Is it useful as a skin cleanser despite its weak activity against Gram-negative (Gram negative) bacteria?

From the Guidelines

Chlorhexidine is a highly effective skin cleanser despite its weak activity against gram-negative bacteria, due to its strong residual activity and effectiveness against gram-positive bacteria. This antiseptic agent works by binding to bacterial cell walls, disrupting membrane integrity, and causing cellular contents to leak 1. While it has limitations against gram-negative organisms, its persistent activity on the skin provides ongoing antimicrobial protection. For optimal use as a skin cleanser, chlorhexidine is typically formulated in 2-4% concentrations and should be allowed to dry completely on the skin before procedures 1.

Key Benefits of Chlorhexidine

• Strong activity against gram-positive bacteria, which constitute a significant portion of the skin's normal flora
• Persistent residual activity on the skin, providing ongoing antimicrobial protection
• Effective in reducing the incidence of multidrug-resistant central venous catheter-related bloodstream infections (CRBSI) 1
• Superior to povidone-iodine solution in skin preparation for surgical site preparation and insertion of vascular catheters 1

Clinical Applications

• Surgical site preparation
• Insertion of vascular catheters
• Daily skin cleansing with a 2% chlorhexidine-impregnated wash cloth to reduce the incidence of multidrug-resistant CRBSI in patients with short-term catheters 1

Important Considerations

• Proper application technique, using a back-and-forth scrubbing motion rather than circular movements, enhances the antiseptic's effectiveness
• Chlorhexidine's activity can be reduced by natural soaps, various inorganic anions, nonionic surfactants, and hand creams containing anionic emulsifying agents 1

From the FDA Drug Label

Uses surgical hand scrub: significantly reduces the number of microorganisms on the hands and forearms prior to surgery or patient care healthcare personnel handwash: helps reduce bacteria that potentially can cause disease patient preoperative skin preparation: for the preparation of the patient's skin prior to surgery skin wound and general skin cleansing The chlorhexidine gluconate is useful as a skin cleanser despite its weak activity against gram negative bacteria, as it reduces the number of microorganisms and helps reduce bacteria on the skin 2.

• Key points:
  • Reduces microorganisms on the skin
  • Helps reduce bacteria on the skin
  • Used for skin wound and general skin cleansing

From the Research

Skin Cleanser Efficacy

• Chlorhexidine gluconate is useful as a skin cleanser despite its weak activity against gram-negative bacteria, as it has been shown to be effective against gram-positive bacteria 3, 4.
• The use of chlorhexidine gluconate as a skin cleanser has been associated with a reduction in the number of gram-positive bacterial species isolated from skin, with a drop of 82% in gram-positive bacterial contamination rate 3.
• Chlorhexidine gluconate has also been shown to be effective in preventing infections due to gram-positive and gram-negative organisms, as well as Candida 4.

Comparison with Other Antiseptics

• Chlorhexidine gluconate has been compared to other antiseptics, such as povidone-iodine, and has been found to have a stronger evidence base for use as a skin decolonization agent 4.
• The combination of chlorhexidine gluconate and povidone-iodine has been shown to be effective against six nosocomial pathogens, including Staphylococcus aureus, Acinetobacter baumannii, and Pseudomonas aeruginosa 5.
• The use of chlorhexidine gluconate and povidone-iodine in combination has been found to be superior to either antiseptic alone in reducing bacterial burden on porcine tissue 5.

Gram-Negative Bacteria

• Chlorhexidine gluconate has been found to have weak activity against gram-negative bacteria, with 18.2% of Enterobacteriaceae resistant to chlorhexidine digluconate 6.
• However, the use of chlorhexidine gluconate as a skin cleanser has been associated with a reduction in the number of contaminated body areas, including those with gram-negative bacteria 3.
• Further studies are needed to evaluate the effectiveness of chlorhexidine gluconate against gram-negative bacteria, particularly those that are multidrug resistant 4.