Are you up to your neck in chlorhexidine? Good!

When I have a little downtime, I like to think of new things to coat with chlorhexidine. If my colleagues and family members aren’t interested, I sometimes debate empty chairs about the merits of chlorhexidine. But regular readers already know how much we love chlorhexidine (despite my being well aware that this love could be fleeting).

As chlorhexidine (CHG) bathing becomes commonplace for ICU patients, it becomes increasingly important to understand exactly what we’re doing, and how we ought to do it. How long does CHG retain activity after a daily application? How much reduction in skin flora can be demonstrated? Are there commonly missed body sites that could lessen the impact of the intervention?

Mary Hayden’s group has a study in this month’s ICHE that begins to address some of these questions. Using a colorimetric indicator, they measured CHG concentrations at several time points between daily CHG application (using CHG cloths*, with no rinse). They found that CHG was usually detectable on the skin for the entire 24 hour period between bathing, but that concentrations dropped over time, with microbial counts inversely associated with CHG concentrations. As the figure below shows, the microbial density at inguinal sites was lower for CHG than either soap-and-water or non-medicated cloths (as might be expected).

Interestingly, the neck region was found to have lower CHG concentrations and higher colony counts, and upon direct observation was noted to receive less thorough cleansing. This could be important, particularly given its close proximity to tracheal/endotracheal tubes and central line insertion sites, and given that it is a body site frequently touched by care givers (while changing dressings, auscultating carotids, measuring CVP, etc., etc.).

*the COI statement points out that Sage, maker of CHG cloths, funded the MIC testing in this study, though the rest of the study was funded by CDC and NAIAD.


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