Chlorhexidine gluconate (CHG) is a powerful antiseptic used in healthcare settings to reduce bacteria on a patient’s skin and prevent healthcare-associated infections (HAIs). The correct application process is critical to ensure the solution's effectiveness and to avoid potential skin irritation or inactivation. This guide provides a detailed look into the standard operating procedures for both CHG wipes and liquid solutions, emphasizing the importance of working from the cleanest to the dirtiest areas of the body.
Step-by-Step Guide for CHG Wipes
Pre-packaged CHG wipes are a common and convenient method for bathing, particularly for immobile or critically ill patients. A typical pack contains a set of six cloths, designed for different sections of the body.
Preparation and Supplies
- Gather equipment: Collect a pack of warmed CHG cloths, clean towels, and fresh linens and clothing.
- Warm the cloths (optional): Wipes can be warmed in a designated warmer, but never in a microwave.
- Perform initial cleansing: Clean away any dirt, urine, or feces with regular water and washcloths, not soap, before applying CHG.
Application Order for Wipes
Follow this sequence to ensure the antiseptic is applied correctly and without re-contaminating clean areas:
- First Cloth: Use the first cloth for the neck, chest, and abdomen, massaging firmly to activate the antiseptic properties.
- Second and Third Cloths: Use one cloth for each arm, including the armpits and hands. Wipe from the shoulder down to the fingertips.
- Fourth and Fifth Cloths: Use one cloth for each leg and foot, wiping from the thigh down to the toes and between the toes.
- Sixth Cloth: Use the final cloth for the back and buttocks, cleaning from the neck down. Assistance may be needed for hard-to-reach areas.
- Let skin air dry: Allow the CHG to completely air dry. Do not pat with a towel or apply any lotions, powders, or deodorants afterward, as these can interfere with the CHG's residual effect.
Step-by-Step Guide for Liquid CHG Solution
Using a liquid CHG solution often involves a bath or shower, and requires careful attention to application and rinsing procedures.
Preparation and Supplies
- Gather equipment: Obtain the liquid CHG solution, a clean (non-cotton) washcloth or mesh sponge, a clean towel, and clean garments.
- Wash face and hair: First, wash the patient's hair and face with regular soap and water, and rinse thoroughly. Some protocols do permit using diluted CHG for the face, but always check institutional guidelines.
Application Order for Liquid
- Apply to body: Turn the water off and apply the CHG solution from the neck down. Avoid sensitive areas like the face, eyes, ears, mouth, genitals, and any open wounds.
- Lather and wait: Lather the CHG gently across the body using the washcloth or sponge. Let the lather sit on the skin for up to 2 minutes, as per protocol, for maximum antiseptic effect.
- Rinse completely: After the waiting period, rinse the body completely with warm water. Do not use regular soap after the CHG application.
- Air dry or pat dry: Pat the patient dry with a clean towel. Avoid applying other products that could inactivate the CHG.
Precautions and Best Practices
- Avoid sensitive areas: Never apply CHG to a patient's face, eyes, ears, mouth, or internal genitalia.
- Open wounds: Do not use CHG on deep wounds, open skin, or burns without explicit medical guidance.
- Medical Devices: CHG is safe to use on and around medical devices like catheters and dressings. After bathing the body, be sure to clean the 6-inch portion of any tubes closest to the patient's body.
- Incontinence: For patients with incontinence, always clean visible soiling with water and a separate cloth first before starting the CHG bath.
- Allergic Reactions: Monitor for signs of skin irritation, such as redness, burning, or a rash. Stop use and contact a healthcare provider if a reaction occurs.
Comparison of CHG Wipes vs. Liquid Wash
| Feature | CHG Wipes (No-Rinse) | Liquid CHG Solution |
|---|---|---|
| Convenience | Highly convenient, especially for bedridden patients. No need for rinsing or drying. | Requires access to a shower or basin and water. More time-consuming. |
| Application | Pre-moistened cloths, single-use per body part to prevent cross-contamination. | Requires a washcloth or sponge for lathering and application. |
| Rinsing | Not required. CHG air-dries, leaving a residual antiseptic effect. | Must be rinsed off thoroughly with water. |
| Cost | Can be more expensive per bath than liquid solution. | Generally more cost-effective for large-scale use. |
| User Preference | Often preferred by nurses for efficiency and ease of use. | Some patients may prefer the feel of a traditional soap and water wash. |
| Moisture | Often contains moisturizers, helping to prevent skin dryness. | Can sometimes cause skin dryness if not formulated with moisturizers. |
Conclusion
Adhering to the correct order of bathing patients with CHG wash is a fundamental component of effective infection control in healthcare. The top-down, clean-to-dirty sequence ensures that bacteria are not spread from contaminated areas to cleaner ones, maximizing the antiseptic's germ-killing potential. By following standardized protocols for either wipes or liquid solutions, healthcare providers can provide safer, more consistent care and significantly contribute to reducing the risk of dangerous hospital-acquired infections. For the most authoritative guidance, healthcare professionals should always consult specific institutional policies and manufacturers' instructions. For further reading on standardized bathing protocols, the Agency for Healthcare Research and Quality (AHRQ) provides detailed documentation: Agency for Healthcare Research and Quality - CHG Bathing Protocols.
