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Wheeless' Textbook of Orthopaedics
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Chlorohexidine (gluconate)



- See: Skin Prep

- Discussion: (chloroprep)
    - kills cells by disrupting their cell membranes and precipitating cell contents;
    - it has extremely low toxicity even when used on the intact skin of  new borns;
    - in comparison to alcohols, antibacterial activity of chlorohexidine gluconate is not as rapid, but the drug remains chemically active for 5 to 6 hours,
               longer than any other currently used prepartion;
    - one advantage of chlorohexidene gluconate over alcohols is that it retains antibacterial action in the presence of blood and other orgainic material;
    - in the study by ME Molina MD et al, (Arthroscopy. Vol 16 (April), 2000: pp 373-378), authors evaluated 3 different sterilization agents to
                  determine which was best to treat contaminated ACL grafts;
                  - comparing an antibiotic solution of neomycin and polymyxin B, 10% providone-iodine solution, and chlorhexidine gluconate solution;
                  - of 3 sterilization techniques used, chlorhexidine gluconate seems to be most efficient w/ only a single broth culture (2%) found to be positive.
                  - antibiotic solution was second best (6%), although there is no statistically significant difference between these 2 groups;
                  - 10% providone-iodine solution was the least effective of all 3 sterilization agents with 24% cultures positive after immersion; 



- Cautions:
    - FDA Public Health Notice: Potential Hypersensitivity Reactions To Chlorhexidine-Impregnated Medical Devices








The impact of preoperative skin disinfection on preventing intraoperative  wound contamination.

Effect of antiseptics, ultraviolet light and lavage on airborne bacteria  in a model wound.

Influence of preoperative showers on staphylococcal skin colonization: a comparative trial of antiseptic skin leansers.

Effects of intra-articular chlorhexidine diacetate lavage on the stifle in healthy dogs.

The effect of chlorhexidine irrigation on tensile wound strength.

Daily scrub with chlorhexidine reduces skin colonization by antibiotic-resistant Staphylococcus epidermidis.

The mechanism of action of chlorhexidine.

The efficacy of mupirocin ointment and chlorhexidine body scrubs in the  eradication of nasal carriage of staphylococcus aureus among patients undergoing long-term hemodialysis.

Effects of four preparations of 0.05% chlorhexidine diacetate on wound healing in dogs.

The effects of chlorhexidine digluconate on human fibroblasts in vitro.

Chlorhexidine resistance in methicillin-resistant Staphylococcus aureus or just an elevated MIC.

Reduced bacteria on transplantable allograft skin after preparation with chlorhexidine gluconate, povidone-iodine, and isopropanol.

In-vitro evaluation of povidone-iodine and chlorhexidine against  methicillin-resistant Staphylococcus aureus.

The effect of whole body disinfection on intraoperative wound contamination.

Effects of whole body disinfection on skin flora in patients undergoing elective surgery.

Non-toxic antiseptic irrigation with chlorhexidine in experimental  revascularization in the rat.

Covering of the toes during hindfoot and ankle surgery: a randomized, controlled, clinical study.












Original Text by Clifford R. Wheeless, III, MD.