Chlorhexidine vs. Alcohol Antisepsis for Equine Surgical Procedures 

Antisepsis prior to equine surgery is critical for infection prevention, especially when performing arthroscopic procedures on joints. Some evidence, however, suggests that commonly used chlorhexidine (CH) preparations might contribute to antimicrobial resistance. Further, detergent-based scrubs with water are time-consuming and can result in skin irritation.  

Previously, 70% alcohol-based antisepsis has shown experimentally to be as effective as 4% CH at reducing bacterial counts on equine skin. Expanding on this, researchers at the Atlantic Veterinary College, in Canada, recently compared the efficacy of 70% isopropyl alcohol (IPA) and 4% CH for reducing colony-forming units (CFU/ml) on equine skin immediately and following arthroscopic surgery.  

Study Population

The study included six horses. The researchers performed a 40-minute sham arthroscopic procedure on the horses’ bilateral tarsocrural joints. For each horse, one hock had a rough scrub with 4% CH followed by a rinse with 70% IPA and then a five-minute sterile scrub with 2% CH and a final IPA rinse. The other hock received a rough scrub with Ivory soap followed by a rinse with 70% IPA and then 90 seconds of sterile scrub with IPA. 

Three horses were euthanized before recovering from anesthesia. The researchers monitored the other three for several days post-op for fever, swelling, heat, pain, lameness, or surgical site discharge prior to euthanizing them.  

Study Findings

The study demonstrated that 70% IPA-based antisepsis without CH can achieve the same antiseptic results as CH antisepsis. Both protocols achieved immediate and post-op antiseptic efficacy with low aerobic bacterial counts for a 40-minute arthroscopic procedure. The authors recommended a larger clinical trial under varying surgical conditions and duration to ensure the alcohol-based antisepsis maintains efficacy. 

Using an isopropyl-based antiseptic protocol can help reduce anesthesia time while also mitigating the potential for antimicrobial resistance.  

Reference

Nakamae Y, Elce YA, Saab ME, McClure JT, Doyle AJ. Alcohol-based antisepsis without the use of chlorhexidine for arthroscopy in horses, Journal of Equine Veterinary Science 2024, DOI: 10.1016/j.jevs.2024.105257

Related Reading

• Long-Term Survival Following Synovial Lavage in Horses
• Mastering Regional Limb Perfusions in Horses
• Chlorhexidine Flush: Potential Treatment for Septic Arthritis in Horses?

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