A Patient's Guide on How to use chlorhexidine wipes before surgery?

Using chlorhexidine gluconate (CHG) wipes has been shown to reduce surgical site infections (SSIs) by as much as 50% in some studies, underscoring its vital role in modern surgical preparation. Knowing how to use chlorhexidine wipes before surgery is therefore a crucial step in ensuring your personal safety and a successful outcome.

Quick Summary

This article provides a comprehensive, step-by-step guide for patients on the correct use of chlorhexidine wipes, also known as CHG wipes, for preoperative skin preparation. It details the timing, application process, and important safety precautions to reduce the risk of surgical site infections.

Key Points

• Pre-Wipe Hygiene: Take a regular shower or bath first, dry completely with a clean towel, and ensure skin is cool and dry before applying wipes.

• Strategic Application: Use a new wipe for each body section, starting from the neck down, and always avoid sensitive areas like the face, eyes, ears, and genitals.

• Do Not Rinse: The long-lasting antiseptic effect of chlorhexidine relies on it remaining on the skin. Do not rinse the solution off after wiping.

• Timing is Important: Follow the prescribed schedule, which typically involves wiping the night before and again the morning of surgery, to achieve maximum antimicrobial effect.

• Monitor for Allergies: Be aware of signs of an allergic reaction, such as a rash, itching, or swelling. Stop use immediately and contact your doctor if symptoms appear.

• Avoid Other Products: Do not apply any lotions, powders, perfumes, or makeup to the treated skin, as they can interfere with the antiseptic's effectiveness.

• Proper Waste Disposal: Dispose of the used wipes in the trash, not down the toilet, to prevent plumbing issues.

The Importance of Chlorhexidine Wipes in Surgical Preparation

Chlorhexidine gluconate, or CHG, is a powerful antiseptic used to clean the skin before surgery. The primary goal of this preoperative cleansing is to reduce the number of germs, or bacteria, on the skin's surface, particularly at and around the surgical site. All humans have a natural flora of germs on their skin, and while normally harmless, these microorganisms can potentially cause an infection if they enter the body through a surgical incision. By following a specific protocol for using CHG wipes, you significantly minimize this risk, contributing directly to your surgical outcome and recovery.

The Pharmacology Behind the Antiseptic Effect

Chlorhexidine is a positively charged molecule that binds to the negatively charged cell walls of bacteria, fungi, and some viruses. This binding action disrupts the microbial cell membrane, causing the contents to leak out and ultimately killing the organism. The sustained release of chlorhexidine from the skin after application provides a prolonged antimicrobial effect, known as substantivity, that can last for hours. This residual activity is a key reason CHG is often preferred over other antiseptics for surgical preparation. It is also less affected by body fluids like blood compared to some alternatives, maintaining its effectiveness throughout the procedure.

Step-by-Step Instructions for Using CHG Wipes

Always follow your healthcare provider's specific instructions, as they may differ based on your procedure. The following is a general protocol based on standard hospital guidelines.

The Night Before Surgery

1. Take a Regular Shower or Bath: Wash your hair and face with your normal shampoo and soap. Rinse thoroughly to remove any residue.
2. Dry Off Completely: Use a clean, fresh towel to pat yourself dry. It is crucial to ensure your skin is completely dry and cool before proceeding, as warm, moist skin can increase the risk of irritation.
3. Wait at Least an Hour: Allow at least 60 minutes after your regular shower for your skin to cool down and dry completely.
4. Use the CHG Wipes: Open the package containing the chlorhexidine cloths. You will typically receive a set of six cloths. Use them in the following order, ensuring you use a new cloth for each body area:
   • Cloth 1: Wipe your neck and chest, avoiding your face and ears.
   • Cloth 2: Wipe both arms, from the shoulder down to the fingertips, including the armpits.
   • Cloth 3: Wipe your abdomen and hips, including skin folds, and outer buttocks. Avoid the genital and rectal area.
   • Cloth 4: Wipe one leg, from the thigh down to the toes, including behind the knee and between the toes.
   • Cloth 5: Wipe the other leg in the same manner as the first.
   • Cloth 6: Wipe your back, from the base of your neck down to your waist. If you need assistance for hard-to-reach areas, ask for help.
5. Let Your Skin Air-Dry: Do not rinse off the solution after using the wipes. Allow your skin to air-dry completely. It is normal for your skin to feel a little sticky until it dries.
6. Dress in Clean Clothes: Put on clean pajamas or nightwear and sleep in freshly laundered sheets.

The Morning of Surgery

• Do Not Shower: Do not take a shower or bath in the morning. The antiseptic effect of the CHG is meant to remain on your skin.
• Repeat the Wipe Process: Repeat the entire wiping process exactly as you did the night before. Use all the remaining cloths provided.
• Air-Dry and Dress: Let your skin air-dry completely and put on the clean clothes or gown provided by the hospital.
• Do Not Apply Products: Avoid applying any lotions, powders, perfumes, deodorants, or makeup after using the wipes.

