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

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.