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Determining the Incidence of Chlorhexidine Gluconate Transfer from Skin to Surgical Gloves
Abstract Number: T2H-364
Abstract Type: Original Research
Introduction: Alcohol-based chlorhexidine gluconate (CHG) is recommended as the antiseptic solution for skin preparation prior to central neuraxial blockade. As CHG is highly neurotoxic and implicated in cases of severe neurological injury, current recommendations to prevent CHG from reaching neuraxial spaces include allowing the solution to fully dry and changing surgical gloves if they are visually contaminated with CHG. The purpose of this study was to determine the incidence of CHG transfer from skin to surgical gloves following skin preparation.
Methods: With ethical approval and informed consent, 20 volunteers were placed in a sitting position and the skin of the lumbar region was prepared in a standardized manner using ChloraPrep® (2% CHG in 70% isopropyl alcohol with sunset yellow dye). The skin preparation area was divided into 4 quadrants and 3 samples were swabbed across each quadrant at 3, 4, 5 and 10 mins following skin preparation using cotton tipped applicators wrapped in Neolon® 2G Surgical Gloves. 5 min samples were used to assess potential CHG re-transfer, or double transfer, from surgical gloves following initial transfer from skin by applying 0.5mL of normal saline to replicate a wet skin surface. Samples were then immediately swabbed and re-swabbed. A swab of skin of the thoracic region was taken as a control. Samples were submerged in 500uL of indicator solution, which yields an intense red colour when CHG is present. Positive samples were confirmed by 3 blinded outcome assessors. Primary outcome was incidence of CHG transfer at 3, 4 and 10 min. Secondary outcomes were incidence of dye transfer and incidence of CHG transfer at 5 min.
Results: Controls were negative for CHG and dye. At 3, 4 and 10 min, 100% of samples were positive for CHG, a significantly greater proportion compared to samples positive for dye (Table 1). At 5 min, 85% (95%CI 61-96) of samples were positive for CHG and 0% (0-20) positive for dye.
Discussion: Incidence of CHG transfer from skin to surgical gloves was 100% at 3, 4 and 10 min. CHG transfer was not always associated with dye transfer, suggesting CHG cannot be easily detected visually. Additionally, positive samples at 5 min suggest when the surgical glove encounters a wet surface, CHG can further transfer onto another medium following initial transfer from skin.
1 Campbell JP et al. Anaesthesia 2014
2 Killeen T et al. Anaesthesia 2012
3 Edmiston CE et al. Infect Control Hosp Epidemiol 2016