Search | Search by Center | Search by Source | Keywords in Title
Campbell ST, Goodnough LH, Bennett CG, Giori NJ. Antiseptics Commonly Used in Total Joint Arthroplasty Interact and May Form Toxic Products. The Journal of arthroplasty. 2018 Mar 1; 33(3):844-846.
BACKGROUND: Multiple antiseptics have been described for use in total joint arthroplasty infection, and the use of multiple antiseptic solutions during a single operation has been described. Our clinical experience is that chlorhexidine (CHX) and Dakin's solution (NaOCl) interact and form a precipitate. The purpose of this study is to determine whether this reaction could be replicated in a laboratory setting, and to determine if other commonly used antiseptics also visibly react when mixed. METHODS: Four percent chlorhexidine gluconate (CHX), 0.5% sodium hypochlorite (NaOCl), 3% hydrogen peroxide (HO), and 10% povidone-iodine (BTD) solutions were obtained and all possible combinations were mixed. Any visible reactions were noted and recorded, and a literature search was performed to characterize the reaction and products. RESULTS: CHX and NaOCl, CHX and HO, and CHX and BTD reacted instantly, forming a precipitate. NaOCl and HO reacted to produce a gas. NaOCl and BTD reacted and produced a color change. The literature review revealed that at least 2 of the reactions tested (CHX + NaOCl and NaOCl + HO) could result in byproducts toxic to humans. CONCLUSION: Surgeons must be aware of these interactions when using antiseptic solutions during procedures. Caution should be used combining or mixing antiseptics, and we recommend against concomitant introduction in a surgical wound.