Is chlorhexidine (CHG) effective as a sterile antiseptic before cyst removal?

Chlorhexidine as a Sterile Antiseptic for Cyst Removal

Chlorhexidine in alcohol is highly effective as a sterile antiseptic before cyst removal and should be the preferred agent due to its superior bactericidal effect and prolonged antimicrobial activity compared to alternatives like povidone-iodine. 1

Efficacy of Chlorhexidine Gluconate (CHG)

Chlorhexidine gluconate is a potent, broad-spectrum antiseptic with several advantages for surgical skin preparation:

• Effective against nearly all bacteria and yeasts
• Faster onset and longer duration of action than povidone iodine
• Retains efficacy in the presence of blood and organic material
• Lower incidence of skin reactions than povidone iodine 1

Research demonstrates that CHG results in a more rapid and superior bactericidal effect that lasts several hours beyond its initial application. Studies show that surfaces prepared with chlorhexidine were six times less likely to be colonized compared to those prepared with povidone iodine 1.

Optimal CHG Formulation

When selecting a CHG formulation for cyst removal, consider:

1. Concentration: 0.5% CHG in alcohol is recommended as it provides effective antisepsis while minimizing risk of toxicity. While 2% CHG formulations are available, there is no convincing evidence of antimicrobial superiority of 2% over 0.5% solutions 1.

2. Base solution: Alcoholic CHG solutions are superior to aqueous formulations. The combination of CHG with alcohol provides enhanced and rapid antimicrobial activity 1, 2.

3. Application method: CHG-impregnated cloths have shown excellent efficacy, with studies demonstrating significant microbial reductions that exceed FDA criteria for preoperative skin preparation 3.

Application Protocol

For optimal antiseptic effect when using CHG before cyst removal:

1. Apply CHG in alcohol using a standardized technique (swab, applicator or spray)
2. Allow the solution to completely dry before proceeding with the procedure
3. Ensure surgical equipment is protected from contamination with CHG during application
4. Check gloves for contamination with CHG and change if necessary before proceeding 1

Residual Activity

One of the key advantages of CHG is its residual antimicrobial activity. Research shows that effective CHG concentrations (above 18.75 μg/mL) persist on skin for up to 24 hours after application, providing ongoing protection against microbial recolonization 4. This makes it particularly valuable for procedures like cyst removal where maintaining a sterile field is essential.

Safety Considerations

While CHG is generally safe for skin antisepsis, be aware of these important precautions:

• Keep CHG well away from sensitive tissues and mucous membranes
• Ensure the solution is completely dry before beginning the procedure
• Use with caution in patients with known hypersensitivity to chlorhexidine
• In very young patients (under two months), use the minimum necessary volume while still ensuring antisepsis 1

Conclusion

Chlorhexidine gluconate in alcohol (preferably 0.5% concentration) is an excellent choice for skin antisepsis before cyst removal. Its superior antimicrobial efficacy, residual activity, and favorable safety profile make it the preferred agent for reducing the risk of surgical site infections in this setting.