Comparison of Preoperative Antiseptics

Feature	Chlorhexidine Gluconate (CHG)	Povidone-Iodine (Betadine)	Plain Soap and Water
Antimicrobial Activity	Broad-spectrum, effective against a wide range of bacteria, fungi, and some viruses.	Broad-spectrum, effective against bacteria, viruses, and fungi.	Basic cleansing, removes some transient bacteria but has no residual effect.
Residual Effect	Excellent and prolonged, lasting for at least 6 hours, sometimes up to 48 hours, due to binding to the skin.	Minimal residual activity after application and easily deactivated by blood.	None. Bacteria begin to regrow immediately after washing.
Speed of Action	Very rapid, effective within 20-30 seconds.	Slower onset of action compared to CHG.	Instantaneous removal of surface germs, but with no lasting effect.
Effectiveness	Studies consistently show superior performance to povidone-iodine in preventing SSIs.	Less effective than CHG in preventing SSIs according to meta-analyses.	Substantially less effective than antiseptic preparations for SSI prevention.
Application	Leave-on, rinse-free formula in wipes or a no-rinse solution.	Typically rinsed off after scrubbing.	Rinse thoroughly with water.
Common Side Effects	Rare but possible skin irritation, dryness, or rash. Rare cases of severe allergic reaction (anaphylaxis).	Potential for skin irritation. May cause allergic reactions in some individuals.	Generally mild, depends on soap sensitivity.

Important Safety Precautions

Adherence to safety guidelines is critical when using CHG wipes to avoid adverse effects. While generally safe, improper use can lead to irritation or more serious issues.

• Avoid Sensitive Areas: Do not use the wipes on your face, head, or genital and rectal areas unless specifically instructed otherwise by your surgeon. If accidental contact with eyes, ears, or mouth occurs, rinse thoroughly with water.
• Do Not Use on Broken Skin: Do not apply CHG wipes to open wounds, cuts, or irritated skin, as this can cause further irritation.
• Recognize Allergic Reactions: Although rare, severe allergic reactions (anaphylaxis) to chlorhexidine can occur. Symptoms include wheezing, difficulty breathing, swelling of the face, or hives. Stop using the product immediately and contact your doctor if you experience any signs of an allergic reaction.
• Check for Allergies: Always inform your healthcare provider if you have a known allergy to chlorhexidine or any topical antiseptics. Alternative skin preparation methods, such as using povidone-iodine or regular soap, can be used if you have a CHG allergy.
• Do Not Shave: Avoid shaving the surgical area for at least 24 to 48 hours before using the CHG cloths. Microscopic nicks from shaving can increase the risk of infection. If hair removal is necessary, your hospital team will use special clippers on the day of surgery.
• Flammability Warning: Products containing alcohol-based CHG are flammable. Avoid using them near open flames, heaters, or electrical devices.
• Fabric Stains: CHG can cause brown stains on fabrics if they are washed with chlorine bleach. Use non-chlorine bleach for laundry.

Conclusion

Using chlorhexidine wipes before surgery is a fundamental and effective step in minimizing the risk of surgical site infections. By carefully following the timing, application sequence, and safety precautions, you can ensure that the antiseptic works effectively. The extended antimicrobial action of CHG provides robust, long-lasting protection against skin pathogens, making it a critical component of modern preoperative patient care. Always remember that your adherence to these instructions, as provided by your healthcare team, is a key factor in promoting a safe and successful surgical outcome.

Recommended Further Reading

• FDA Drug Safety Communication on Chlorhexidine: FDA warns about reactions with antiseptic chlorhexidine gluconate

Frequently Asked Questions

What is chlorhexidine and why is it used before surgery?

Chlorhexidine gluconate (CHG) is a powerful antiseptic agent used to cleanse the skin before surgery. It kills germs on the skin and has a lasting residual effect, significantly reducing the risk of surgical site infections (SSIs).

Do I need to rinse off the chlorhexidine solution after using the wipes?

No, you should not rinse off the solution. The rinse-free formula is designed to leave a residual film of antiseptic on your skin, providing a continuous antimicrobial effect for an extended period.

Which areas of my body should I avoid when using the wipes?

You should avoid using the wipes on your face, head, eyes, ears, nose, and genital or rectal areas. These are sensitive areas that can become irritated or injured by the solution.

What should I do if I experience a skin reaction after using the wipes?

While rare, a skin reaction like a rash, itching, or redness can occur. If this happens, stop using the wipes and notify your healthcare provider. In very rare cases of a severe allergic reaction (anaphylaxis), seek immediate medical attention.

Is it okay to shave the surgical area before using the wipes?

You should not shave the surgical area within 24 to 48 hours of your procedure. Shaving can cause small cuts that increase infection risk. If hair removal is needed, the hospital staff will use clippers.

How should I dress after using the CHG wipes?

After your skin has air-dried completely, you should put on freshly laundered clothes or the clean gown provided by the hospital. It is also recommended to sleep in clean bedsheets the night before surgery.

Can I use lotions, deodorants, or makeup after using the chlorhexidine wipes?

No, you should not apply any lotions, powders, perfumes, deodorants, or makeup after using the CHG wipes. These products can interfere with the antiseptic's effectiveness and should be avoided.

Why do I have to use the wipes multiple times?

Repeated use of the CHG wipes, typically the night before and the morning of surgery, takes advantage of a 'stacked effect.' Each application further reduces the bacterial load on your skin, enhancing the overall preventative effect against infection.