title: Effects of vapocoolant spray on skin sterility prior to intravenous cannulation.
abstract: BACKGROUND
  Alkane vapocoolant sprays evaporate rapidly, lower skin temperature and result in a temporary interruption in pain sensation. They reduce the pain of intravenous cannulation. However, concern exists that they may recontaminate the sterile cannulation site.
  
  
  OBJECTIVE
  To determine the effects of vapocoolant spray on skin sterility prior to cannulation.
  
  
  METHODS
  Fifty patients from the emergency department of a large tertiary metropolitan hospital were enrolled in this study. Bacterial skin swabs were taken from the dorsum of both hands of each patient. From one hand, a swab was taken following standard chlorhexidine disinfection, and a second swab was taken following the application of vapocoolant spray. From the other hand, a swab was taken from unprepared (non-disinfected) skin, and a second swab was taken following vapocoolant application. Skin swabs were sent for microbiological culture and quantitative comparison.
  
  
  RESULTS
  The administration of vapocoolant after skin disinfection did not increase the bacterial colony count significantly: median 0.0 [interquartile range (IQR) 0.0] vs 0.0 (IQR 0.0) (P = 0.71). The administration of vapocoolant to the unprepared skin decreased the colony count significantly: median 33.5 (IQR 68) vs 3.0 (IQR 11) (P < 0.001).
  
  
  CONCLUSIONS
  Alkane vapocoolant spray does not recontaminate the skin after disinfection, and should pose no increased risk of infection when used as an anaesthetic agent prior to intravenous cannulation following disinfection. While it does have inherent bactericidal activity, this is not sufficient for it to be used as the sole disinfectant.
authors.affiliation: Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: J G
authors.initials: JG
authors.lastname: Evans
authors.affiliation: Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia. Electronic address: David.Taylor@austin.org.au.
authors.forename: D McD
authors.initials: DM
authors.lastname: Taylor
authors.affiliation: Microbiology Department, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Hurren
authors.affiliation: Microbiology Department, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Ward
authors.affiliation: Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Yeoh
authors.affiliation: Microbiology Department, Austin Hospital, Heidelberg, Victoria, Australia; Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: B P
authors.initials: BP
authors.lastname: Howden
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000009:adverse effects*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D002404:Catheterization; D002710:Chlorhexidine / Q000008:administration & dosage; D015169:Colony Count, Microbial; D004636:Emergency Service, Hospital; D005260:Female; D006225:Hand / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D012867:Skin / Q000382:microbiology*; D014739:Victoria; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: Anaesthetic techniques – topical, cannulation, bacteriology; Local anaesthetics; Vapocoolant