Re: skin prep for haemodialysis – question

[Matthias Maiwald (SHHQ)]

Dear Lindy, dear Colleagues,

Not being a dermatologist, my rudimentary understanding is that there are (a) true allergies, and (b) skin irritation (irritant contact dermatitis).

Alcohols are not thought to be causing allergies, but can cause skin irritation, while other antiseptic ingredients apparently can cause both.

An (older) article that I recently came across while searching is this:

Stingeni L, Lapomarda V, Lisi P. Occupational hand dermatitis in hospital environments. Contact Dermatitis. 1995 Sep;33(3):172-6.
https://www.ncbi.nlm.nih.gov/pubmed/8565458

Given that haemodialysis is a long-term commitment requiring ongoing use of antiseptics, it may be worth considering a referral to a dermatologist for a full assessment of what is going on.

My understanding is that several antiseptic manufacturers provide individualized ingredients in suitable formats for skin patch/prick testing upon request. May be worth considering.

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Carien Coleman
Sent: Friday, 9 December, 2016 10:45 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: skin prep for haemodyalisis – question

Hi Lindy,

Octenidine is going to be available in Australia very soon and might be available already. If you contact me directly I can provide you the details of the company, etc. Octenidine is not a chemical agent per say and is used throughout Europe, including on very premature neonates.

Kind regards,
Carien

Carien Coleman | Infection Control CNC
The Sunshine Coast Private Hospital
Syd Lingard Drive | BUDERIM QLD 4556
PO Box 5050 | Maroochydore BC QLD 4558
T: (07) 5430 3245 | F: (07) 5430 3154
E: carien.coleman@uchealth.com.au

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Claire Rickard
Sent: Friday, 9 December 2016 9:14 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: skin prep for haemodyalisis – question

Hi Lindy, I agree with Tim & Carolyn, you could use 70% alcohol (and of course let it dry :)). If this is going to be a regular patient, there is another good agent (and generally well tolerated e.g. Used in neonates) called octenidine which is used ++ in Europe but not currently registered in Aust, u could get your pharmacist to get Special Access Scheme approval from TGA and order from o/s.
Hope this helps, C

Claire Rickard RN PhD FAHMS FACN
Director, Alliance for Vascular Access Teaching and Research (AVATAR), & Professor, National Centre of Research Excellence in Nursing Interventions, Menzies Health Institute Queensland

Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane & Women’s Hospitals
Honorary Professor, University of Manchester
Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
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On 9 December 2016 at 08:59, <Carolyn.Chenoweth@fmc-asia.com> wrote:
Hi Lindy,
See below for haemodialysis access cleansing that we recommend for patients in our dialysis clinics across Australia and Asia Pacific.

1. Educate patients to wash their fistula with normal liquid hand soap (we do not use antimicrobial hand soap) at dedicated clinical hand basins (no liquids e.g. dialysate emptied into these sinks) on arrival.
If patients have mobility issues and can’t access the clinical hand basins we offer alcohol based hand rubs to clean their hands and fistula.

2. We recommend Chlorhexidine (0.5% to 2%) combined with alcohol, swabs for all skin cleansing prior to cannulation.
2% chlorhexidine can cause skin irritation while rarely have issues with 0.5% or 1%chlorhexidine and alcohol.
If chlorhexidine can’t be tolerated at all we either use povidine iodine or plain alcohol swabs.
The very rare patients who are highly sensitive to everything we just ensure very good hand washing and washing fistula with liquid hand soap.

With best regards
Carolyn Chenoweth
Quality & Infection Prevention and Control Manager, Australia
Asia Pacific Quality & IPC SME. CICP

Fresenius Medical Care Australia Pty Ltd
Payneham Dialysis Clinic,
2 Portrush Road
PAYNEHAM 5070
Australia
T: +61 (0) 8 8165 4313
M: +61 (0) 407 810 800
http://www.fmc-ag.com

From: “EXTERN ACIPC Infexion Connexion” <AICALIST@AICALIST.ORG.AU>
To: AICALIST@AICALIST.ORG.AU
Date: 09/12/2016 07:59 AM
Subject: skin prep for haemodyalisis – question
________________________________

Hello

We have a pt with sensitivity to povidine /iodine and CHG who has a fistula & is having regular haemodialysis .

Other than cleaning her skin with sterile normal saline prior to cannulating them for their dialysis is there any other skin antisepsis that could be used.

I have looked at referenced from CDC and APIC but there is nothing useful re any other skin antisepsis just wondering if anyone out there was using anything else in these pts with success or is sterile normal saline the only best option to stick with ?

Many thanks

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

Wise and humane management of the patient is the best safeguard against infection
(Florence Nightingale Circa 1860)

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—

Claire Rickard RN PhD FAHMS FACN
Director, Alliance for Vascular Access Teaching and Research (AVATAR), & Professor, National Centre of Research Excellence in Nursing Interventions, Menzies Health Institute Queensland

Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane & Women’s Hospitals
Honorary Professor, University of Manchester
Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
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