How do I bathe with chlorhexidine (CHG) 2 percent solution?

How to Bathe with Chlorhexidine 2%

Daily bathing with 2% chlorhexidine gluconate solution is recommended for ICU patients over two months of age to reduce healthcare-associated infections, applied to the entire body surface while avoiding eyes, ears, and mucous membranes, allowing the solution to remain on the skin briefly before rinsing. 1

Patient Selection and Safety Considerations

Who should receive chlorhexidine bathing:

• ICU patients aged over two months 1
• Adult hematology-oncology patients may benefit 1
• Patients with central venous catheters at high risk for bloodstream infections 1

Critical contraindications and warnings:

• Do NOT use in infants under two months of age - life-threatening skin injuries have been reported, especially in infants with birth weight below 1,000 grams who are less than 7 days postnatal age 1
• Avoid contact with eyes - can cause conjunctivitis and severe corneal damage 1, 2
• Avoid contact with ears - ototoxicity precludes use in or near the middle/inner ear 1, 2
• Do not apply to brain tissue or meninges 1, 2

Step-by-Step Bathing Procedure

Preparation:

• Use 2% chlorhexidine gluconate solution (not the 4% concentration used for surgical hand scrubs) 1
• Chlorhexidine-impregnated washcloths are an effective alternative delivery method 1
• Perform hand hygiene before assisting with patient bathing 1

Application technique:

• Apply the 2% chlorhexidine solution to the entire body surface systematically 1
• Use gentle mechanical friction during application to enhance antimicrobial activity 1
• Avoid these areas: eyes, ears, mucous membranes, and open wounds 1, 2
• Allow the antiseptic solution to remain on the skin briefly for antimicrobial effect 1
• The solution can then be rinsed off with water 1

Frequency:

• Perform daily bathing for ICU patients 1
• Continue throughout the ICU stay or while central venous catheters are in place 1

Expected Outcomes and Effectiveness

Proven benefits:

• 23% reduction in multidrug-resistant organism acquisition (5.10 vs 6.60 cases per 1,000 patient-days) 1
• 28% reduction in hospital-acquired bloodstream infections (4.78 vs 6.60 cases per 1,000 patient-days) 1
• Significant reduction in central line-associated bloodstream infections in ICU patients 1
• Chlorhexidine has substantial residual antimicrobial activity that persists on the skin after application 1, 2

Uncertain effectiveness:

• The benefit in non-ICU patients remains uncertain, though one cluster-randomized study showed reduction in central line infections 1
• Pediatric hematology-oncology patients did not show the same benefit as adults 1

Common Pitfalls and How to Avoid Them

Skin reactions:

• Products containing 4% chlorhexidine (used for hand hygiene) are most likely to cause dermatitis with frequent use - ensure you are using the 2% concentration for bathing 1, 2
• Adverse effects occurred in 71% of patients using 4% whole-body washing versus 33% with placebo, but were reversible in most cases 3
• Monitor for skin irritation, which is concentration-dependent 1

Incomplete coverage:

• Groin-area colonization responds particularly well to chlorhexidine bathing 3
• Ensure systematic coverage of all body surfaces except contraindicated areas 1
• Whole-body washing alone may not eradicate colonization in the gastrointestinal tract or wounds 3

Timing considerations:

• For patients with ostomies or fistulae, temporally separate ostomy/fistula care from chlorhexidine bathing 1
• Avoid catheter care immediately after changing or emptying ostomy appliances 1
• Perform hand hygiene after ostomy care before proceeding with bathing 1

Drug interactions:

• Chlorhexidine's antimicrobial activity can be reduced by natural soaps, inorganic anions, nonionic surfactants, and hand creams containing anionic emulsifying agents 1
• Do not use regular soap immediately before or after chlorhexidine application 1