A Safe and Aseptic Method of Benzalkonium Chloride Dilution for Preoperative Facial Skin and Mucosa Preparation

Abstract

Background: Benzalkonium chloride (BAC) is widely used as an effective antiseptic and disinfectant not only in plastic surgery, but also in everyday life. BAC has an advantage over other antiseptics used for preoperative skin preparation, such as povidone-iodine and chlorhexidine because it causes less irritation of the skin and mucosa and is less toxic. Nonetheless, when BAC is used at higher than desired concentrations, there is a possibility of adverse effects.Methods: Prior to May 2020, 10 mL of 10% BAC was mixed with 1,000 mL of distilled water and diluted to 0.1% on a weekly basis. Afterwards, the method of diluting BAC was modified; for each patient, 1.3 mL of 10% BAC and 100 mL of normal saline were mixed immediately before facial surgery.Results: From March 2007 to May 2020, 0.1% BAC was used for preoperative skin and mucosa preparation. Erroneous dilution of BAC has caused four cases of chemical burns. All the cases were attributed to human error that resulted in higher than desired concentrations of BAC in the antiseptic solution. All the affected patients suffered from first-degree and superficial second-degree chemical burns; however, they were healed uneventfully through proper wound management. Since the application of the dilution method changed since May 2020, no complications have been reported.Conclusion: We have devised a safe and aseptic method for diluting BAC. The new dilution method, which yields a constant concentration of BAC, can be used for preoperative skin and mucosa preparation without accidents.