[0001] The present invention relates to a process and kit for preventing the formation in a health care environment of antimicrobial resistant microorganisms. The present invention also relates to a process for the gradual elimination from such an environment of antimicrobial resistant microorganisms.

[0002] It is well known that infections with pathogenic microorganisms are spread to patients by skin contact with health care personnel, say, working in a hospital.

[0003] Commonly, the only recommendation to prevent the spread of infection within a hospital is for a health care professional to frequently wash his or her hands with an antiseptic hand washing product containing a biocide. The use and frequency of hand washing routines have become an integral part of infection control. It is ideally after each patient contact that the hands of health care personnel should be washed with an antiseptic hand washing product containing a biocide.

[0004] The formation of antimicrobial resistant strains of microorganisms, however, can be caused by prolonged contact and over exposure to the same biocide through the natural selection of those microorganisms that survive the biocide. Hospitals normally make the same biocide available to all their health care personnel so that, after each patient contact, the hands are washed with the same biocide. [0005] Even with the strictest adherence to hand washing routines by health care personnel in a hospital, there are reports of the growing concern at the increase of antimicrobial resistant microorganisms and, more specifically, antibiotic resistant strains of microorganisms infecting patients by skin contact with health care personnel.

[0006] There are many published reports and guidelines for hand washing procedures for health care personnel working in a hospital. A report at the 105 ^th General Meeting of the American Society for Microbiology in June 2005 states: "that methiciline resistant staphylococcus aureus (MRSA) studies demonstrated the need for frequent hand washing in health care settings due to the potential of MRSA being transferred from person to person".

[0007] The hand washing instructions issued in August 2008 by the Department of Microbiology and Immunology in the Faculty of Medicine of Melbourne University in accordance with Australian standard procedure AS/NZS 4815 provide strict rules for the procedure of how the hands are to be washed.

[0008] However, none of these reports and guidelines for hand washing procedures for health care personnel recommend a hand washing routine in which health care personnel use a different hand washing product containing a different biocide at each hand wash.

[0009] It is an object of the present invention to overcome, or at least substantially ameliorate, the disadvantages and shortcomings of the aforementioned prior art. [0010] It is another object of the present invention to provide a process for the prevention of infections due to the transfer of transient antimicrobial resistant microorganisms from the hands of health care personnel to patients in a health care environment.

[0011] Accordingly, the present invention provides a process for preventing the formation in a health care environment of antimicrobial resistant pathogenic microorganisms, comprising:-

(i) providing a first antiseptic hand washing product containing a first biocide,

(ii) providing a second antiseptic hand washing product containing a second biocide different to the first biocide, (iii) washing the hands of a health care professional infected, or at risk of being infected, with one or more pathogenic microorganism after skin contact with a patient, the washing being with the first product, and

(iv) washing the hands of the health care professional after further skin contact with another patient with the second product so as to effectively eliminate any pathogenic microorganism infecting the hands of the health care professional after the washing with the previous product.

[0012] Preferably, the process further provides a third or more additional antiseptic hand washing product containing a respective third or further biocide, and repeating step (iv) with the, or each of the, third or more additional antiseptic hand washing product. [0013] According to a second aspect of the invention there is provided the use of two or more different antiseptic hand washing products, alternately or in rotation, by a health care professional infected, or at risk of being infected, with one or more pathogenic microorganisms to wash their hands after skin contact with a patient, wherein each hand washing product contains a different biocide.

[0014] Preferably a third or more different antiseptic hand washing products each containing a different biocide are used in rotation by the health care professional for washing their hands after skin contact with a patient.

[0015] According to yet another aspect of the invention there is provided a kit for preventing the formation of antimicrobial resistant microorganisms in a health care environment comprising two or more dispenser apparatus each filled with a different antiseptic hand washing product containing a different biocide together with instructions to a health care professional to wash their hands after skin contact with a patient with a first hand washing product contained in a first dispenser apparatus and to wash their hands after contact with another patient with a second hand washing product contained in a second dispenser apparatus.

[0016] Preferably, the kit comprises a third or more additional dispenser apparatus containing a respective third or further antiseptic hand washing product containing a different biocide together with instructions to a health care professional to wash their hands after skin contact with patients using the three or more products in rotation.

[0017] It is preferred that the biocides contained in the antiseptic hand washing products are selected from the group consisting of: an alcohol, 5-chloro-2-(2,4-dichlorophenoxy)phenol (Triclosan), Chlorhexidine, quaternary ammonium compounds, octenidine dihydrochloride, parachlorometaxylenol (PCMX), and iodophors.

[0018] In a preferred form, the first and second biocides are Chlorhexidine and Triclosan, respectively.

[0019] In another preferred form, the first, second and third biocides are an alcohol, Triclosan and Chlorhexidine, respectively.

[0020] Frequent hand washing with antiseptic products each containing different biocides prevents the formation of antimicrobial resistant microorganisms and, more specifically, antibiotic resistant strains of microorganisms, as the bacterial, fungal and viral hand flora would not be continuously exposed to the same biocide.

[0021] Furthermore, washing the hands after each skin contact with a patient with a different antiseptic hand washing product containing a different biocide avoids irritation and dermatitis of the skin, as the skin is not being continuously confronted with the same biocides and washing agents also contained in the antiseptic hand washing products.

[0022] The term "comprising" as used herein is intended to be interpreted in an inclusive sense, akin to the terms "including" and "containing". The term "comprising" is not intended to be interpreted in an exclusive sense, akin to the terms "consisting of or "composed of. [0023] The washing of the hands of health care professionals using antiseptic hand washing products containing different biocides can be facilitated by placing dispenser apparatus, such as dispenser bottles, filled with each of the different antiseptic hand washing products at a suitable distance from each other in a wash room or other dedicated facility in a health care environment.

[0024] Each dispenser apparatus will constitute a separate washing station at which a health care professional must wash his or her hands after skin contact with a patient.

[0025] The antiseptic hand washing products can be selected from, but are not restricted to, those which contain as biocides: an alcohol, Chlorhexidine, 5-chloro-2-(2,4-dichlorophenoxy)phenol (Triclosan), quaternary ammonium compounds, parachlorometaxylenol (PCMX), octenide dihydrochloride and an iodophor.

[0026] The following examples illustrate some preferred sequences of antiseptic hand washing products each containing different biocides that can be used as hand washing routines, and which are suitable for the prevention of formation of antimicrobial resistant pathogenic microorganisms. They should not be construed as limiting.

Biocide Sequence 1 Wash 1 , use Chlorhexidine, Wash 2, use Triclosan.

Biocide Sequence 2 Wash 1 , use an Alcohol, Wash 2, use Triclosan, Wash 3, use Chlorhexidine.

Biocide Sequence 3 Wash 1 , use an Alcohol, Wash 2, use Quaternary ammonium compound, Wash 3, use PCMX,

Wash 4, use Octenidine dihydrochloride, Wash 5, use Thclosan.

Biocide Sequence 4 Wash 1 , use lodophor, Wash 2, use Triclosan, Wash 3, use Chlorhexidine, Wash 4, use PCMX.

[0027] It will be apparent to persons skilled in the art that a large number of combinations and permutations of biocide sequences may be suitable for use in washing routines of the present invention. These may include many proven, commercially available, antiseptic hand washing products, as well as biocide containing products not yet in use.

[0028] It will also be apparent to persons skilled in the art that various modifications may be made in details of process steps and composition of biocides used in the process without departing from the scope or ambit of the present invention.