Alcohol-based antisepsis without the use of chlorhexidine for arthroscopy in horses.
Authors: Nakamae Y, Elce Y A, Saab M E, McClure J T, Doyle A J
Journal: Journal of equine veterinary science
Summary
# Editorial Summary Chlorhexidine gluconate (CHG) has long been the gold standard for surgical site preparation in equine arthroscopy, but alcohol-based alternatives may offer equivalent antimicrobial efficacy with potential advantages for cost and availability. Researchers compared traditional CHG protocols (4% rough scrub followed by 5-minute 2% sterile scrub) against 70% isopropyl alcohol (IPA) alone (neutral soap rough scrub plus 90-second IPA sterile scrub) in six horses undergoing bilateral tarsocrural arthroscopy, collecting skin samples before scrubbing, immediately after preparation, and at surgical completion to measure bacterial colony-forming units (CFU/mL). Both protocols achieved equivalent reductions in bacterial load, with no significant difference in immediate log₁₀CFU/mL reduction (P = 0.46) or sustained reduction through the 40-minute procedure (P = 0.42)—both groups reduced contamination by at least 2 logs immediately and maintained this reduction to surgery's end. These findings suggest IPA-based preparation without CHG may serve as a viable alternative for arthroscopic procedures, potentially reducing chemical exposure and preparation costs, though equine practitioners should note the study's limitations (small sample size, brief surgical duration, lack of researcher blinding) and recognise that further investigation across longer procedures and varied surgical types would strengthen confidence in this protocol shift.
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Practical Takeaways
- •IPA-based antisepsis without chlorhexidine can effectively prepare equine joints for arthroscopy, providing a potential alternative for surgeons or facilities with chlorhexidine sensitivities or preferences
- •Both protocols achieved clinically meaningful 2-log bacterial reduction; IPA protocol required shorter sterile scrub time (90 s vs 5 min), potentially streamlining surgical prep
- •Results are limited to a small sample (6 horses) and short 40-minute procedures; applicability to longer surgeries or other procedures requires further investigation
Key Findings
- •70% isopropyl alcohol-based antisepsis achieved equivalent immediate log₁₀CFU/mL reduction compared to 4% chlorhexidine gluconate (P=0.46)
- •Both protocols sustained at least 2-log reduction in bacterial counts from pre-scrub to end of surgery (P=0.42)
- •IPA-based protocol (90 s sterile scrub) was non-inferior to CHG protocol (5 min sterile scrub) for surgical site preparation in equine arthroscopy