title: Chlorhexidine spray versus single use sachets for skin preparation before regional nerve blockade for elective caesarean section: an effectiveness, time and cost study.
abstract: BACKGROUND
  The importance of skin preparation before regional nerve blockade to prevent infection remains unchallenged. A multi-use spray chlorhexidine may have benefits over single use sachets in terms of convenience and cost, but its efficacy is unknown. We conducted a prospective randomised trial to compare spray and sachet chlorhexidine.
  
  
  METHODS
  Elective caesarean section patients were randomised to receive chlorhexidine as a spray (chlorhexidine 0.5% in an alcoholic solution Hydrex DS Derma spray, Adams Healthcare, Leeds, UK) or sachet chlorhexidine (chlorhexidine 0.05% aqueous solution, Unisept, Seton. Leeds, UK) before a standardised combined spinal epidural technique. Skin colonisation was examined before skin preparation and again after epidural catheter removal.
  
  
  RESULTS
  Both techniques were effective in reducing skin colonisation (P=0.0001). There was no difference in effectiveness between the groups, with the spray reducing skin colonisation from 88.5% before to 3% after catheter removal, compared with 90% to 12% in the sachet group. Time to achieve skin preparation was significantly reduced in the spray group (2.6 min compared to 4.5 min; P=0.02). The spray cost per patient was 0.01 compared to sachet 0.33.
  
  
  CONCLUSIONS
  We suggest a chlorhexidine spray is as effective as single use sachets and is also quicker to apply and less costly.
authors.affiliation: Department of Obstetric Anaesthesia, St. James's University Hospital, Leeds, UK. kayrobins14@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Robins
authors.forename: R
authors.initials: R
authors.lastname: Wilson
authors.forename: E J
authors.initials: EJ
authors.lastname: Watkins
authors.forename: M O
authors.initials: MO
authors.lastname: Columb
authors.forename: G
authors.initials: G
authors.lastname: Lyons
mesh_terms: D000328:Adult; D000336:Aerosols; D002585:Cesarean Section / Q000191:economics; D002710:Chlorhexidine / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D004202:Disinfectants / Q000008:administration & dosage / Q000191:economics; D004349:Drug Packaging; D005260:Female; D006801:Humans; D009407:Nerve Block / Q000191:economics; D019999:Pharmaceutical Solutions; D011247:Pregnancy; D012867:Skin / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000336:Aerosols; D004202:Disinfectants; D019999:Pharmaceutical Solutions; D002710:Chlorhexidine