Chlorhexidine Gluconate [4%]

• Preoperative Skin Antisepsis: Used for surgical site skin preparation to reduce microbial flora and prevent surgical site infections.
• Disinfection of Skin Prior to Invasive Procedures: Including injections, catheter insertions, and blood draws.
• Wound Cleansing: For minor wounds, abrasions, and burns to prevent infection.
• Hand Hygiene: Used as a surgical hand scrub and antiseptic hand wash in healthcare settings.
• Disinfection of Medical Devices: Cleaning and sterilization of medical equipment surfaces.
• Off-label Uses: May be used in intensive care units for central line-associated bloodstream infection (CLABSI) prevention protocols.

• Topical Application: Apply 4% chlorhexidine gluconate solution to the skin using sterile gauze or applicators. The site should be allowed to dry completely before any surgical procedure or application of dressings.
• Surgical Hand Scrub: Used according to institutional protocols, typically involving a 2 to 6-minute scrub prior to surgery.
• Frequency: Once prior to surgery or invasive procedure. For wound cleansing, apply once or twice daily as directed.
• Special Populations: Use with caution in neonates, elderly, and patients with skin conditions. No dose adjustment is typically required.
• Duration: As clinically indicated for skin antisepsis or wound care.

Chlorhexidine gluconate 4% is a cationic bisbiguanide antiseptic that interacts with the negatively charged phospholipids in microbial cell membranes. This interaction causes disruption of the membrane integrity, leading to leakage of intracellular contents. At this concentration, it exhibits bactericidal activity through precipitation and coagulation of cytoplasmic proteins and nucleic acids. The drug is effective against a wide range of Gram-positive and Gram-negative bacteria, fungi, and some viruses. Additionally, chlorhexidine adsorbs to the skin and mucous membranes, providing persistent antimicrobial activity for prolonged protection.

• Absorption: Minimal systemic absorption through intact skin, even at 4% concentration.
• Distribution: Primarily remains localized at the site of application with strong binding to skin proteins.
• Metabolism: Not metabolized systemically when used topically.
• Excretion: Not applicable due to negligible systemic absorption.
• Half-life: Not clinically significant in topical use.

• Pregnancy: Category B. Topical use at 4% is considered safe during pregnancy as systemic absorption is minimal.
• Lactation: No evidence of harm; considered safe when used topically with negligible transfer into breast milk.

• Topical antiseptic and disinfectant.

• Known hypersensitivity to chlorhexidine or any excipients in the formulation.
• Severe skin conditions at application site (e.g., eczema or dermatitis).
• Use contraindicated in patients with a history of allergic contact dermatitis to chlorhexidine.
• Not for use in eyes, ears, or intravascular injection.

• Avoid contact with eyes, ears, and mucous membranes.
• Allow the solution to dry completely before draping or using heat sources to avoid fire risk due to flammability.
• Discontinue use if signs of hypersensitivity or severe skin irritation occur.
• Rare cases of anaphylaxis have been reported; monitor for allergic reactions especially during first exposure.
• Use cautiously in neonates and elderly patients with fragile skin.
• Avoid application to large open wounds or burns without medical supervision due to potential systemic absorption.

Common:

• Local skin irritation, redness, burning, or stinging sensation at the application site.
• Dryness or scaling of skin.

Serious/Rare:

• Allergic contact dermatitis.
• Anaphylactic reactions (rare).
• Eye irritation upon accidental exposure.

• No significant systemic drug interactions due to minimal absorption.
• May be inactivated by anionic detergents and soaps; avoid simultaneous use.
• No known significant interactions with food or alcohol.

• Reinforced as the antiseptic of choice for surgical skin preparation and central line insertion sites due to superior efficacy in infection prevention.
• Increased clinical awareness about rare but potentially severe hypersensitivity and anaphylaxis cases, prompting careful patient monitoring.
• Updated guidelines recommend chlorhexidine gluconate 4% for skin antisepsis over povidone-iodine in many surgical settings.

• Store at controlled room temperature 20°C to 25°C (68°F to 77°F).
• Protect from freezing, heat, and direct sunlight.
• Keep container tightly closed and avoid contamination.
• Keep away from open flames and ignition sources due to flammability risk.