Performance of Bio-Occlusive Dressing as Barrier Protection from Presurgical Chlorhexidine Skin Preparation

ABSTRACT

Purpose/Aim of the study: Chlorhexdine has been shown to provide excellent and cost-effective presurgical antisepsis. However, standard presurgical concentrations of chlorhexidine (2–4%) are known to cause ocular injury, even in cases in which a bio-occlusive dressing (Tegaderm™) was applied beforehand to the closed eye.

Materials and Methods: Three experiments were conducted to assess the barrier performance of Tegaderm™ to chlorhexidine skin prep in vitro and on non-ocular skin. The experiments used water as a control group.

Results: In the first in vitro experiment, the chlorhexidine group showed penetration at the edges of the Tegaderm™ at 5 minutes while the water (control) group never penetrated the Tegaderm™. A subsequent experiment testing the central permeability of the tegaderm showed it to be impermeable to both chlorhexidine and water after 90 minutes. In the in vivo experiment, the chlorhexidine group showed penetration at 10 minutes, while the water (control) group never penetrated the Tegaderm™.

Conclusions: These data suggest Tegaderm™ is permeable at the edges to chlorhexidine but not water. Based on this, along with reports of ocular injury from chlorhexidine skin preparation of the head despite prior application of Tegaderm™ over the eyes, we advise against using bio-occlusive adhesive dressing to protect the ocular surface from chlorhexidine exposure. We suggest an alternative presurgical antiseptic agent such as povidone-iodine be employed whenever possible.

KEYWORDS:

• Chlorhexidine
• toxic keratitis
• surgical scrub
• Tegaderm™
• bio-occlusive dressing

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding

This work was made possible in part by NIH-NEI EY002162 - Core Grant for Vision Research and by the Research to Prevent Blindness Unrestricted Grant.

Additional information

Funding

This work was made possible in part by NIH-NEI EY002162 - Core Grant for Vision Research and by the Research to Prevent Blindness Unrestricted Grant.