Chlorhexidine Gluconate is a broad-spectrum antiseptic and disinfectant used in a variety of medical, dental, and cosmetic applications. It is an antimicrobial agent effective against a wide range of bacteria, fungi, and some viruses. Chlorhexidine Gluconate is commonly found in products like mouthwashes, surgical scrubs, skin cleansers, and wound care products due to its ability to reduce the risk of infections.

Chemical Composition and Structure

Chlorhexidine Gluconate is a salt formed from the combination of chlorhexidine (a biguanide compound) and gluconic acid. The chemical structure includes:

• Chlorhexidine: The active antimicrobial component, which contains a central biguanide group attached to two chlorophenyl groups.
• Gluconate: The counterion, a gluconic acid derivative that enhances the solubility of chlorhexidine in water.

The presence of these components gives Chlorhexidine Gluconate its characteristic ability to bind to cell membranes, disrupting their integrity and causing microbial cell death.

Physical Properties

• Appearance: Chlorhexidine Gluconate is typically a colorless to pale yellow liquid, depending on its concentration.
• Odor: It has a faint, somewhat medicinal odor.
• Solubility: Chlorhexidine Gluconate is highly soluble in water and alcohol, making it easy to incorporate into aqueous solutions or alcohol-based formulations.
• Stability: It is generally stable under standard conditions but can degrade if exposed to light and high temperatures. It is best stored in opaque containers.

Benefits and Functions

• Antimicrobial activity: Chlorhexidine Gluconate is effective against a wide range of microorganisms, including Gram-positive and Gram-negative bacteria, fungi, and some viruses.
• Skin antiseptic: It is widely used as a skin antiseptic before surgical procedures or in wound care products to prevent infections.
• Oral hygiene: Chlorhexidine Gluconate is commonly used in mouthwashes and dental products for its ability to reduce oral bacteria, helping to prevent plaque formation, gingivitis, and oral infections.
• Long-lasting effect: Chlorhexidine binds to the skin and mucous membranes, providing a sustained antimicrobial effect even after the initial application, which is why it is often used in prolonged infection control measures.

Applications

Medical Applications

• Pre-surgical skin disinfection: It is often used in hospitals and clinics as a pre-surgical skin antiseptic to reduce the risk of postoperative infections.
• Wound care: Chlorhexidine Gluconate is included in certain wound care products like cleansers and dressings to prevent bacterial growth and promote healing.
• Dental care: It is used in mouthwashes and dental gels to reduce bacteria in the mouth, preventing gum disease and oral infections.

Cosmetic and Personal Care

• Skin cleansers: It is used in some body washes and facial cleansers, particularly those designed for acne treatment, due to its ability to kill acne-causing bacteria.
• Antiseptic hand sanitizers: Some hand sanitizers include Chlorhexidine Gluconate for added antimicrobial properties.

Environmental and Safety Considerations

• Biodegradability: Chlorhexidine Gluconate is not highly biodegradable and should be disposed of with care. It can accumulate in water sources, potentially affecting aquatic life.
• Safety Profile: While generally considered safe for topical use, Chlorhexidine Gluconate can cause irritation in sensitive individuals. It may cause skin rashes, allergic reactions, or staining of the teeth if used improperly or for extended periods.
• Precautions: Chlorhexidine should not be used near the eyes or in large quantities on mucous membranes without supervision, as it can cause irritation or allergic reactions.

References__________________________________________________________________________

Jusino-Leon GN, Matheson L, Forsythe L. Chlorhexidine Gluconate Baths: Supporting Daily Use to Reduce Central Line-Associated Bloodstream Infections Affecting Immunocompromised Patients. Clin J Oncol Nurs. 2019 Apr 1;23(2):E32-E38. doi: 10.1188/19.CJON.E32-E38. 

Abstract. Background: Chlorhexidine gluconate (CHG) has a broad-spectrum antimicrobial property that has proven to be effective in prolonging skin antisepsis and decreasing pathogens often seen in oncology units. Objectives: The aim was to reduce the incidence of central line-associated bloodstream infections in a hematology-oncology unit through the staff's continued adherence to the institution's protocol for CHG baths with wipes, and to identify barriers and the degree to which they interfered with optimal use of the CHG wipes. Methods: The project focused on supporting staff and nurses by providing education and training on current practices to staff and patients, and identifying barriers. Direct observation and chart audits were the approach chosen to implement the project. Findings: For the project study period, the unit had three nonpreventable bloodstream infections and zero preventable bloodstream infections.

Main RC. Should chlorhexidine gluconate be used in wound cleansing? J Wound Care. 2008 Mar;17(3):112-4. doi: 10.12968/jowc.2008.17.3.28668. 

Abstract. The antiseptic chlorhexidine gluconate is available as a hand scrub and, in a weaker dilution, as a wound cleanser. The former is often used in wound care, although there is little evidence to support the use of either dilution as a cleanser.

Reynolds SS, Woltz P, Keating E, Neff J, Elliott J, Hatch D, Yang Q, Granger BB. Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial. Implement Sci. 2021 Apr 26;16(1):45. doi: 10.1186/s13012-021-01112-4. 

Abstract. Background: Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff's compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff's knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates.....Results: Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff's knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Conclusions: Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices.

Rubin C, Louthan RB, Wessels E, McGowan MB, Downer S, Maiden J. Chlorhexidine gluconate: to bathe or not to bathe? Crit Care Nurs Q. 2013 Apr-Jun;36(2):233-6. doi: 10.1097/CNQ.0b013e31828404d1.

Abstract. Despite infection-prevention initiatives, hospital-acquired infections (HAIs) are still a common occurrence. Chlorhexidine gluconate (CHG) is an important antibacterial agent. Research indicates that the intervention of bathing with CHG can reduce the number of HAIs. Chlorhexidine gluconate is known to reduce the bioload of several bacteria, including multiple strains of methicillin-resistant Staphylococcus aureus. Research regarding the intervention of bathing with CHG was assessed and found to reduce central line-related blood stream infections, ventilator-associated pneumonia, and vancomycin-resistant enterococci. The reduction in HAIs was found to be greater as compared to bathing with soap and water. The reduction of these HAIs will allow for a saving of resources, finances and staff time, which may ultimately be passed on to the patient. While further research is indicated, a strong conclusion is drawn that bathing with CHG reduces the number of HAIs.