Applicator-Based Versus Bulk-Bottle Delivery of the Same Alcoholic Chlorhexidine: A Single-Center, Non-Randomized Pilot Micro-Costing Study of Two Surgical Skin-Antisepsis Workflows

28/10/2026

AI Summary

Applicator workflow eliminated two bulk-protocol steps, shortening application time by approximately 29.8 seconds.
Applicator yielded 72.8% lower residual antiseptic and 27.9% lower total waste, reducing liquid waste by 42.3 g (95% CI -62.1 to -22.6).
Aggregate cost was lower by €7.57 per case, but savings depend on reprocessing valuation and operator crossover; time savings uncertain without drying timing.

Healthcare (Basel). 2026 Oct 15;14(20):3456. doi: 10.3390/healthcare14203456.

ABSTRACT

BACKGROUND/OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

PMID:42940501 | DOI:10.3390/healthcare14203456

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