Chlorhexidine Gluconate (Topical)
(klor HEKS i deen GLOO koe nate)
- 3M Avagard [OTC]
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Betasept Surgical Scrub: 4% (118 mL, 237 mL, 473 mL, 946 mL, 3780 mL [DSC])
Hibiclens: 4% (15 mL, 118 mL, 236 mL, 473 mL, 946 mL, 3790 mL) [contains fd&c red #40, isopropyl alcohol]
Generic: 4% (118 mL, 237 mL, 473 mL, 946 mL, 3800 mL)
Hibistat: 0.5% (50 ea [DSC]) [contains isopropyl alcohol]
Tegaderm CHG Dressing: (Dressing) (1 ea)
Generic: 2% (2 ea, 6 ea)
Antiseptic Skin Cleanser: 4% (118 mL, 237 mL) [dye free; contains isopropyl alcohol]
Dyna-Hex 2: 2% (473 mL) [contains isopropyl alcohol]
Brand Names: U.S.
- Antiseptic Skin Cleanser [OTC]
- Betasept Surgical Scrub [OTC]
- Dyna-Hex 2 [OTC]
- Hibiclens [OTC]
- Hibistat [OTC] [DSC]
- Tegaderm CHG Dressing [OTC]
- Antibiotic, Topical
Chlorhexidine has activity against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast; it is both bacteriostatic and bactericidal, depending on its concentration. The bactericidal effect of chlorhexidine is a result of the binding of this cationic molecule to negatively charged bacterial cell walls and extramicrobial complexes. At low concentrations, this causes an alteration of bacterial cell osmotic equilibrium and leakage of potassium and phosphorous resulting in a bacteriostatic effect. At high concentrations of chlorhexidine, the cytoplasmic contents of the bacterial cell precipitate and result in cell death.
Topical: Neonates: Detectable serum concentrations have been noted following topical chlorhexidine administration (Chapman 2013; Cowen 1979; Garland 2009)
Use: Labeled Indications
Topical: Skin cleanser for preoperative skin preparation, skin wound and general skin cleanser for patients; surgical scrub and antiseptic hand rinse for healthcare personnel
Hypersensitivity to chlorhexidine or any component of the formulation
Skin cleanser for preoperative skin preparation, skin wound and general skin cleanser for patients; surgical scrub and antiseptic hand rinse for healthcare personnel: Topical:
Surgical scrub: Scrub hands and forearms for 3 minutes paying close attention to nails, cuticles, and interdigital spaces, and rinse thoroughly, wash for an additional 3 minutes, rinse, and dry thoroughly.
Surgical hand antiseptic: Lotion: Dispense 1 pumpful in palm of 1 hand; dip fingertips of opposite hand into solution and work it under nails. Spread remainder evenly over hand and just above elbow, covering all surfaces. Repeat on other hand. Dispense another pumpful in each hand and reapply to each hand up to the wrist. Allow to dry before gloving.
Healthcare personnel hand antiseptic:
Liquid or solution: Wash with ~5 mL for 15 seconds; rinse thoroughly with water and dry
Lotion: Apply to clean, dry hands and nails. Dispense 1 pumpful (2 mL) into the palm of 1 hand; apply evenly to cover both hands up to the wrists; allow to dry without wiping.
Towelette: Rub 15 seconds paying close attention to nails and interdigital spaces; no watering or toweling necessary
Preoperative skin preparation:
Solution: Apply liberally to surgical site and swab for at least 2 minutes. Dry with sterile towel. Repeat procedure (swab for additional 2 minutes and dry with sterile towel).
Applicator (ChloraPrep One-Step):
Dry surgical sites (eg, abdomen, arm): Completely wet treatment area; use gentle back and forth strokes for ~30 seconds. Allow solution to air dry for ~30 seconds. If using an ignition source (eg, electrocautery), allow solution to completely dry for a minimum of 3 minutes for hairless skin and up to 1 hour in hair; do not blot or wipe away. Note: Prior to use with electrocautery procedures, consult specific product labeling to determine if the ChloraPrep product may be used near an ignition source.
