Chlorhexidine Gluconate Uses
Chlorhexidine gluconate (CHG) is a broad-spectrum antiseptic agent used primarily for skin antisepsis before invasive procedures, hand hygiene in healthcare settings, daily bathing of ICU patients to prevent infections, and oral antisepsis for gingivitis management. 1, 2, 3
Primary Clinical Applications
Skin Antisepsis for Invasive Procedures
Chlorhexidine in alcohol (0.5-2% CHG in 70% alcohol) is the preferred antiseptic for skin preparation before central neuraxial blockade (spinal/epidural procedures), superior to povidone-iodine in both speed and duration of antimicrobial action. 1
For central neuraxial procedures specifically, 0.5% chlorhexidine in alcohol should be preferred over 2% solutions due to neurotoxicity concerns, despite similar antimicrobial efficacy. 1
CHG is effective for preoperative skin preparation across general, orthopedic, cardiothoracic, and obstetrical surgical procedures, reducing surgical site infection risk. 4
The solution must be allowed to dry completely before skin puncture to maximize antimicrobial effect and prevent inadvertent introduction into deeper tissues. 1
Hand Hygiene and Surgical Scrubs
4% chlorhexidine gluconate preparations are the standard for surgical hand antisepsis and healthcare worker handwashing, demonstrating superior antimicrobial efficacy compared to lower concentrations (0.5-2%). 1, 5
Aqueous or detergent formulations containing 0.5-0.75% chlorhexidine are more effective than plain soap but less effective than 4% preparations. 1
Chlorhexidine has substantial residual antimicrobial activity that persists for hours after application, unlike alcohol alone. 1, 5
Surgical scrub duration can be reduced to 2-5 minutes when using chlorhexidine-based products, rather than traditional 10-minute scrubs, without compromising efficacy. 1
Addition of low concentrations (0.5-1.0%) of chlorhexidine to alcohol-based preparations results in greater residual activity than alcohol alone. 1
Daily Patient Bathing for Infection Prevention
Daily bathing with 2% chlorhexidine gluconate solution is recommended for ICU patients over two months of age to reduce healthcare-associated infections, including multidrug-resistant organism acquisition (23% reduction) and hospital-acquired bloodstream infections (28% reduction). 2
The 2% solution should be applied to the entire body surface with gentle mechanical friction, avoiding eyes, ears, and mucous membranes, then allowed to remain briefly before rinsing. 2
Patients with central venous catheters at high risk for bloodstream infections should receive chlorhexidine bathing. 2
Adult hematology-oncology patients may benefit from chlorhexidine bathing protocols. 2
Chlorhexidine-impregnated washcloths provide an effective alternative delivery method for daily bathing. 2
Oral and Dental Applications
Chlorhexidine mouthwash is indicated for short-term adjunctive management of gingivitis, reducing dental plaque and clinical symptoms. 6, 3
CHG mouthwash can reduce the risk of dry socket (alveolar osteitis) following tooth extraction. 3
Evidence supports use to reduce aerosolization of bacteria during dental procedures. 3
Chlorhexidine works by killing or preventing growth of bacteria on oral mucosa. 6
Catheter-Related Infection Prevention
Catheters impregnated with chlorhexidine and antimicrobial agents reduce the incidence of catheter-related bloodstream infections. 7
Catheters inserted following 0.5% chlorhexidine in alcohol skin preparation are six times less likely to be colonized compared to povidone-iodine preparation. 1
Wound and Skin Cleaning
CHG is indicated for cleaning skin after injury, though wounds involving more than superficial skin layers should not be routinely treated with chlorhexidine. 8, 6
Recent studies suggest 0.05% CHG wound irrigation prior to closure (followed by saline rinse) produces >5-log reduction against healthcare-associated pathogens and reduces microbial adherence to implantable devices. 4
Antimicrobial Spectrum and Mechanism
Chlorhexidine is effective against nearly all bacteria and yeasts, with broad-spectrum activity that includes methicillin-resistant and methicillin-sensitive Staphylococcus aureus. 1
CHG has good activity against enveloped viruses (herpes simplex, HIV, influenza, RSV) but substantially less activity against non-enveloped viruses (rotavirus, adenovirus, enteroviruses). 1
Antimicrobial activity is only minimally affected by the presence of organic material, including blood, unlike povidone-iodine. 1, 9
Chlorhexidine binds strongly to proteins in skin and mucosa, providing persistent antimicrobial effects. 7
Concentration-Specific Applications
4% Chlorhexidine Gluconate
- Primary use: surgical hand preparation and healthcare worker hand hygiene. 5
- Provides greatest antimicrobial efficacy but highest risk of contact dermatitis with frequent use. 1, 5
2% Chlorhexidine Gluconate
- Primary use: daily patient bathing for infection prevention in ICU settings. 2
- Used for preoperative antiseptic bathing/showering prior to hospital admission. 4
0.5% Chlorhexidine in Alcohol
- Primary use: skin antisepsis before central neuraxial blockade and other invasive procedures where neurotoxicity is a concern. 1
Critical Safety Considerations and Contraindications
Anatomical Restrictions
Do not use in contact with meninges, as chlorhexidine is neurotoxic and can cause severe neurological complications. 1, 8
Avoid contact with eyes (can cause conjunctivitis and severe corneal damage, especially with >1% concentrations). 1, 5, 9, 8
Do not use in or near ears due to ototoxicity; contraindicated in surgery involving inner or middle ear. 1, 5, 9
Do not use in the genital area as a preoperative skin preparation. 8
Do not use as a preoperative skin preparation of the head or face. 8
Age-Related Restrictions
FDA has not approved chlorhexidine products for children younger than 2 months of age; use cannot be recommended in this population. 9, 10
In children under two months of age, if used, the volume should be the minimum necessary while still ensuring antisepsis. 1
Premature infants face increased risks including contact dermatitis, chemical burns, and systemic absorption due to immature skin barrier function. 9
Application Precautions
Repeated general skin cleansing of large body areas should not be done except when underlying conditions necessitate bacterial population reduction. 8
Stop use if irritation, sensitization, or allergic reaction occurs. 8
Chlorhexidine's activity can be reduced by natural soaps, inorganic anions, nonionic surfactants, and hand creams containing anionic emulsifying agents—avoid using regular soap immediately before or after application. 1, 2, 9
Common Pitfalls to Avoid
Never allow chlorhexidine to contact cerebrospinal fluid during neuraxial procedures—keep solutions away from procedure equipment, allow complete drying before puncture, and check gloves for contamination. 1
Do not use 4% chlorhexidine for patient bathing—this concentration is for hand hygiene only and increases dermatitis risk. 2, 5
Ensure systematic coverage of all appropriate body surfaces during bathing while strictly avoiding contraindicated areas. 2
Temporally separate ostomy/fistula care from chlorhexidine bathing and perform hand hygiene between tasks. 2
Be aware that occasional nosocomial infection outbreaks have been traced to contaminated chlorhexidine solutions—proper storage and handling are essential. 1, 9
Adverse Effects Profile
Contact dermatitis is concentration-dependent, with 4% products most likely to cause reactions with frequent use. 1, 5
Allergic reactions range from mild contact dermatitis to life-threatening anaphylaxis, though severe reactions are uncommon. 9, 7
Oral use causes reversible tooth discoloration and increased tartar formation. 6, 3
Minimal systemic absorption occurs through intact skin when used as recommended. 1, 9