Chlorhexidine Gluconate 4% Body Wash Instructions for MRSA Decolonization
For a patient with a positive MRSA nares swab undergoing surgery, use chlorhexidine gluconate 4% body wash daily for 5 days before surgery, combined with mupirocin 2% nasal ointment twice daily for the same period, completing the regimen 1-2 weeks before the scheduled procedure. 1
Specific Application Protocol
Daily Body Wash Technique
- Apply chlorhexidine gluconate 4% soap for full-body washing once daily during the 5-day treatment period 1, 2
- Wet the entire body with water first 3
- Apply the minimum amount necessary to cover all skin surfaces and wash gently, paying particular attention to the nails, cuticles, and interdigital spaces 3
- Rinse thoroughly under running water 3
- Dry completely with a clean towel 3
Timing and Duration
- Begin the decolonization protocol 1-2 weeks before surgery to allow adequate time for completion and verification 1, 4
- Continue daily chlorhexidine body washes for 5 consecutive days 1, 2
- If the 5-day course cannot be completed preoperatively, complete it post-surgery 1
Combined Decolonization Regimen
Nasal Mupirocin Component
- Apply mupirocin 2% ointment to the anterior nares twice daily for 5 days simultaneously with chlorhexidine body washes 1, 2
- This combination approach is more effective than either agent alone 1, 5
Oral Decontamination
- Add chlorhexidine gluconate 0.12% oral rinse twice daily during the perioperative period, particularly for cardiac surgery patients 1
- This reduces oropharyngeal colonization and decreases respiratory infections 1
Preoperative Day-of-Surgery Protocol
Antiseptic Cloth Application
- Use chlorhexidine gluconate antiseptic cloths the evening before and the morning of surgery 6
- This provides an additional layer of decolonization immediately before the procedure 6
Surgical Site Preparation
- Apply chlorhexidine product liberally to the surgical site and swab for at least 2 minutes, then dry with a sterile towel 3
- Repeat this procedure for an additional 2 minutes and dry again with a sterile towel 3
Critical Implementation Considerations
Patient Education
- Instruct patients to watch educational materials about proper MRSA decontamination technique 7
- Emphasize the importance of completing the full 5-day regimen even if surgery is postponed 1
Special Precautions
- Use with care in premature infants or infants under 2 months of age, as chlorhexidine may cause irritation or chemical burns 3
- Monitor for skin irritation, which occurs more frequently with chlorhexidine (71% reported any symptom) but is typically reversible 8
High-Risk Surgery Populations
- This protocol is strongly recommended for cardiac and orthopedic surgery patients with documented MRSA colonization 1, 4
- For immunocompromised patients or those receiving prosthetic implants, more aggressive protocols may be warranted 2, 9
Expected Outcomes
Decolonization Efficacy
- The combination of mupirocin and chlorhexidine achieves a 95.2% decolonization rate for MRSA carriers 10
- At 3 months follow-up, 74% of treated patients remain culture-negative for MRSA 5
Surgical Site Infection Reduction
- This decolonization protocol reduces SSI rates by approximately 69% in elective joint arthroplasty (from 1.11% to 0.34%) 6
- In orthopedic surgery with hardware implantation, SSI rates decrease by more than 50% (from 3.8% to 1.1%) 7
Common Pitfalls to Avoid
- Do not postpone elective surgery to complete decolonization unless it poses no additional risk to the patient 1
- Avoid incomplete treatment courses, as partial decolonization is less effective 1
- Do not rely on chlorhexidine body wash alone without nasal mupirocin, as the nose is a primary MRSA reservoir 2, 8
- Ensure adequate contact time (at least 2 minutes per application for surgical site preparation) 3