Chlorhexidine Brand Recommendations for Skin Decolonization
For skin decolonization, use chlorhexidine gluconate (CHG) 2% or 4% solutions, with specific brands including Hibiclens (4% CHG) or generic 2-4% CHG formulations, applied as daily bathing or washcloths in combination with intranasal mupirocin for optimal MRSA decolonization. 1
Recommended Formulations and Concentrations
For General Skin Decolonization
- 4% chlorhexidine gluconate solution is the standard concentration for skin antisepsis and decolonization 2, 3
- 2% CHG formulations are equally effective and may cause less skin irritation, particularly when used with moisturizing agents 4, 5
- CHG can be diluted to as low as 0.4% (20% of original 2% solution) without losing antiseptic efficacy 4
For Surgical Skin Preparation
- 2% chlorhexidine in 70% alcohol (e.g., ChloraPrep) is recommended for general surgical procedures 6
- This alcoholic formulation provides superior and more rapid bactericidal action compared to aqueous solutions 1
For Central Neuraxial Procedures
- 0.5% chlorhexidine in 70% alcohol (e.g., Hydrex solution) is preferred over 2% solutions due to neurotoxicity concerns 1, 6
- No difference in antimicrobial efficacy exists between 0.5% and 2% concentrations for this application 1
Application Protocol for Decolonization
Daily Bathing Regimen
- Apply CHG during daily bathing or showering, focusing on high-risk colonization sites (nares, axillae, perineum, groin) 3, 7
- CHG-impregnated washcloths can be used for non-rinse application, which significantly reduces healthcare-associated infections 8
- The manufacturer recommends two scrubs rather than one for optimal bacterial reduction 4
Combined Decolonization Strategy
- 5-day decolonization protocol: twice-daily intranasal mupirocin PLUS daily CHG bathing 1
- This combination approach is more effective than either agent alone 3, 7
- Alternative: dilute bleach baths (1/4-1/2 cup per full bath) may be considered, though data are sparse 1
Important Safety Considerations
Contraindications and Warnings
- Do not use in contact with meninges, in the genital area, or as preoperative preparation of the head or face 2
- Keep out of eyes, ears, and mouth - may cause serious permanent eye injury or deafness if instilled in middle ear 2
- For wounds involving more than superficial skin layers, CHG should not be routinely used 2
Special Populations
- In children under 2 months of age, minimize the volume of CHG while ensuring adequate antisepsis 1, 6
Clinical Efficacy Evidence
Infection Prevention
- CHG washcloths reduce central-line-associated bloodstream infections by 57% (IRR 0.43) 8
- Surgical site infections are reduced by 71% (RR 0.29) with CHG use 8
- VRE colonization decreases by 57% (IRR 0.43) and MRSA colonization by 52% (IRR 0.48) 8
Comparative Effectiveness
- CHG is superior to povidone-iodine for most applications, with faster onset, longer duration, and efficacy maintained in presence of blood 1, 6
- Epidural catheters are 6 times less likely to be colonized with CHG compared to povidone-iodine 1
Common Pitfalls to Avoid
- Avoid petroleum-based lotions (e.g., Vaseline Intensive Care) after CHG application, as they completely inactivate CHG's antibacterial effects 5
- Compatible moisturizers like "Lotion Soft Skin Conditioner" can be used without reducing CHG efficacy 5
- Allow solution to dry completely before proceeding with procedures to maximize antimicrobial action 6
- Do not use CHG routinely without confirmed colonization, as overuse promotes resistance development 7