the manufacturer of the CHG product
your affected HCWs are using and request their assistance and additional
information. They typically take this sort of request most seriously and are
keen to find viable solutions.

Probably you have thought of all of these issues but maybe they are worth
revisiting given the difficulties of introducing alternate or new products.

I also recall having read somewhere of seasonal variation in how hands react
to some HH solutions – a relationship with humidity if I recall properly –
perhaps Darwin is the only currently humid place in Australia this Winter.

Hope this helps
Cath

—–Original Message—–
Jennifer Benjamin
cause Chlorhexidine

Triclosan products are generally well tolerated and still has antimicrobial
properties

Jen Benjamin
Infection Control Consultant
Melbourne Pathology
M: 0402 000 590

“We take it personally”

This message and any files transmitted with it may contain privileged and
confidential information intended only for the use of the addressee named
above. If you are not the intended recipient of this message you must not
disseminate, copy or take any action in reliance on it. If you have received
this message in error, please notify the sender immediately.

________________________________

Chlorhexidine

Hello all

I have had a couple of staff who are apparently sensitive to Chlorhexidine
products.

Dermatology review is difficult to access in the NT so my question is what
do other ICP recommend for hand hygiene in this case. I realise you can’t
endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department
of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889|
e…margaret.gleeson@nt.gov.au | http://www.nt.gov.au/health

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[Glenys Harrington]

Margaret,

I have used the following process in conjunction with Pharmacy and Nurse
Managers(NMs) to minimise and standardise the number of HH products
throughout the hospital.

HCWs with skin problems were asked to have their skin problem assessed by
staff health service or their own GP – we advised staff that this was
important particularly in the event that the condition worsened/workcover
issues etc.

IC reviewed the HCWs HH practices (observation)- I often found staff were
over washing.

If HCW HH practices were OK (i.e. not over washing) HCWs were issued with 1
bottle of an alternative product for sensitive skin (a Triclosan product) to
try for 1 week.

If after 1 week their skin condition had improved we arranged for the NM to
order a personal supply for HCW.

HCWs were instructed that to: a) use a new dispenser (may need to order
separately as not always distributed with HH product by
supplier/manufacturer) with each new bottle and b) ask other staff not to
used their product to minimise the risk of contamination of the
pump/dispenser.

If no improvement after 1 week they were referred via staff clinic to the
allergy clinic for assessment.

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia

H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au

ABN 47533508426

—–Original Message—–
Jennifer Benjamin
cause Chlorhexidine

Triclosan products are generally well tolerated and still has antimicrobial
properties

Jen Benjamin
Infection Control Consultant
Melbourne Pathology
M: 0402 000 590

“We take it personally”

This message and any files transmitted with it may contain privileged and
confidential information intended only for the use of the addressee named
above. If you are not the intended recipient of this message you must not
disseminate, copy or take any action in reliance on it. If you have received
this message in error, please notify the sender immediately.

________________________________

Chlorhexidine

Hello all

I have had a couple of staff who are apparently sensitive to Chlorhexidine
products.

Dermatology review is difficult to access in the NT so my question is what
do other ICP recommend for hand hygiene in this case. I realise you can’t
endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department
of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889|
e…margaret.gleeson@nt.gov.au | http://www.nt.gov.au/health

Department of Health and Families is a Smoke Free Workplace

If you are not the intended recipient of this message, any use, disclosure
or copying of the message or any attachments is unauthorised.
If you have received this message in error, please advise the sender. No
representation is given that attached files are free from viruses or other
defects.
Scanning for viruses is recommended.

Messages posted to this list are solely the opinion of the authors, and do
not represent the opinion of AICA. Archive of all messages are available at
http://aicalist.org.au/archives – registration and login required. Replies
to this message will be directed back to the list. To create a new message
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not represent the opinion of AICA.
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[TERRI CRIPPS]

Hello Margaret,

My experience with hand hygiene products is a personal one as I am one of those people with allergies. When the hospital that I was working in at the time changed from one brand of chlorhexidine soap to another brand it turned out that I was allergic to the new brand’s preservative contained in the soap that the previous brand had not contained. Since the hospital was not willing to order in the previous brand from the previous supplier but were willing to get in a Triclosan containing soap from the new brand company – my problem was solved. Since changing jobs and hospitals, I was pleasantly surprised to find that my new hospital supplied the Chlorhexidine soap brand that I had previously used with no problem. I have used this brand of Chlorhexidine product recently with no ill effects.

Now having to do hand hygiene assessments on others myself, I follow the same sort of line as Cath Murphy has said in her reply, but I use the tool provided on the Hand Hygiene Australia website and also is on the Clinical Excellence Commission (CEC NSW) website. I also find it difficult to get the staff into a Dermatologist as the GP’s seem reluctant to refer on preferring to treat the staff member themselves.

