Common CHG bathing questions, answered

The following content is sponsored by Mölnlycke Health Care.

Surgical site infections, central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilator-associated pneumonia — what do they have in common? Beyond being harmful and costly healthcare-associated infections, they are also similar in that bundled approaches using chlorhexidine gluconate can help prevent them.

Chlorhexidine gluconate, or CHG, is a chemical with broad-spectrum antimicrobial properties. Increasingly, studies have found that, as part of a bundle, daily use of CHG is tied to decreases in rates of the aforementioned infections. For instance, a study presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology found daily bathing with CHG for pediatric patients cut bloodstream infections by 59 percent.

Additionally, studies have found that bathing with CHG can help reduce methicillin-resistant Staphylococcus aureus and Clostridium difficile infections.

But for CHG bathing to work effectively, the product must be applied properly every time. That's where hospital and staff patient education comes in, according to Ann Meyer, the clinical manager for antiseptics at Mölnlycke Health Care. Ms. Meyer spends time traveling to hospitals talking with staff about their processes and helping them incorporate CHG bathing into their protocols.

During her time in the field working with managers and front-line workers alike, Ms. Meyer has fielded many questions regarding CHG in general and also about HIBICLENS, Mölnlycke Health Care's 4 percent CHG soap product.

Below are some of the common questions or misconceptions she has encountered during her time working with hospitals.

Isn't killing all of the flora on a patient harmful? It is true that CHG will kill off normal, usually harmless, flora from a patient's skin. But, as Ms. Meyer puts it, "Why wouldn't you want it dead?"

For instance, many patients are colonized with Staphylococcus aureus, which is generally not a problem. But when a patient goes into a high-risk situation like a surgery or the intensive care unit, flora usually found on the body could cause an infection, Ms. Meyer says. Additionally, the harmless flora killed by the CHG solution will grow back in time.

Her motto is, "Bathe the patient in the hospital, protect them in the hospital, then send them home and let it [the flora] all grow back."

Aren't we developing more resistant bacteria by using CHG? Antibiotic resistance is a hot topic in healthcare today, making many front-line clinicians and managers alike more concerned with how they can contribute to slowing down the spread of antibiotic resistance. But Ms. Meyer says CHG use shouldn't be tied to the issue of antibiotic resistance.

"CHG works differently than an antibiotic; it has a different mechanism of action[1]," Ms. Meyer explains. There has been little evidence of bacteria developing resistance to clinical concentrations of CHG (4 percent and 2 percent).

If applied as soap, doesn't the CHG just wash off? Even though HIBICLENS is a soap as opposed to a disposable wipe, it is just a different way to apply the same active ingredient onto a patient, Ms. Meyer says. Once applied, CHG binds to the skin. So, even though it is a soap that does involve washing and rinsing the patient, the CHG remains on the skin and can continue to kill flora until the next daily bath.

How long does a CHG product have to remain on the skin? There has been some confusion about how long CHG soap needs to stay on the skin to be effective, according to Ms. Meyer. For instance, it may take about 10 minutes for the CHG to kill some of the more hardy germs, while others will die in the first few seconds.

"People mistakenly think that they have to allow the HIBICLENS to lay on the skin for that long," she says. The product does not need to physically remain on the skin for 10 minutes before being washed off with water, because CHG binds to the skin as it is applied.

"CHG can continue protecting a patient for up to 24 hours. As long as you applied it full-strength to the skin, it's going to work for you," Ms. Meyer says.[2]

Won't using a CHG soap be more time-consuming than a wipe? A common issue that arises if a hospital switches from a disposable CHG wipe to a soap is efficiency. Ms. Meyer says the CHG product should be as user-friendly as possible for staff, but maintains that a soap can often be as convenient as a wipe and combating the efficiency issue is as simple as educating the staff.

"We make [the process] as close as possible to what they're doing right now," she says, detailing how she and others from Mölnlycke Health Care go into hospitals, sit with the staff to understand their current processes, then make suggestions to seamlessly integrate HIBICLENS.

Soap CHG products can be integrated into any bathing protocol that's already in place, which means it may even eliminate a step when the process involves both properly bathing a patient and using a CHG wipe.

Other advantages of CHG soap

Beyond the potential for it to be a time-saver, using a CHG soap like HIBICLENS has other advantages over a disposable wipe, according to Ms. Meyer.

For instance, a CHG soap has the potential to boost patient experience. "Patients are writing online that they are dissatisfied that they did not receive a bath in the hospital," Ms. Meyer says, because they don't perceive the wipe-down with a CHG cloth as being a true bath. When CHG is applied as a soap, it eliminates that problem.  

Finally, disposable CHG wipes can carry major costs with them. According to figures from the market, such wipes can cost upwards of $5.52 per patient bath, while using a soap product is more cost-efficient while still being effective.



[2] MBT Study No. 582-106, Protocol #582.

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