///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Determining the Incidence of Chlorhexidine Gluconate Transfer from Skin to Surgical Gloves

Abstract Number: T2H-364
Abstract Type: Original Research

James D Taylor BSc1 ; Vit Gunka MD FRCPC2; Anthony Chau MD FRCPC MMSc3; Elena Polishchuk PhD4; Arianne Albert PhD5; Simon Massey MB BCh MRCP FRCA FRCPC6

Introduction: Alcohol-based chlorhexidine gluconate (CHG) is recommended as the antiseptic solution for skin preparation prior to central neuraxial blockade.[1] As CHG is highly neurotoxic and implicated in cases of severe neurological injury,[2] 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.[1] 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.[3] 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

SOAP 2019