Applicator-Based Versus Bulk-Bottle Delivery of the Same Alcoholic Chlorhexidine: A Single-Center, Non-Randomized...

Delivery format may change the resources consumed by surgical skin antisepsis even when the antiseptic is unchanged. We compared two workflows using identical 2% chlorhexidine in 70% isopropyl alcohol: a single-use pre-filled applicator and our center's bulk-bottle protocol.

Single-center, non-randomized pilot micro-costing study (hospital perspective, €2024) of 20 elective abdominal procedures (10 per workflow) performed by non-overlapping surgeon groups. Time was measured stepwise to completion of application, excluding the air-drying interval; waste was weighed.

Two bulk-protocol steps, decanting onto a cloth and blotting excess with gauze (39.8 s combined), have no applicator counterpart. Residual alcoholic chlorhexidine was 72.8% lower and total waste 27.9% lower (-42.3 g; 95% CI -62.1 to -22.6). Materials differed by €1.17 per procedure (€3.26 on the same regulatory basis), a difference that reverses if reprocessing is valued below about 78% of its average allocated cost. Aggregate workflow time differed by -29.8 s (95% CI -61.4 to -1.9) and total cost, 85% of it time valued and realizable only if released minutes become usable activity, by -€7.57 (-14.38 to -1.56). Case mix biased both in favor of the applicator: among unilateral hernia repairs (seven vs. four) they fell to -7.3 s (-33.0 to +19.6) and -€2.74 (-8.26 to +3.05), whereas waste differences were unchanged. Operator nesting makes intervals for time, cost and liquid waste likely too narrow.

With the same antiseptic, the applicator workflow removes two handling steps and was associated with less wasted antiseptic. Whether it saves time or money requires a study crossing operators over workflows and timing drying.