Letter to the editor regarding “Chemical disinfection in healthcare settings: critical aspects for the development of global strategies”
Roald Papke 11 Sana Klinikum Lichtenberg, Berlin, Germany
Letter to the editor
In the publication by Exner et al. [1], it states “Alcohol-based handrubs, containing ethanol or 1-propanol or 2-propanol as their main active substances are the gold standard for handrubs in Europe. For example, the German KRINKO recommends the use of alcohol-based products without any other additives such as chlorhexidine (CHG) or mecetronium ethylsulfate. Concern as to resistance development of certain bacterial strains to chlorhexidine is increasing, e.g., CHG resistance may be detected in multi-resistant isolates such as extremely drug-resistant Klebsiella pneumoniae [2], [3], [4], [5], [6].”
In the cited KRINKO recommendation [4] sustained effective additives in alcohol-based hand disinfectants are not recommended, and the following antiseptic agents are given exemplary: chlorhexidine digluconate, octenidine hydrochloride, polihexanide, triclosan, quaternary ammonium compounds, ampholytes and phenol derivatives. In this context, allow me to ask whether mecetronium ethylilsulfate can be used as an active ingredient.
Notes
Competing interests
The author declares that he has no competing interests.
References
[1] Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Chemical disinfection in healthcare settings: critical aspects for the development of global strategies. GMS Hyg Infect Control. 2020 Dec 23;15:Doc36. DOI: 10.3205/dgkh000371[2] Kampf G. Acquired resistance to chlorhexidine – is it time to establish an ‘antiseptic stewardship’ initiative? J Hosp Infect. 2016 Nov;94(3):213-27. DOI: 10.1016/j.jhin.2016.08.018
[3] Hardy K, Sunnucks K, Gil H, Shabir S, Trampari E, Hawkey P, Webber M. Increased Usage of Antiseptics Is Associated with Reduced Susceptibility in Clinical Isolates of Staphylococcus aureus. mBio. 2018 May;9(3):e00894-18. DOI: 10.1128/mBio.00894-18
[4] Kommission für Krankenhaushygiene und Infektionsprävention am Robert Koch-Institut. Empfehlungen zur Händehygiene. Bundesgesundheitsbl. 2016;59:1189-220.
[5] Saleem HG, Seers CA, Sabri AN, Reynolds EC. Dental plaque bacteria with reduced susceptibility to chlorhexidine are multidrug resistant. BMC Microbiol. 2016 Sep;16:214. DOI: 10.1186/s12866-016-0833-1
[6] Choudhury MA, Sidjabat HE, Rathnayake IU, Gavin N, Chan RJ, Marsh N, Banu S, Huygens F, Paterson DL, Rickard CM, McMillan DJ. Culture-independent detection of chlorhexidine resistance genes qacA/B and smr in bacterial DNA recovered from body sites treated with chlorhexidine-containing dressings. J Med Microbiol. 2017 Apr;66(4):447-53. DOI: 10.1099/jmm.0.000463
