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Peer-reviewedCC BYHealthcare (Basel, Switzerland)

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.

  • Francisco Guillen-Grima1,2,3,4,5
  • Maria Pilar Garcia-Garcia2
  • Laura Guillen-Aguinaga6
  • Belen Romanco-Moreno7
  • Ander Eizaguirre-Artolozaga8
  • Enrique Aguinaga-Ontoso9,10
10 affiliations
  1. 1Department of Preventive Medicine, Clínica Universidad de Navarra, 28027 Madrid, Spain.
  2. 2Department of Preventive Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
  3. 3Healthcare Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain.
  4. 4CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 28029 Madrid, Spain.
  5. 5Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain.
  6. 6Department of Otolaryngology-Head and Neck Surgery, Clínica Universidad de Navarra, 28027 Madrid, Spain.
  7. 7Operating Rooms Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
  8. 8Independent Researcher, 92110 Clichy, France.
  9. 9Department of Sociosanitary Sciences, University of Murcia, 30120 Murcia, Spain.
  10. 10Department of Preventive Medicine, Virgen de la Arrixaca University Clinical Hospital, 30120 Murcia, Spain.
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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.

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Cite

BibTeXRIS
BibTeX
@article{guillengrima2026applicatorbased,
  title = {{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.}},
  author = {Francisco Guillen-Grima and Maria Pilar Garcia-Garcia and Laura Guillen-Aguinaga and Belen Romanco-Moreno and Ander Eizaguirre-Artolozaga and Enrique Aguinaga-Ontoso},
  journal = {Healthcare (Basel, Switzerland)},
  year = {2026},
  month = oct,
  doi = {10.3390/healthcare14203456},
  url = {https://europepmc.org/article/MED/42940501},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - 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.
AU  - Francisco Guillen-Grima
AU  - Maria Pilar Garcia-Garcia
AU  - Laura Guillen-Aguinaga
AU  - Belen Romanco-Moreno
AU  - Ander Eizaguirre-Artolozaga
AU  - Enrique Aguinaga-Ontoso
PY  - 2026
DA  - 2026/10/15
JO  - Healthcare (Basel, Switzerland)
DO  - 10.3390/healthcare14203456
UR  - https://europepmc.org/article/MED/42940501
AB  - 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.
SN  - 2227-9032
ER  -