Thanks,

Terri Cripps | CNC Infection Control | Sydney Children’s Hospital
‘: (02) 9382 1876 | fax: (02) 9382 2084 |* : terri.cripps@sesiahs.health.nsw.gov.au| “:www.sch.edu.au| page: 47140

________________________________

Hello all
I have had a couple of staff who are apparently sensitive to Chlorhexidine products.
Dermatology review is difficult to access in the NT so my question is what do other ICP recommend for hand hygiene in this case. I realise you can’t endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889| e…margaret.gleeson@nt.gov.au | http://www.nt.gov.au/health

Department of Health and Families is a Smoke Free Workplace
If you are not the intended recipient of this message, any use, disclosure or copying of the message or any attachments is unauthorised.
If you have received this message in error, please advise the sender. No representation is given that attached files are free from viruses or other defects.
Scanning for viruses is recommended.

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA. Archive of all messages are available at http://aicalist.org.au/archives – registration and login required. Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au To send a message to the list administrator send an email to aicalist-request@aicalist.org.au. You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

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[Matthias.Maiwald@KKH.COM.SG Subject: Re: Dermatitis in staff with probable cause Chlorhexidine In-Reply-To:]

Dear Group,

I think an answer to this question also depends on what kind of hand
hygiene is involved. If it is for standard hand hygiene in patient care (as
in 5 moments) and concerning an alcohol-based hand rub, then one might want
to try an alcohol product without chlorhexidine. For the occasional
handwashes when not using alcohol, plain soap without chlorhexidine would
be an option. Such an omission might also clarify if the problem is due to
chlorhexidine or not. Adverse reactions to chlorhexidine have been
described, but are apparently not very common. The standardised hand rub
formulations by the WHO have excellent antimicrobial activity (fulfill very
stringent standards) and do not contain chlorhexidine. One option would be
to get pharmacy to make a small personal supply of the WHO formulation for
the affected staff member. The availability of commercial products in
Australia that have (a) good antimicrobial activity, (b) good user
acceptability including emollient additives and (c) no chlorhexidine
appears to be very limited (there may not be any).

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA, D(ABMM)
Consultant in Microbiology
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 1389
Fax +65 6394 1387

Glenys Harrington
To
Sent by: AICA AICALIST@AICALIST.ORG.AU
Infexion cc
Connexion
Re: Dermatitis in staff with
probable cause Chlorhexidine

29/06/2010 08:23
PM

Please respond to
AICA Infexion
Connexion

Margaret,

I have used the following process in conjunction with Pharmacy and Nurse
Managers(NMs) to minimise and standardise the number of HH products
throughout the hospital.

HCWs with skin problems were asked to have their skin problem assessed by
staff health service or their own GP – we advised staff that this was
important particularly in the event that the condition worsened/workcover
issues etc.

IC reviewed the HCWs HH practices (observation)- I often found staff were
over washing.

If HCW HH practices were OK (i.e. not over washing) HCWs were issued with 1
bottle of an alternative product for sensitive skin (a Triclosan product)
to
try for 1 week.

If after 1 week their skin condition had improved we arranged for the NM to
order a personal supply for HCW.

HCWs were instructed that to: a) use a new dispenser (may need to order
separately as not always distributed with HH product by
supplier/manufacturer) with each new bottle and b) ask other staff not to
used their product to minimise the risk of contamination of the
pump/dispenser.

If no improvement after 1 week they were referred via staff clinic to the
allergy clinic for assessment.

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia

H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au

ABN 47533508426

—–Original Message—–
Of
Jennifer Benjamin
cause Chlorhexidine

Triclosan products are generally well tolerated and still has antimicrobial
properties

Jen Benjamin
Infection Control Consultant
Melbourne Pathology
M: 0402 000 590

“We take it personally”

This message and any files transmitted with it may contain privileged and
confidential information intended only for the use of the addressee named
above. If you are not the intended recipient of this message you must not
disseminate, copy or take any action in reliance on it. If you have
received
this message in error, please notify the sender immediately.

________________________________

Chlorhexidine

Hello all

I have had a couple of staff who are apparently sensitive to Chlorhexidine
products.

Dermatology review is difficult to access in the NT so my question is what
do other ICP recommend for hand hygiene in this case. I realise you can’t
endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department
of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889|
e…margaret.gleeson@nt.gov.au | http://www.nt.gov.au/health

Department of Health and Families is a Smoke Free Workplace

If you are not the intended recipient of this message, any use, disclosure
or copying of the message or any attachments is unauthorised.
If you have received this message in error, please advise the sender. No
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Scanning for viruses is recommended.

Messages posted to this list are solely the opinion of the authors, and do
not represent the opinion of AICA. Archive of all messages are available at
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—————————————————————————–
The information contained in this e-mail or in any attachment is
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