Moist surgical sites (eg, inguinal area): Completely wet treatment area; use gentle back and forth strokes for ~ 2 minutes. Allow solution to air dry for ~ 1 minute. If using an ignition source (eg, electrocautery), allow solution to completely dry for a minimum of 3 minutes for hairless skin and up to 1 hour in hair; do not blot or wipe away. Note: Prior to use with electrocautery procedures, consult specific product labeling to determine if the ChloraPrep product may be used near an ignition source.
Preparation of skin prior to an injection: Swab: Apply swab to procedure site for 15 seconds; allow to air dry for 30 seconds (do not blot or wipe dry). Note: Maximum treatment area for 1 swab is ~2.5 inches x 2.5 inches.
Wound care and general skin cleansing: Rinse area with water, then apply minimum amount necessary to cover skin or wound area and wash gently. Rinse again thoroughly.
Refer to adult dosing.
Dosing: Renal Impairment
There are no dosage adjustments provided in the manufacturer's labeling.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer's labeling.
Topical: Keep out of eyes, ears, and mouth. Do not routinely apply to wounds which involve more than superficial layers of skin. Avoid contact with meninges (ie, do not use on lumbar puncture sites). Solutions may be flammable (may contain alcohol); consult specific product labeling to determine if product may be used with electrocautery procedures; if product can be used near an ignition source (eg, cautery, laser), avoid exposure to open flame and/or ignition source until completely dry; avoid application to hairy areas which may significantly delay drying time. When using the ChloraPrep® applicator, do not touch sponge. Hold applicator sponge down and pinch wings of applicator once to activate ampul and release antiseptic.
Store at room temperature. Alcohol-containing topical products are flammable; keep away from flames or fire.
There are no known significant interactions.
If chlorhexidine is used as a disinfectant before midstream urine collection, a false-positive urine protein may result (when using dipstick method based upon a pH indicator color change).
Dermatologic: Allergic sensitization, erythema, hypersensitivity reaction, rough skin, xeroderma
<1%, postmarketing, and/or case reports: Anaphylaxis (Health Canada May 2016), dyspnea, facial edema, nasal congestion
Concerns related to adverse effects:
• Hypersensitivity reactions: Serious allergic reactions, including anaphylaxis, have been reported.
Dosage form specific issues:
• Topical: For topical use only. Keep out of eyes, ears, and the mouth; if contact occurs, rinse with cold water immediately; permanent eye injury may result if agent enters and remains in the eye. Deafness has been reported following instillation in the middle ear through perforated ear drums. Avoid applying to wounds that involve more than the superficial skin layers. Avoid repeated use as general skin cleansing of large surfaces (unless necessary for condition). Not for preoperative preparation of face or head; avoid contact with meninges (do not use on lumbar puncture sites). Avoid applying to genital areas; generalized allergic reactions, irritation, and sensitivity have been reported. Solutions may be flammable (products may contain alcohol); avoid exposure to open flame and/or ignition source (eg, electrocautery) until completely dry; avoid application to hairy areas which may significantly delay drying time. Use with caution in children <2 months of age due to potential for increased absorption, and risk of irritation or chemical burns. May cause staining of fabrics (brown stain) due to a chemical reaction between chlorhexidine gluconate bound to fabric and chlorine (if sufficient chlorine is present from certain laundry detergents used during laundering process).
• Appropriate use: Topical: When used as a topical antiseptic, improper use may lead to product contamination. Although infrequent, product contamination has been associated with reports of localized and systemic infections. To reduce the risk of infection, ensure antiseptic products are used according to the labeled instructions; avoid diluting products after opening; and apply single-use containers only one time to one patient and discard any unused solution (FDA Drug Safety Communication, 2013).
No reports of adverse effects in newborns have been reported, even though chlorhexidine is commonly used during labor and in the neonate. Moreover, only very small amounts of disinfectant reach the maternal circulation and the fetus.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience dryness or itching. Have patient report immediately to prescriber skin irritation (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.