Third-degree burns caused by ignition of chlorhexidine: A case report and systematic review of the literature

Vo, Anthony; Bengezi, Omar

doi:10.1177/229255031402200411

Cited by 11 publications

(8 citation statements)

References 5 publications

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“…These surgical fires are rare and considered as one of the few “never events”. Such events can be prevented by allowing the disinfectants enough time to dry, avoiding liquid pooling, and using soaked drapes 45 – 47 .…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

Mastrocola

Matziolis

Böhle

et al. 2021

Sci Rep

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Preoperative skin preparation is an effective method to prevent surgical site infections (SSI). Alcoholic chlorhexidine (CHG) and povidone iodine (PV-I) are the most widely used antiseptic agents. This meta-analysis aims to determine their efficacy in reducing natural bacterial skin flora in clean orthopedic surgery. A systematic search was conducted through current literature up to June 2021 to identify clinical randomized trials that compared the efficacy of alcoholic chlorhexidine and povidone iodine in reducing bacterial skin colonization after preoperative skin preparation. A meta-analysis was conducted. Of 235 screened articles, 8 randomized controlled trials were included. The results of the meta-analysis demonstrate a significantly lower positive culture rate in the chlorhexidine group than in the povidone iodine group (RR = 0.53, 95% Cl: 0.32–0.88). The present data show the superiority of chlorhexidine in reducing the normal bacterial flora compared to povidone iodine in clean orthopedic surgery.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

Mastrocola

Matziolis

Böhle

et al. 2021

Sci Rep

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“…Cytotoxicity to keratinocytes was shown at bactericidal concentrations [21]. [76][77][78][79] Although no "gold standard" of irrigation fluid currently exists for the management of open fracture wounds, a survey completed by 1764 surgeons found that the majority of surgeons' favour both normal saline and low-pressure lavage as part of the initial treatment [38]. In a recent document from the 2 nd International Consensus Meeting on Musculoskeletal Infection no particular recommendation was made with regards the use of dilute povidone-iodine (betadine) irrigation or other antiseptic irrigation solutions during total ankle arthroplasty (TAA) or other foot and ankle procedures due to lack of good quality evidence [39].…”

Section: Human Studiesmentioning

confidence: 99%

Antiseptic Use in Orthopaedic Wounds

Begum

Borg

Mazoochy

et al. 2020

JPRI

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Objectives: The aim of this study is to review the available literature addressing the safety and efficacy of antiseptics in surgical wounds. The different antiseptic solutions, irrigation volumes, time scales and delivery methods have been compared so that evidence-based recommendations on antiseptic use in orthopaedic, foot and ankle surgical procedures can be proposed. Methods: A literature search was performed using the online databases Medline and EMBase to identify in-vitro and in-vivo studies pertaining to antiseptic use in an orthopaedic context. Terms including antiseptic, irrigation fluid, bacitracin, hydrogen peroxide, povidone-iodine and chlorhexidine were searched. Literature published in English from inception to July 2020 in which the full text was accessible was considered for inclusion. Cellular and animal studies were included on the basis that authors analysed antiseptic efficacy and/or toxic effect of antiseptic on cells present in orthopaedic wounds. Clinical studies that met the criteria for inclusion in this review assessed antiseptic use in a surgical context, with a focus on foot and ankle procedures. These included case reports, case series, case control, prospective and retrospective studies as well as randomised controlled trials. Studies were categorised as in-vitro, animal and human studies. Twenty-three, eleven and forty-four studies were identified as in-vitro, animal and human studies respectively. These have been summarised and presented herein in a narrative format. Results: There is strong evidence that skin preparation with antiseptics before orthopaedic procedures reduces the risk of post-operative infection. Conclusion: Routine prophylactic intra-operative antiseptic use should be performed with caution as they increase the risk of local and systemic complications. However, there is strong evidence supporting the use of antiseptics pre-operatively when preparing the skin. Determining the best antiseptic preparation remains a matter of debate since a single agent or solution is not effective against all organisms. Further research is therefore needed to assess the efficacy of antiseptics in prevention and treatment of infections.

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“…These reactions are most common in the perioperative setting (Evans et al, 2017, Opstrup et al, 2019). There is also a risk of both physical and chemical burns associated with its use in the perioperative setting (Sivathasan et al, 2010, Vo and Bengezi, 2014). Physical burns can occur with the use of chlorhexidine mixed with alcohol, which can catch fire when cautery is applied (Vo and Bengezi, 2014).…”

mentioning

confidence: 99%

“…There is also a risk of both physical and chemical burns associated with its use in the perioperative setting (Sivathasan et al, 2010, Vo and Bengezi, 2014). Physical burns can occur with the use of chlorhexidine mixed with alcohol, which can catch fire when cautery is applied (Vo and Bengezi, 2014). Chemical burns from chlorhexidine have been reported in pediatric populations and with the use of tourniquets (Sivathasan et al, 2010).…”

mentioning

confidence: 99%

“…Despite this increasing awareness of chlorhexidine hypersensitivity, physical or chemical burns remain an underrecognized complication of chlorhexidine use. Intraoperatively, there is a risk of physical burns caused by pooled chlorhexidine catching fire after cautery is applied (Vo and Bengezi, 2014). Chemical burns from exposure to chlorhexidine have been reported in pediatric and neonatal patients and in adults on whom a tourniquet has been used (Sivathasan et al, 2010).…”

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confidence: 99%

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A chlorhexidine conundrum after an epidural delivery: The difficulty of differentiating between chlorhexidine burns and hypersensitivity reactions

Blake

O’Dea

Murrell

2019

International Journal of Women's Dermatology

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Chlorhexidine is a commonly used disinfectant throughout Australian hospitals. It is responsible for a number of iatrogenic complications. We describe a case of 27-yearold female who sustained a severe, blistering reaction at the site of chlorhexidine application, associated with significant pain. This reaction was initially managed with wet dressings and topical corticosteroids, but there was no improvement in pain or rash. Management was then changed to silver-coated polyethylene mesh dressings, with resolution of pain and rash after four days. No debridement was required, and area healed without scarring.Chlorhexidine is associated with a number of hypersensitivity reactions, ranging from anaphylaxis to irritant and allergic contact dermatitis. However, physical or chemical burns remain an underrecognised complication of chlorhexidine use. Intra-operatively, there is a risk of physical burn secondary to pooled chlorhexidine catching alight after cautery is applied, and this has been described in ten cases in the literature. Chemical burns from exposure to chlorhexidine can occur in neonatal patients, and in adult patients where a tourniquet has been used.It can be difficult to differentiate between chlorhexidine hypersentivity and burns clinically. When evaluating these patients, a differential diagnosis of burns should be considered, particularly if patients are not responsive to first line therapies. Surgeons and anaesthetists should consider the risk of burns when in theatres, and prevent any pooling of chlorhexidine - particularly when cautery is being used. Using chlorhexidine without alcohol, and allowing at least three minutes for the solution to dry can further reduce the risk of surgical fires.

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Third-degree burns caused by ignition of chlorhexidine: A case report and systematic review of the literature

Cited by 11 publications

References 5 publications

Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery

Antiseptic Use in Orthopaedic Wounds

A chlorhexidine conundrum after an epidural delivery: The difficulty of differentiating between chlorhexidine burns and hypersensitivity reactions

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