Risk of Infection with Ethyl Chloride Spray
Ethyl chloride spray poses minimal risk of infection when used appropriately in clinical settings, as it remains sterile throughout its clinical use and may even have some antimicrobial properties.
Evidence on Sterility and Infection Risk
Sterility of Ethyl Chloride Itself
- Research demonstrates that ethyl chloride spray remains sterile through its shelf life and routine clinical use 1
- A 2021 study showed no bacterial or fungal contamination in ethyl chloride bottles used in clinical settings, regardless of duration and amount of use 1
Effect on Skin Sterility
- Application of ethyl chloride spray does not compromise skin sterility after proper antiseptic preparation 2
- A prospective study found no significant increase in positive cultures after application of ethyl chloride to properly prepared injection sites (5% vs 3%, p=0.65) 2
Potential Antimicrobial Properties
- Ethyl chloride may actually have antimicrobial activity
- One study demonstrated a highly significant reduction in bacterial count (57.3% reduction, p<0.0001) for plates treated with ethyl chloride spray compared to controls 3
- Another study found that ethyl chloride alone had significantly fewer specimens with colony-forming units than controls (p=0.001) 4
- The combination of povidone-iodine followed by ethyl chloride spray showed significantly better disinfection than either product used alone (p=0.001) 4
Clinical Applications and Guidelines
Use in Medical Procedures
- Ethyl chloride is mentioned in guidelines for intra-articular therapies as a topical anesthetic option 5
- The European Alliance of Associations for Rheumatology (EULAR) notes that several task force members suggested ethyl chloride spray might increase infection risk when not applied correctly, but they "failed to find any evidence for this" 5
Proper Application Technique
- When using ethyl chloride spray, follow aseptic techniques similar to those used for other procedures:
- Perform proper hand hygiene before application 5
- Ensure the area is clean before application
- Allow the spray to evaporate completely before proceeding with any invasive procedure
Precautions and Considerations
- If using ethyl chloride before energy-based devices, exercise caution as it is flammable 5
- There is one reported case of unwanted ignition with laser therapy that caused a first-degree burn 5
- Ethyl chloride should not be poured into open containers on the same tray as equipment for central neuraxial blockade to avoid cross-contamination 5
Conclusion for Clinical Practice
Ethyl chloride spray presents minimal infection risk in clinical practice when used properly. Evidence suggests it maintains its sterility during routine use and may even provide some antimicrobial benefit. For optimal safety:
- Follow standard aseptic techniques when using ethyl chloride
- Allow complete evaporation before invasive procedures
- Be aware of its flammability when used near energy-based devices
- Consider its potential benefits as both a topical anesthetic and possible antimicrobial agent
While there are limited high-quality studies specifically examining infection risk with ethyl chloride spray, the available evidence indicates that when used appropriately, it does not increase infection risk in clinical settings.