Comparison of chlorhexidine and alcohol-based antisepsis of the distal limbs of horses.
Authors: Doyle Aimie J, Saab Matthew E, Lewis Krystina M, McClure J Trenton
Journal: Equine veterinary journal
Summary
# Chlorhexidine versus alcohol-based skin antisepsis in horses: a direct comparison Preparing the distal limb adequately before procedures such as regional anaesthesia or surgery is critical for infection prevention, yet evidence comparing commonly used antiseptic protocols remains limited. Researchers allocated 41 horses in a randomised trial design to four treatment groups applied to clipped distal limbs: a five-minute chlorhexidine gluconate (4%) scrub; ethanol (80%) applied as either a 90-second scrub or spray to clipped sites; and ethanol scrubbed onto unclipped skin. Bacterial counts were quantified before and after treatment, with no statistically significant difference in log₁₀ CFU/mL reduction between the chlorhexidine scrub and ethanol scrub on clipped sites for either forelimbs or hindlimbs, whilst both spray application and scrubbing unclipped sites with ethanol proved significantly less effective on hindlimbs specifically. From a cost-benefit perspective, the 80% ethanol scrub on clipped skin performed equivalently to the chlorhexidine protocol, potentially offering economic advantages in high-throughput clinical settings. Clinicians may consider ethanol-based antisepsis as an evidence-supported alternative to traditional chlorhexidine for distal limb preparation, provided proper technique (scrubbing rather than spraying) and adequate clipping are employed, though application method appears particularly important when treating hindlimbs.
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Practical Takeaways
- •For distal limb preparation, an 80% ethanol scrub on clipped skin is as effective as traditional chlorhexidine scrub—consider ethanol as a cost-equivalent alternative with potentially faster application time (90s vs 5min).
- •If using ethanol, always scrub rather than spray, and clip the site first; spray application and unclipped sites showed significantly poorer bacterial reduction in hindlimbs.
- •The choice between CHG and ethanol scrub can be made based on availability, cost, and clinical preference rather than antimicrobial efficacy for routine distal limb antisepsis.
Key Findings
- •Ethanol 80% scrub (ETC) on clipped sites reduced bacterial counts as effectively as 4% chlorhexidine gluconate scrub (CHG), with no significant difference in mean log10 CFU/mL reduction in forelimbs or hindlimbs.
- •In hindlimbs, CHG showed significantly greater bacterial reduction than unclipped ethanol scrub (ETUC) and ethanol spray application (ETS).
- •No significant cost-benefit difference was found between CHG and ETC when applied as scrubs to clipped sites.
- •Clipping the site and scrubbing technique (versus spray application) were critical factors for ethanol efficacy on distal limbs.