ChloraPrep 2%/70%

The medicinal product is to be used for disinfection of the skin prior to invasive medical procedures.

For cutaneous use.

ChloraPrep 2%/70% with Tint may be used on all age groups and patient populations.).

One applicator is used containing 3 ml, 10.5 ml or 26 ml of the ChloraPrep 2%/70% with Tint alcoholic solution.

The choice of applicator will depend on the invasive procedure being undertaken and the clinician's preference.

The applicator is removed from the wrapper and held with the sponge facing downward. The applicator is squeezed gently to break the ampoule containing the antiseptic solution, which is released onto the sponge in a controlled flow (for the 26 ml applicator the lever is pressed). Pinch wings once only to activate the applicator and release the antiseptic. Do not repeatedly pinch or pump the wings in an attempt to accelerate the saturation of the foam. The broken ampoule remains safely contained within the applicator. The sponge is gently pressed against the patient's skin in order to apply the antiseptic solution. Once the solution is visible on the skin, use gentle back and forth strokes to prep the site for 30 seconds. The 26 ml applicator includes two swabs. Clean intact umbilicus with enclosed swabs when applicable. (Moisten swabs by pressing against solution-soaked sponge applicator.) The area covered should be allowed to air dry completely.

It is recommended that ChloraPrep 2%/70% with Tint remain on the skin post-procedure to provide continued antimicrobial activity. The tint will slowly fade from the skin. If removal is necessary, remove with soap and water or alcohol.

Known hypersensitivity to ChloraPrep 2%/70% with Tint or any of its components, especially in those with a history of possible chlorhexidine-related allergic reactions.

The solution is flammable. Do not use electrocautery procedures or other ignition sources until the skin is completely dry.

Remove any soaked materials, drapes or gowns before proceeding with the intervention. Do not use excessive quantities and do not allow the solution to pool in skin folds or under the patient or drip on sheets or other material in direct contact with the patient. Where occlusive dressings are to be applied to areas previously exposed to ChloraPrep 2%/70% with Tint, care must be taken to ensure no excess product is present prior to application of the dressing.

For external use only on intact skin.

ChloraPrep 2%/70% with Tint contains chlorhexidine. Chlorhexidine is known to induce hypersensitivity, including generalised allergic reactions and anaphylactic shock. The prevalence of chlorhexidine hypersensitivity is not known, but available literature suggests this is likely to be very rare. ChloraPrep 2%/70% with Tint should not be administered to anyone with a potential history of an allergic reaction to a chlorhexidine-containing compound.

The solution is an irritant to eyes and mucous membranes. It should therefore be kept away from these areas. If the solution comes in contact with the eyes, they should be washed promptly and thoroughly with water.

The use of chlorhexidine solutions, both alcohol based and aqueous, for skin antisepsis prior to invasive procedures has been associated with chemical burns in neonates. Based on available case reports and the published literature, this risk appears to be higher in preterm infants, especially those born before 32 weeks of gestation and within the first 2 weeks of life.

Do not use on open skin wounds. Do not use on broken or damaged skin. In addition, direct contact with neural tissue or the middle ear must be avoided.

Prolonged skin contact with alcohol containing solutions should be avoided.

It is important to ensure that the correct method of applications is strictly followed. When the solution has been applied in an over-vigorous manner to very fragile or sensitive skin or after repeated use, local skin reaction may occur including: erythema or inflammation, itching, dry and/or flaky skin and local application site pain. At the first sign of local skin reaction application of ChloraPrep 2%/70% with Tint should be stopped.

ChloraPrep 2%/70% with Tint has no influence on the ability to drive and use machines.

Skin disorders:

Very rarely (<1/10,000) allergic or irritation skin reactions have been reported with chlorhexidine, isopropyl alcohol and Sunset Yellow (E110) including: erythema, rash (e.g. erythematous, papular, or maculopapular), pruritus and blisters or application site vesicles. Other local symptoms have included skin burning sensation, pain and inflammation.

