From the Guidelines
Chlorhexidine 4% liquid is used as an antiseptic skin cleanser to reduce bacteria on the skin, providing both immediate and persistent antimicrobial activity against a broad spectrum of microorganisms, as supported by the guideline for hand hygiene in health-care settings 1. To use it properly, apply the liquid to wet skin and wash gently for at least one minute, then rinse thoroughly with water.
Key Considerations
- For surgical preparation or wound cleaning, use as directed by your healthcare provider.
- For general skin cleansing, it can be used daily.
- For pre-surgical preparation, it's typically used once or twice daily for several days before surgery.
- Avoid contact with eyes, ears, and mouth as it can cause irritation or damage.
- Don't use on deep wounds, serious burns, or genital areas unless specifically directed by a healthcare provider.
Mechanism of Action
Chlorhexidine works by disrupting bacterial cell membranes, providing both immediate and persistent antimicrobial activity against a broad spectrum of microorganisms, including gram-positive bacteria, gram-negative bacteria, and fungi, although its activity against nonenveloped viruses is substantially less 1.
Safety Precautions
While chlorhexidine has a good safety profile when used as recommended, there have been reports of suspected anaphylactic reactions associated with its use, particularly in certain countries, and it is prudent to allow skin disinfectant to completely dry before beginning an invasive procedure 1.
Concentration and Efficacy
The efficacy of chlorhexidine is concentration-dependent, with 4% chlorhexidine gluconate being more effective than lower concentrations, although the choice of concentration should also consider the risk of neurotoxicity, as highlighted in the safety guideline for skin antisepsis for central neuraxial blockade 1.
From the FDA Drug Label
For external use only ANTISEPTIC/ANTIMICROBIAL SKIN CLEANSER FOR EXTERNAL USE ONLY The use of Chlorhexidine (CHX) 4% liquid is as an antiseptic/antimicrobial skin cleanser for external use only 2 2.
- It is used to reduce the bacterial population of the skin 2.
- Not for internal use, and not for use on large body areas except when necessary to reduce bacterial population 2.
- Not for use on wounds that involve more than the superficial layers of the skin 2.
From the Research
Use of Chlorhexidine (CHX) 4% Liquid
- Chlorhexidine (CHX) 4% liquid is used as a preoperative skin preparation to reduce the risk of surgical site infections 3, 4, 5, 6.
- Studies have shown that CHX 4% liquid is effective in reducing bacterial colonization and postoperative wound infection compared to other antiseptics such as povidone iodine 4, 6.
- CHX 4% liquid has been found to be safe and effective for use as a perioperative skin-prepping agent, with broad clinical application throughout the healthcare environment 5.
- The use of CHX 4% liquid as a preoperative skin preparation has been found to be superior to povidone iodine in preventing surgical site infections after clean-contaminated surgery 6.
- A review of current evidence found some evidence that preoperative skin preparation with CHX was associated with lower rates of surgical site infections following clean surgery, although the quality of this evidence was low 7.
Key Findings
- CHX 4% liquid has been found to be effective in reducing bacterial colonization and postoperative wound infection 4, 6.
- CHX 4% liquid is safe and effective for use as a perioperative skin-prepping agent 5.
- CHX 4% liquid is superior to povidone iodine in preventing surgical site infections after clean-contaminated surgery 6.
Comparison with Other Antiseptics
- CHX 4% liquid has been compared to other antiseptics such as povidone iodine, with findings suggesting that CHX is more effective in reducing bacterial colonization and postoperative wound infection 4, 6.
- A review of current evidence found that alcohol-containing products, including CHX, had the highest probability of being effective in preventing surgical site infections, although the quality of this evidence was low 7.