Chlorhexidine droplet splash from a skin preparation gallipot: effect of height of pouring

Abstract

SummaryChlorhexidine contamination of equipment used in central neuraxial anaesthesia has been implicated in causing adhesive arachnoiditis. We measured the extent of chlorhexidine splash during pouring into a gallipot (antiseptic skin preparation container) from heights of 5 cm, 10 cm, 15 cm and 20 cm. Twenty experiments were performed at each height. Measurements made up to a horizontal distance of 40 cm radius from the gallipot showed a median (IQR [range]) maximum spread of splash droplets ≥ 2 mm diameter of 26.2 (10.2-36.4 [0-40]) cm. The 40-cm radius measurement area was divided into 5-cm-wide zones to assess spread. At pouring heights of 15 cm and 20 cm, all zones were contaminated. These results demonstrate that pouring chlorhexidine into a gallipot generates significant splash, and we recommend that this should be avoided near equipment used for neuraxial anaesthesia.

Safety guideline: skin antisepsis for central neuraxial blockade

“…Moreover, Evans et al. have shown that pouring chlorhexidine into a gallipot generates splash that spreads at least 40 cm. The authors recommended that antiseptic solutions should not be poured into containers located on the same tray as equipment for CNB, and that the equipment should be covered until the back has been prepared with antiseptic.…”

Chlorhexidine droplet splash – time to revisit the swabstick?

“…The paper by Evans et al. provides evidence to support the view that the mode of application may be as important as the choice and concentration of antiseptic, a point which I emphasised in my original editorial .…”

Chlorhexidine droplet splash – time to revisit the swabstick?

“…I read with interest the study by Evans et al. about chlorhexidine droplet splash from a skin preparation gallipot. The study neatly demonstrates the risks of contamination of equipment with poured antiseptic solutions.…”