Is daily use of chlorhexidine (CHG) gluconate on the body appropriate, or should it be limited to areas around invasive devices like tubes?

Chlorhexidine Gluconate Use: Body-Wide vs. Tube-Site Application

Daily chlorhexidine gluconate (CHG) bathing is recommended for ICU patients over two months of age, while for non-ICU patients and around tubes/catheters, CHG should be used specifically at insertion sites and during site care. 1

Recommendations for CHG Use in Different Settings

ICU Patients

• Daily chlorhexidine bathing is recommended for ICU patients over two months of age to reduce central line-associated bloodstream infections (CLABSI) 1
• Multiple studies have demonstrated significant reduction in skin colonization with potential pathogens and decreased risk of catheter-related infections with daily CHG bathing in ICU settings 2
• The 2% CHG in 70% isopropyl alcohol formulation has shown the greatest efficacy in reducing infection rates 1

Non-ICU Patients

• The effectiveness of routine daily CHG bathing in non-ICU patients remains uncertain and is not strongly supported by current evidence 1
• For non-ICU patients, CHG use should be focused on specific sites where invasive devices are present rather than routine whole-body application 1

Around Tubes and Catheters

• CHG (2% in 70% isopropyl alcohol) should be used for skin preparation before catheter insertion and for cleaning catheter exit sites 1
• For central venous catheters, CHG should be applied to the insertion site and allowed to air dry before catheter insertion or dressing application 1
• CHG-impregnated dressings are effective in reducing extraluminal contamination at catheter exit sites and should be considered for patients with non-tunneled central venous catheters at high risk for infection 1

Special Considerations and Precautions

Pediatric and Neonatal Patients

• CHG use is not recommended in infants younger than two months due to potential adverse effects 1
• Life-threatening skin injuries have been reported in infants with birth weight below 1,000 grams who are less than 7 days postnatal age 1, 3
• For neonates, alternative antiseptics should be considered based on clinical judgment 4

Safety Considerations

• CHG is for external use only and should be kept away from eyes, ears, and mouth 5
• It may cause serious and permanent eye injury if placed in the eye during procedures 5
• CHG should not be used on wounds involving more than superficial layers of skin 5
• Discontinue use if irritation, sensitization, or allergic reaction occurs 5

Application Techniques

For Catheter Sites

• Before accessing catheters, disinfect the catheter hubs, connectors, and injection ports with 2% CHG in 70% isopropyl alcohol 1
• Allow the antiseptic solution to completely air dry before accessing the site 1
• For non-tunneled central venous catheters, the exit site should preferably be covered with a sterile, transparent, semi-permeable polyurethane dressing, which should be changed every 7 days 1

For Daily Bathing (ICU Patients)

• Use no-rinse, 2% CHG-impregnated cloths for daily patient cleansing in ICU settings 2
• Ensure thorough application to all skin surfaces except face, mucous membranes, and non-intact skin 2
• Do not rinse off after application; allow to air dry 2

Common Pitfalls to Avoid

• Using CHG for repeated general skin cleansing of large body areas outside of ICU settings without clear indication 5
• Applying CHG to mucous membranes or sensitive areas like eyes, ears, and genitals 5
• Failing to allow CHG to completely dry before inserting catheters or applying dressings 1
• Using CHG in infants younger than two months without considering alternatives 1, 3