Chlorhexidine Gluconate topicalPronunciation
Class: Local Anti-infectives, Miscellaneous
Chemical Name: N,N′′-Bis(4-chlorophenyl)-3,12-diimino- 2,4,11,13-tetraazatetradecanediimidamide di-d-gluconate
Molecular Formula: C22H30Cl2N10•2C6H12O7
CAS Number: 18472-51-0
Brands: Avagard, Betasept, Biopatch, Chlorostat, Hibiclens, Hibistat
Uses for Chlorhexidine Gluconate
Surgical Hand Antisepsis
Chlorhexidine gluconate 2 or 4% skin cleanser solutions have more persistent anti-infective activity compared with other available anti-infective cleansers.105
Surgical Site Preparation
Preoperative Whole-body Disinfection
Hand Hygiene in Health-care Personnel
Considered an alternative for decontaminating hands; alcohol-based preparations are recommended instead for decontaminating hands (if they are not visibly soiled) since alcohol-based preparations are most effective for standard hand antisepsis by health-care personnel.105
Superficial Skin Wound and General Skin Cleansing
Catheter Site Preparation and Catheter Site Care
Skin disinfection prior to insertion of intravascular, central venous, or arterial catheters† and for postinsertion site care to prevent catheter-related infections in patients with vascular and nonvascular percutaneous devices.47 51 55 100 11
Chlorhexidine gluconate 2% solution is the preferred agent for such antisepsis.106
Blood Collection Site Preparation
Periurethral cleansing prior to urinary catheterization.103
Bladder irrigation†5 57 104 in an attempt to decrease the incidence of bacteriuria and bacteremia associated with the use of indwelling catheters.3 5 103 (See Hypersensitivity Reactions under Cautions.)
Chlorhexidine Gluconate Dosage and Administration
Apply chlorhexidine containing dressings at the site of vascular and nonvascular percutaneous devices.111
Surgical Hand Antisepsis
Chlorhexidine Gluconate Solution 2 or 4% (Skin Cleanser)Topical
Prolonged scrub times (e.g., 10 minutes) not necessary and may increase incidence of skin damage.105
Sponge/brush containing 4% skin cleanser: open package and remove nail cleaner.1 Wet hands with water and use nail cleaner under fingernails and to clean cuticles.1 Wet hands and forearms to elbows with warm water (avoid use of very cold or very warm water).1 Wet sponge side of sponge/brush; squeeze and pump immediately to work up adequate lather.1 Apply lather to hands and forearms using only sponge side of product; then start 3-minute scrub using brush side of product to scrub only nails, cuticles, and interdigital areas.1 Rinse hands and forearms thoroughly with warm water, then scrub for an additional 3 minutes using sponge side only.1 Rinse hands and forearms thoroughly with running water and dry with sterile towel.1
Chlorhexidine Gluconate 1% Solution in Alcohol Base (Hand Rub)Topical
Wash hands, forearms, and nails with an unmedicated soap (without an anti-infective) and dry completely.105 108 Apply 2 mL of solution onto palm of one hand; dip fingertips of other hand into solution and massage under nails.108
Spread remaining solution over hand and forearms, up to just above the elbow, making certain to cover all surfaces.108
Repeat procedure using another 2 mL of solution using opposite hand.108
Finally, apply additional 2 mL of solution onto palm of either hand and reapply to both hands, up to wrists.108
Rub hands together briskly until all solution is rubbed into hands and forearms and dries completely; do not use towels to dry since this decreases solution efficacy.108
Never use water in conjunction with the alcohol-based solution.108
Surgical Site Preparation
Chlorhexidine Gluconate 2 or 4% Solution (Skin Cleanser).Topical
Hand Hygiene in Health-care Personnel
Chlorhexidine Gluconate 2 or 4% Solution (Skin Cleanser)Topical
Wet hands with warm water (avoid use of very cold or very hot water); dispense approximately 5 mL of the skin cleanser into cupped hands.1 78 107 Work up a lather (do not use excessive pressure to produce additional lather) and wash hands for 15 seconds.1 78 Rinse hands thoroughly with warm water, then dry.1 78 107
Chlorhexidine Gluconate 0.5 or 1% in Alcohol Base (Hand Rub)Topical
Hands must first be physically clean and dry before application of solution.2 108 Dispense approximately 5 mL of the 0.5% solution or 2 mL of 1% solution into cupped hands and rub vigorously until dry (about 15 seconds); pay particular attention to nails and interdigital spaces.2 108 Solution dries rapidly while hands are rubbed; do not use water or other toweling.2 108
