Skin Sterility After Application of Ethyl Chloride Spray
ABSTRACT Ethyl chloride topical anesthetic spray is labeled as nonsterile, yet it is widely used during injection procedures performed in an outpatient setting. The purpose of this study was to investigate the sterility of ethyl chloride topical anesthetic spray applied before an injection. Our a priori hypothesis was that application of the spray after the skin has been prepared would not alter the sterility of the injection site.
We conducted a prospective, blinded, controlled study to assess the effect of ethyl chloride spray on skin sterility. Fifteen healthy adult subjects (age, twenty-three to sixty-one years) were prepared for mock injections into both shoulders and both knees, although no injection was actually performed. Three culture samples were obtained from each site on the skin: one before skin preparation with isopropyl alcohol, one after skin preparation and before application of ethyl chloride, and one after ethyl chloride had been sprayed on the site. In addition, the sterility of the ethyl chloride was tested directly by inoculating cultures with spray from the bottles.
Growth occurred in 70% of the samples obtained before skin preparation, 3% of the samples obtained after skin preparation but before application of ethyl chloride, and 5% of the samples obtained after the injection site had been sprayed with ethyl chloride. The percentage of positive cultures did not increase significantly after application of ethyl chloride (p = 0.65). Spraying of ethyl chloride directly on agar plates resulted in growth on 13% of these plates compared with 11% of the control plates; this difference was also not significant (p = 0.80).
Although ethyl chloride spray is not sterile, its application did not alter the sterility of the injection sites in the shoulder and knee.
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ABSTRACT: BACKGROUND Refrigerant sprays have been widely used to reduce pain in the office setting. However, more recently, their use has been limited by both concern regarding flammability and questions of bacterial contamination. OBJECTIVE We investigated the microbiological effect of 1,1,1,3,3 pentafluoropropane and 1,1,1,2-tetrafluoroethane when sprayed after povidone-iodine application in 50 volunteers. MATERIALS AND METHODS In 50 volunteers, 3 cultures were taken (1) at time 0 before antiseptic application, (2) after povidone-iodine topical antiseptic, and (3) after spraying with vapocoolant. Cultures at 3 time intervals were analyzed in a blinded fashion, and Gram stains obtained when cultures were positive. RESULTS Bacterial growth was found in 98% of cultures taken before antiseptic was applied (Group 1), in 28 cultures (56%) after povidone-iodine was applied, and in 24 cultures (48%) after spraying with vapocoolant. There was a statistically significant difference found between Group 1 (no antiseptic) and both Group 2 (after antiseptic but before vapocoolant) and Group 3 (after vapocoolant) (p < .001). CONCLUSION The topical antiseptic povidone-iodine significantly reduces skin colonization when compared with unprepared skin (p < .001). The vapocoolant 1,1,1,3,3 pentafluoropropane and 1,1,1,2-tetrafluoroethane is sprayed on skin prepared with povidone-iodine; there is no statistically significant increase in bacterial colonization.Dermatologic Surgery 09/2014; 40(10). DOI:10.1097/01.DSS.0000452654.29636.56
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ABSTRACT: Injections of the knee joint and the surrounding structures are one of the most common interventions performed by providers of musculoskeletal care. With appropriate patient selection, injections may provide substantial short-term relief with infrequent complications. Longer-term outcomes, including modification of the underlying disease processes, are debated within the literature. In this review, we provide an overview of injection therapy in and around the knee, with a focus on the indications, complications, pertinent techniques (including preparation, approaches, and aftercare), types of injectables (corticosteroids, viscosupplementation, and platelet-rich plasma), and evidence-based recommendations for roles of injection therapy in both intra- and extra-articular disease processes.Operative Techniques in Sports Medicine 06/2012; 20(2):172–184. DOI:10.1053/j.otsm.2012.03.016