Incorporation of chlorhexidine in alcohol skin swabs is not without risks of allergic reactions including anaphylaxis
We read with interest the article by Marty Cooney et al (2020) that showed significantly reduced central line-associated bloodstream infections after changing to chlorhexidine gluconate/alcohol device swabs instead of alcohol-only swabs in the inpatient dialysis population. Although lowering infections in this patient population is extremely important, the introduction of additional antiseptic agents may increase the risk of adverse events, such as allergic reactions. Our centre has previously reported on the problem of chlorhexidine allergy in patients undergoing urological procedures (Nakonechna et al, 2014; Totty et al, 2017), and a similar trend among dialysis patients has also been reported (Bahal et al, 2017; Chan et al, 2019).
A glimpse of the scale of this problem can be seen in the retrospective survey report of current practice into investigations of perioperative anaphylaxis, with 13 centres (from UK, Europe, Australia, New Zealand and USA) reporting a total of 252 chlorhexidine-related cases of anaphylaxis (Rose et al, 2019), and the 6th National Audit Project of anaesthetic hypersensitivity reactions by the Royal College of Anaesthetists, UK, identified chlorhexidine as the third most common cause of perioperative anaphylaxis (overall 9%) (Cook and Harper, 2018).
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