Chlorhexidine Gluconate/Isopropyl Alcohol

This investigation evaluated if skin sterility is maintained following application of Gebauer's Ethyl Chloride® vapocoolant spray. In this prospective, blinded, controlled study, the medial forearm (site of arterial line placement) and lower back (site of epidural placement) were swabbed before and after sterilisation and treatment with vapocoolant. Data were collected from 72 participants. There was no difference in microbial abundance between samples obtained from the wrist with ChloraPrep™ versus ChloraPrep + Gebauer's Ethyl Chloride (P>0.99), or in positive cultures (P=0.317). On the lower back, there was no difference in microbial abundance following ChloraPrep versus ChloraPrep + Gebauer's Ethyl Chloride (P=0.317), or in positive cultures (P=0.317). Supply chain shortages of lidocaine have prompted consideration of alternative local anaesthetics. These findings support use of Gebauer's Ethyl Chloride as an alternative to lidocaine for minimally invasive procedures such as placement of arterial lines and epidurals. Further investigation is necessary to explore the safety of vapocoolants in more invasive procedures.

Operating room fires can have devastating consequences and as such must be prevented. There exists a paucity of literature requiring further elucidation regarding manufacturer recommendations of a predefined waiting period prior to patient draping after using alcohol-based surgical antiseptics, in order to reduce the risk of operating room fires.

This was further investigated by exposing two common alcohol-based surgical antiseptics to electrosurgery and open flames at various power settings and time intervals in an ex vivo porcine model. The simulated surgical site was prepped following manufacturer recommendations and exposed to monopolar electrosurgery at low and high power, using both PURE CUT and COAGULATION modes, and open flame, at 15-s increments after application.

While using PURE CUT mode at both low and high power, no ignition was observed on hairless surgical sites prepped with ChloraPrep® at any time point. However, use of COAGULATION mode at both low and high powers resulted in ignition consistently out to 1-min post-application. Additionally, if the prepped area subjectively appeared wet, especially with pooling of the antiseptic, both COAGULATION mode and open flame caused ignition. Dry time was found to be about 59 s for both prep solutions. It was also observed that the amount of pressure directly correlated with the amount of prep dispersed and increased dry times.

In conclusion, our data suggest an average dry time of less than 1-min, with ignition only observed when the antiseptic was visibly wet. Ignition did not occur on hairless skin with electrocautery on CUT mode using ChloraPrep at any time point. Additionally, ignition on hair-bearing skin was not observed past 3 min, with current manufacturer recommendations stating 1 h wait time for hair-bearing skin. Arbitrarily waiting a specific predetermined dry time until patient draping, as recommended by the manufacturers, may be unnecessary and lead to hours’ worth of time wasted each year. Ongoing research will further investigate the utility of drying the antiseptic after application and its affect on not only preventing ignition but also antimicrobial efficacy.