Chlorhexidine (Topical Application Route)

Belonging to a group of medications called antiseptic antibacterial agents, Chlorhexidine is a topical antiseptic solution applied directly to the skin prior to surgery, before an injection or after an injury.

Overview:

When used as a sterilizing agent, Chlorhexidine is very effective at preventing infections and other complications during surgery or other medical procedures that break the skin. It is also very useful for the purpose of cleaning wounds after injuries. It is available to physicians in a wide variety of dosage forms. It can come as part of a dressing or be applied by a sponge or pad, but often is applied directly to the skin as a liquid, lotion, gel, cream or solution. It is marketed under numerous brand names in the US and Canada including the following: Betasept, Chlorostat, Biopatch, Hibiclens, and Hibistat.

The most common use of Chlorhexidine products are as a surgical scrub for a doctor to sterilize their hands prior to surgery, when it is used correctly it is one of the best for this purpose. It is also used by other healthcare professionals as a universal precaution against bacterial transmission during a variety of procedures including dental care. When used for other purposes, such as treating wounds or preparing skin for surgical incisions certain precautions may need to be taken as Chlorhexidine is a very harsh chemical agent. It is not meant to be a routine antiseptic like rubbing alcohol swabs before injections. Prolonged use of this product on the skin may have some undesirable effects.

While generally a very beneficial medical product, there is an FDA warning regarding a rare but serious allergic reaction to Chlorhexidine products. The instances of these allergic reactions have increased in recent years and more needs to be done to raise awareness about it because it is such a commonly used topical aid for a wide variety of procedures and a fundamental part of universal precautions followed by medical personnel. The most serious form of this allergic reaction is anaphylaxis, which can be life-threatening.

Condition treated:

  • Infection
  • Sepsis

Type of medicine:

  • Antiseptic antibacterial agent

Side effects:

In general, most people who use Chlorhexidine as a topical agent will not see any side effects from its use. However, as with any medication, it does have the potential to have unwanted effects along with its intended purpose as an antiseptic. The following side effects may not occur but all patients and doctors using the product should be aware of the possibility of serious side effects and what to do if they occur.

While the exact probability of side effects are not known, if any of the following occur a doctor should be informed immediately:

  • Swelling of the face, hands or feet
  • Dificulty breathing
  • Blistering
  • Skin rash
  • Swelling of extremities
  • Redness of skin or around the wound
  • Skin irritation
  • Itching
  • Peeling skin
  • Painful burning sensation at application area

Other side effects not listed may still occur. If any other side effects occur let your doctor know as soon as possible.

Dosage:

The use of this medicine will vary depending on the patient, what procedure it is used for and the condition it is treating. All orders on the label of the product should be followed although it will usually be applied by trained medical professionals. The information to follow represents the instructions of the manufacturer and should not be taken in contravention of the recommendations of your physician. If your dose is different than the averages represented here, defer to the advice of your doctor. A great number of factors will determine how much is used, including the strength of the dose, how long it has been since it was last used and the purpose of applying the Chlorhexidine.

When used in a topical dosage form (including applicators and solutions) to clean the hands the following procedure should be followed. First, wash the hands with soap and water before towel-drying. Apply the topical solution making certain to get it between the fingers and under the fingernails. Since the medicine is quick-drying it should not be either dried or washed with water after application. As a word of caution, there is very high alcohol content in this product and it presents a risk as a flammable agent. Do not apply near open flames or while smoking.

When using its liquid form, pour 5ml of the liquid into the palm of one hand. Rub hands together for at least 15 seconds making sure to apply it between the fingers and under the fingernails. As with the applicators, it should be allowed to dry on its own without a towel. Do not get hands wet after application.

When used to clean the skin or to treat a wound, Chlorhexidine should be applied using the following procedure. First rinse the area of the wound with water and apply the smallest amount of liquid to cover the wound or affected area. As a word of caution, this product should not be used on children who are younger than two years old.

Chlorhexidine is also used as a prep for surgery or an injection, when used for this purpose you should follow all the guidelines previously stated including the flammable warning. The pouch holding the applicator should be opened with care as to not touch the tip of the applicator. Rub this against the skin with the flat side using a back-and-forth motion for at least 30 seconds. Ensure that the area is completely covered by the solution before stopping the application. Allow the skin to air-dry for about one minute or until it no longer feels wet. Do not dry with a towel or wet again after application. Do not cover the area with clothing or dressings before it is completely dry as this can absorb the product and reduce its antiseptic effectiveness. However, if it is applied to a hair area such as the scalp and excess moisture does not dry, the hair should be blotted with a towel until dry to remove the excess.

