Octenisan md Nasengel, 6 ml

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This is the first clinical study assessing the effectiveness of topical intranasal octenidine and universal antiseptic bathing with chlorhexidine or octenidine on the reduction of MRSA prevalence in extended care facilities. The reduction in the prevalence of MRSA colonisation by 43–58% suggest the effectiveness of intranasal octenidine on decolonisation of MRSA carriage and nosocomial transmission in extended care facilities. The decline in MRSA colonisation of 58% in Hospital A from 2015 (chlorhexidine bathing) to 2016 (chlorhexidine bathing and intranasal octenidine) was similar to the 60% reduction in multidrug-resistant organisms reported in another study involving universal chlorhexidine bathing and intranasal povidone-iodine [ 11]. Van Rijen M, Bonten M, Wenzel R, Kluytmans J. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst Rev. 2008;2:129.

Patients testing positive for MSSA carriage were given nasal decolonisation treatment to use 5 days prior to surgery and 5 days after (10 days total). Group one, from 2010 until August 2017, used nasal mupirocin 2% (Bactroban, GlaxoSmithKline UK Ltd, Brentford, UK). Group two, from August 2017, used an octenidine HCl 0.1% nasal decolonisation agent (Octenisan Nasal Gel, Schϋlke & Mayr UK Ltd, Sheffield, UK). Group three used neomycin 0.5% and Chlorhexidine 0.1% nasal cream (Naseptin, Alliance Pharmaceuticals Ltd, Chippenham, UK), this was used as an alternative to mupirocin due to periods of national supply shortage. All patients received an octenidine HCl body wash (Octenisan, Schϋlke & Mayr UK Ltd, Sheffield, UK) for daily use 5 days prior to surgery. Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;346:1871–7. Specialist initiated - These are medicines that require little or no monitoring by the GP, but should only be prescribed in general practice after they have been initiated following specialist referral. Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing Natsuhara KM, Shelton TJ, Meehan JP, Lum ZC. Mortality during total hip periprosthetic joint infection. J Arthroplasty. 2019;34:S337–42.

Do not use in combination with PVP iodine, as this can lead to discoloration and impaired antiseptic effect of the PVP iodine. For all of the related safety information please refer to the Safety Data Sheet. To view the Safety Data Sheet please visit www.schuelke.com Specialist recommended - These are medicines that require little or no monitoring by the GP, but should only be prescribed in general practice after they have been recommended following specialist referral. Jeans E, Holleyman R, Tate D, Reed M, Malviya A. Methicillin sensitive Staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty. J Infect. 2018;77:405–9.

These are medicines that require significant monitoring. The decision to treat with an AMBER medicine should be made by specialists only. If a Shared Care Protocol exists then this must be followed. Amber 1 medicines require more monitoring by the GP than Amber 2 medicines. The, Agency E medicines. guideline on the evaluation of medicinal products indicated for treatment of bacterial infections. 2014; Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/addendum-guideline-evaluation-medicinal-products-indicated-treatment-bacterial-infections_en.pdf There is no evidence that topical anti-infective nasal preparations have any therapeutic value in rhinitis or sinusitis. MRSA colonisation in the nares, as well as on the axilla and groin, of patients declined significantly in Hospital A (nares 2015: 20.8%, 2016: 6.0%, P=0.006; axilla and groin 2015: 28.2%, 2016: 14.5%, P=0.033) and Hospital B (nares 2015: 28.6%, 2016: 17.2%, P=0.001; axilla and groin 2015: 38.6%, 2016: 22.9%, P<0.001), but not in Hospital C (nares 2015: 23.7%, 2016: 20.5%, P=0.618; axilla and groin 2015: 32.9%, 2016: 28.9%, P=0.577). Dadashi M, Hajikhani B, Darban-Sarokhalil D, van Belkum A, Goudarzi M. Mupirocin resistance in Staphylococcus aureus: A systematic review and meta-analysis. J Glob Antimicrob Resist. 2020;20:238–47.Joint effects* (simultaneous influences) of Hospitals A, B and C, and years 2015 and 2016, respectively, on the prevalence of MRSA colonisation *adjusted for age, gender, Charlson's comorbidity index >5, prior MRSA carriage in preceding 12 months, prior antibiotics exposure in preceding 12 months, length of hospital stay prior to MRSA screening. **Prevalence of MRSA colonization in Hospital C in 2015 served as the reference. Pérez-Fontán M, Rosales M, Rodríguez-Carmona A, Moncalián J, Fernández-Rivera C, Cao M, et al. Treatment of Staphylococcus aureus nasal carriers in CAPD with mupirocin. Adv Perit Dial. 1992;8:242–5. Pelfort X, Romero A, Brugués M, García A, Gil S, Marrón A. Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty. Acta Orthop Traumatol Turc. 2019;53:426–31. Al-Doori Z, Goroncy-Bermes P, Gemmell CG, Morrison D. Low-level exposure of MRSA to octenidine dihydrochloride does not select for resistance. J Antimicrob Chemother. 2007;59:1280–1. Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today. 2017;3:137–40.

Staphylococcus aureus is recognised as the most common causative organism in early postoperative PJI [ 7]. Since the majority are associated with an endogenous source [ 11, 21, 22], MSSA colonisation is considered a modifiable risk factor. A Cochrane review showed decolonisation was effective at reducing nosocomial infections (RR 0.55 [ 23, 24]). Similarly, a meta-analysis by Zhu et al. concluded MSSA screening and decolonisation significantly reduced PJI (OR 0.40) [ 13]. Decolonisation forms part of the World Health Organisation SSI guidelines [ 25]. Over time the proportion of patients re-swabbed on admission increased, as such there is a statistically significant difference in the proportion between the groups. This is a potential source of bias. The research team discussed this with the nursing staff responsible for admitting patients, it appears the decision was down to the member of staff’s interpretation of the protocol and not any patient factors.

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van Belkum A, Verkaik NJ, de Vogel CP, Boelens HA, Verveer J, Nouwen JL, et al. Reclassification of Staphylococcus aureus nasal carriage types. J Infect Dis. 2009;199:1820–6. Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: Clinical implications and potential alternatives for the eradication of mrsa. J Antimicrob Chemother. 2015;70:2681–92. octenisan ® md nasal gel is used for moistening and decontamination by physical cleaning of the nasal vestibules. External influences can cause the nose to rapidly dry out and become irritated. This can be remedied by supplying the nasal vestibules with sufficient moisture. The moisturizing effects of hydrogel promote a favorable physiological milieu which prevents the settlement of bacteria. Furthermore, restoring the physiological functions of protection and cleaning contribute to effective decontamination of multiresistant pathogens. Lesions of the nasal epithelium are also supplied with moisture through the hydrogel and thus can heal optimally. Epithelial cells must be able to proliferate and migrate for the healing process. This is best possible in a moist wound environment This is a holding category for drugs that have not been formally assessed by NPAG and awarded a traffic light designation. Grey medicines, or those not included elsewhere, are those that NPAG has not assessed for therapeutic use and prescribers should refrain from prescribing where possible.