Frequency not known: dermatitis, eczema, urticaria, chemical burns in neonates.At the first sign of local skin reaction the use of ChloraPrep 2%/70% with Tint should be discontinued.

Immune disorders:

Frequency not known: Hypersensitivity including anaphylactic shock.

The most commonly reported adverse reactions reported are associated with application site reactions. These were noted to occur most often within the area of application of the solution (i.e. at the prep site) and very rarely spread. The adverse reactions were often self-limiting in nature or resolved following treatment with topical steroids and / or antihistamines. The most commonly reported reactions were non-serious in nature and included application site rash, application site erythema, application site vesicles, application site pain and application site pruritus. Frequency, type and severity of adverse reactions in children are expected to be the same as in adults.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme

Website: www.mhra.gov.uk/yellowcard.

There are no reports of overdose with this product.

Pharmacotherapeutic group: Chlorhexidine, combinations, ATC code: D08A C52.

Mode of Action: Bisbiguanide antiseptics exert their lethal effect upon bacterial cells through non-specific interaction with acidic phospholipids of the cell membranes.

Chlorhexidine gluconate is a cationic biguanide. Its antimicrobial action is due to the disruption of the cell membrane and the precipitation of cell contents. It has a bactericidal or bacteriostatic action against a wide range of gram-positive and gram-negative bacteria. It is relatively ineffective against mycobacteria. It inhibits some viruses and is active against some fungi. It is inactive against bacterial spores. It has a superior residual property in comparison to currently available skin antiseptics. Chlorhexidine gluconate has a strong binding property to skin and has a residual property on the skin that has been documented at 48 hours. Chlorhexidine gluconate is not neutralised in the presence of organic matter.

Isopropyl alcohol is a rapidly bactericidal and a fast acting broad spectrum antiseptic, but is not considered persistent. Its mechanism of action appears to be denaturation of proteins.

ChloraPrep 2%/70% with Tint is a sterile antiseptic solution containing a combination of 2% Chlorhexidine gluconate in 70% Isopropyl alcohol, which is effective for both rapid and persistent reduction of bacterial load across various body regions for a broad spectrum of organisms. Isopropyl alcohol (70%) provides an immediate kill of transient and resident microorganisms on the stratum corneum and 2% Chlorhexidine gluconate binds to the superficial cell layers of the epidermis and provides a residual, or persistent, antimicrobial property that prevents regrowth of microorganisms.

Clinical studies with 2% Chlorhexidine gluconate in 70% Isopropyl alcohol have demonstrated that the combination offers equal or similar effectiveness in reducing skin bacterial load and more sustained antibacterial effects over longer periods after application, compared to the individual components alone, as well as to other commonly used antiseptics such as Povidone-iodine.

ChloraPrep 2%/70% with Tint meets the criteria for chemical disinfectants and antiseptic products as established by European Standards:

EN 1040 - basic bactericidal activity (Phase 1)

EN 1275 - basic yeasticidal activity (Phase 1)

EN 13727 - bactericidal activity (Phase 2/Step 1)

EN 13624 - fungicidal activity (Phase 2/Step 1)

ChloraPrep 2%/70% with Tint meets these EN criteria for bactericidal and fungicidal activity for the following organisms at contact times ranging from 5 to 15 minutes, with the exception of Aspergillus brasiliensis. Additional testing of ChloraPrep 2%/70% with Tint at full concentration against Aspergillus brasiliensis for exposure up to 60 minutes met EN 13624 criteria, as follows:

Table: In vitro microbiocidal effects

There is little absorption of isopropyl alcohol or of chlorhexidine gluconate through intact skin. Pharmacokinetic studies have not been conducted with the product.

There are no preclinical data of relevance to the prescriber that are not already included elsewhere in the SPC.

Chlorhexidine is incompatible with soap, hypochlorite bleach and other anionic agents. Hypochlorite bleaches may cause brown stains to develop in fabrics, which have previously been in contact with preparations containing chlorhexidine.

This product is for single use only.

Any unused product or waste material should be discarded in accordance with local requirements. No additional environmental precautions for disposal are necessary.