Interactions:

As a topical antiseptic, Chlorhexidine is at a very low risk to interact with other drugs. However, as with most medications, there are some recorded interactions with medications and products that the user should be aware of. It is always a good practice to inform your doctor of all drugs, vitamins, herbal remedies and supplements that you are taking as there is a chance that it may interact with Chlorhexidine in a detrimental fashion. In some cases, the doctor may decide that certain interacting medications will need to be used together despite the risks. In other cases, additional precautions may be necessary to ensure that Chlorhexidine can be safely used with them. If there is any doubt or if you have had a history of poor drug interactions discuss this with your doctor prior to using Chlorhexidine as a topical solution. As an additional note, some food and drink may not be safe to consume at the same time that Chlorhexidine is applied. Some adverse reactions have been recorded when alcohol or tobacco products were used at the same time as Chlorhexidine products.

Another concern when using Chlorhexidine is the potential to interact with medical problems that the patient has. The prescribing physician should be aware if you have a history of any of the following conditions:

  • Deep or open wounds
  • Wounds that are slow to heal
  • Excessive bleeding

Warnings:

Due to the risk of a potentially fatal allergy to Chlorhexidine, you should inform your doctor if you have had an allergic reaction to this product in the past or if you have a history of allergies to any medicine. It is a good idea to keep your medical care providers fully appraised of any allergies you have, whether or not it is related to your medical care.

If you notice your skin condition becoming worse after Chlorhexidine is applied, inform your doctor immediately. If there is irritation of the skin that does not subside (including red, itchy skin or a burning sensation) this may be an indicator of a serious allergic reaction.

Chlorhexidine should not be used as an extended treatment or for treatment of large parts of the body. This powerful topical antiseptic should be used only as directed by your doctor. It can also result in serious injury if it is applied to bodily openings including the eyes, ears, and mouth. Instructions included with this product should be followed closely to prevent harm to the patient. If instructions are present regarding washing of clothes be careful to follow these instructions as Chlorhexidine can have an unfavourable reaction to the bleach in some cleaning products. Be careful of application around open flames, a heater or electronic devices as the solution has high alcohol content and is extremely flammable. Only apply Chlorhexidine in a well-ventilated area.

Storage:

In general, Chlorhexidine products will be maintained at a hospital, but if you apply it at home follow the guidelines that are listed on the package. Keep this product secure and out of the reach of children or pets and make sure to dispose of the product when it is no longer needed. If it is past its expiration date do not use the Chlorhexidine product. Store the product appropriately in its sealed container at room temperature. It should be kept away from any source of heat, moisture or direct light. This product should not be allowed to freeze. Additionally, as a flammable product, care should be taken to store it where it will not be at risk to be exposed to a source of fire or electricity.

Summary:

As a topical antiseptic used to combat potential bacterial infections, Chlorhexidine is a very effective medical solution. Chlorhexidine products are generally used in hospital settings or at clinics to prepare patients for injections or surgical procedures. It is usually applied by a nurse or other qualified healthcare professional. In some cases, it may be necessary for the patient to apply Chlorhexidine themselves, such as home-use for self-administered injections or IVs. This is not ideal as there is a potential to overuse the product and this can cause serious skin irritation. It is very important that this product is used as directed and it should not be used for an extended period of time.

Different forms of Chlorhexidine are used for different conditions and with different instructions, these should be followed carefully. A patient should be fully appraised of the potential ill effects before being prescribed any of these products for self-application or home care purposes. If you have been provided with a Chlorhexidine product for this purpose, be sure to follow all doctors orders to include how to clean the skin before and after application. Chlorhexidine is a product that is unsafe to use on anything other than the skin. If the patient gets it in their eyes, mouth, nose or if it is swallowed this should be treated as a poisoning event. Additionally, it should not be used on the genital area and if any is applied to this part of the body it should be washed off immediately.

 

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Last Reviewed:
January 31, 2018
Last Updated:
February 09, 2018