Use of Chlorhexidine for Facial Abscess Drainage
Chlorhexidine 2% is recommended for skin preparation prior to draining a facial abscess as it is superior to povidone-iodine for preventing surgical site infections. 1
Evidence for Chlorhexidine Use in Skin Preparation
Chlorhexidine-alcohol 2% has been demonstrated to be superior to povidone-iodine for preventing surgical site infections in a large randomized controlled trial (n=849 patients) that included abdominal and non-abdominal surgeries 1
Systematic reviews and meta-analyses show that chlorhexidine is associated with lower surgical site infection rates compared to iodine-based products (risk ratio 0.70; 95% CI, 0.52-0.92) 2
Chlorhexidine is also associated with significantly fewer positive skin cultures after application compared to iodophor products (risk ratio 0.45; 95% CI, 0.36-0.55) 2
Application Method Considerations
When applying chlorhexidine to the face, care must be taken to avoid contact with the eyes, inner ear, and mucous membranes 1
Pre-soaked antiseptic sponge applicators ("swab-sticks") are recommended as they minimize the risk of spillage and cross-contamination compared to pouring antiseptic into open containers 1
A single application of chlorhexidine is sufficient; repeated applications are unnecessary and may increase risk of complications 1
Allow the chlorhexidine solution to dry completely before proceeding with the drainage procedure 1
Special Considerations for Facial Use
While the face has a rich blood supply that generally supports healing, proper skin antisepsis remains essential before abscess drainage to prevent complications 1
The primary treatment for abscesses is drainage of the pus, with antimicrobial therapy being secondary or unnecessary in uncomplicated cases 1, 3
For facial abscesses specifically, the proximity to critical structures (eyes, mouth, nasal passages) makes proper skin antisepsis particularly important 1
Potential Concerns and Precautions
Allergic reactions to chlorhexidine, though rare, can occur and include contact dermatitis, urticaria, and in very rare cases, anaphylaxis 1
Most cases of severe reactions to chlorhexidine have involved application to mucous membranes, so particular caution should be exercised when working near the mouth, nose, or eyes 1
In patients with recurrent abscesses, be aware that prolonged chlorhexidine use has been associated with the development of reduced chlorhexidine susceptibility in some bacteria, particularly MRSA 4
Post-Drainage Management
Incision and drainage remains the primary treatment for abscesses, with antibiotics generally unnecessary for uncomplicated cases 3
For recurrent abscesses, consider a 5-day decolonization regimen including daily chlorhexidine washes and decontamination of personal items 1
The recommended duration of antimicrobial therapy, if needed based on clinical presentation, is typically 5 days 1