Pledgets: vigorously rub hands with a hand wipe for approximately 15 seconds, paying particular attention to nails and interdigital spaces.2 Solution dries rapidly while hands are rubbed; do not use water or other toweling.2
Superficial Skin Wound and General Skin Cleansing
Chlorhexidine Gluconate 2 or 4% Solution (Skin Cleanser).Topical
Rinse the area thoroughly with water before application of the solution.1 78 107 Apply the minimum amount of skin cleanser to cover the skin or wound area.1 78 107 Wash the area gently with the skin cleanser, then thoroughly rinse again.1 78 107
Catheter Site Preparation and Catheter Site CareTopical
Apply solution and air dry before catheter insertion.106
Cautions for Chlorhexidine Gluconate
Skin cleanser and alcohol-based solutions are for external use only; do not use in eyes, ears, or mouth.1 2 78 107 108 Skin cleanser should not be used for preoperative skin preparation of the face or head.1
Use with caution on mucous membranes and apply on wound surfaces at the lowest bactericidal concentration (0.05%) (not commercially available in the US) to decrease the risk of anaphylactic reactions.63
Ocular and Otic Effects
Possible irreversible corneal damage after accidental ocular exposure.60
Alcohol-based preparations (Hibistat, Avagard) should not be exposed to excessive heat (i.e., temperatures exceeding 40°C); keep away from flames or devices that may generate an electric spark.2 108 These preparations dry rapidly as the hands are rubbed together2 108 and are no longer flammable after drying.108
Serious, systemic hypersensitivity reactions, including hypotension, tachycardia, shortness of breath, skin erythema, and anaphylaxis, have been reported with preparations applied topically to the skin3 4 63 64 66 or given intraurethrally,3 4 64 65 intranasally,67 or on central venous catheter (CVCs) impregnated with the drug.3 4 68 69
Local contact dermatitis reported when chlorhexidine-impregnated dressings were used to cover CVC insertion site in neonates.3 62 100 May be severe, may require discontinuance of the chlorhexidine dressing, and have occurred most frequently in low birthweight neonates.62 100
Binds to many fabrics, particularly cotton, and may not be removed by washing.79 Permanent brown stain may occur if sufficient chlorine is present during washing.79 Consult manufacturer’s recommendations for laundering advice.79
Unlikely to be distributed into human milk following topical or intravaginal application.71
Multiple episodes of bradycardia and cyanosis reported in a neonate when chlorhexidine was applied to the nursing mother’s breasts for prevention of mastitis.74 Wash nipples thoroughly with water prior to nursing if used for skin cleansing.71
Common Adverse Effects
Interactions for Chlorhexidine Gluconate
Chlorhexidine Gluconate Pharmacokinetics
In pregnant women who received a 2% solution intravaginally† as a vaginal wash during labor, concentrations ranging from 0.01–0.083 mcg/mL were detected in the blood (limits of detection 0.01 mcg/mL) of approximately 33% of these women.71
Serum concentrations of 11 ng/mL reported in a neonate after oral exposure when chlorhexidine gluconate was used on the nursing mother’s nipples to prevent mastitis.74
Not known whether chlorhexidine crosses the placenta or is distributed into milk.a
If absorbed percutaneously following topical application to the skin, appears to be mainly excreted unchanged in feces.5
Dressing, Pledgets, Solution
Actions and Spectrum
Cationic compound;5 6 adsorbed onto negatively charged cell surfaces of susceptible organisms, with specific and strong adsorption to certain phosphate-containing compounds.5 6 Integrity of the cell membrane is disrupted, resulting in increased permeability.5 6
Active against some aerobic and anaerobic gram-positive and gram-negative bacteria.1 2 4 5 6 102 Also has some activity against Chlamydia trachomatis,77 certain fungi,4 5 6 and certain viruses,4 5 52 but inactive against mycobacteria48 and generally inactive against bacterial spores.15
Advice to Patients
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
J & J
Pledgets (saturated with solution)
0.5% w/w with isopropyl alcohol 70%
Hibistat Hand Wipe
0.5% w/w with isopropyl alcohol 70%
Hibistat Hand Rinse
1% w/w with alcohol 61%
Avagard Hand Antiseptic
Chlorostat Skin Cleaner and Surgical Scrub
Betasept Surgical Scrub
Hibiclens Skin Cleanser
Hibiclens Skin Cleanser
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
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AHFS Drug Information. © Copyright, 1959-2013, Selected Revisions July 1, 2006. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
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