Introduction
Hibiclens (chlorhexidine gluconate) is a topical antiseptic skin cleanser widely used in healthcare settings and for personal hygiene. It belongs to the biguanide class of antimicrobials and has been a cornerstone of infection prevention for decades. Hibiclens provides broad-spectrum antimicrobial activity against gram-positive and gram-negative bacteria, viruses, and fungi, making it valuable for surgical scrubbing, healthcare personnel handwashing, and patient preoperative skin preparation.
Mechanism of Action
Chlorhexidine gluconate exerts its antimicrobial effect through disruption of microbial cell membranes. The positively charged chlorhexidine molecules bind to negatively charged bacterial cell walls, causing disruption of cellular integrity. At lower concentrations, it acts bacteriostatically by causing leakage of intracellular components. At higher concentrations, it has bactericidal activity through precipitation of cytoplasmic contents and cell death. Chlorhexidine maintains substantive activity by binding to proteins in the stratum corneum, providing persistent antimicrobial effects even after rinsing.
Indications
FDA-approved indications include:
- Surgical hand scrub
- Healthcare personnel handwash
- Patient preoperative skin preparation
- Skin wound cleansing
- General skin cleansing
Off-label uses include:
- Central venous catheter site care
- Oral care in ventilated patients (lower concentration formulations)
- Acne treatment adjunct
- Decolonization of methicillin-resistant Staphylococcus aureus (MRSA)
Dosage and Administration
Surgical hand scrub: Apply 5 mL to wet hands and forearms, scrub vigorously for 3 minutes, rinse thoroughly Healthcare personnel handwash: Apply 3-5 mL to wet hands, wash for 15 seconds, rinse thoroughly Patient preoperative skin preparation: Apply generously to surgical site, scrub for 3-5 minutes, rinse thoroughly General use: Apply to wet skin, lather for 15-30 seconds, rinse thoroughly Special populations:- Pediatric patients: Use with caution due to increased skin permeability
- Geriatric patients: Consider potential for increased skin dryness
- Patients with compromised skin: Dilute or use alternative agents
Pharmacokinetics
Absorption: Minimal systemic absorption through intact skin (<1%); increased absorption through damaged skin or mucous membranes Distribution: Binds strongly to skin proteins and mucous membranes Metabolism: Not metabolized systemically Elimination: Primarily excreted unchanged in feces via biliary elimination; minimal renal excretionContraindications
- Hypersensitivity to chlorhexidine gluconate or any product components
- Use on meninges or in the middle ear due to potential neurotoxicity
- Application to large areas of damaged skin or burns
- Use during otologic surgery if perilymphatic system could be exposed
Warnings and Precautions
- Anaphylaxis: Rare but serious hypersensitivity reactions have been reported
- Eye exposure: May cause permanent corneal damage; rinse immediately with water if contact occurs
- Ototoxicity: Avoid contact with middle ear and meninges
- Skin reactions: May cause irritation, dryness, or dermatitis with prolonged use
- Chemical burns: Reported when used with electrosurgical devices or lasers
- Pregnancy: Category B - Use only if clearly needed
- Pediatric use: Increased risk of systemic absorption; use cautiously
Drug Interactions
- Incompatibilities: Anionic surfactants (soaps) may inactivate chlorhexidine; rinse thoroughly before application
- Iodine compounds: May form complexes that reduce efficacy of both agents
- Hydrogen peroxide: May cause temporary brown discoloration of skin
- Electrosurgical devices: Potential fire hazard when used together
Adverse Effects
Common (≥1%):- Skin dryness and irritation
- Itching or burning sensation
- Erythema
- Skin fissuring
- Anaphylaxis and hypersensitivity reactions
- Severe skin reactions including dermatitis
- Eye damage with accidental exposure
- Ototoxicity with middle ear exposure
- Chemical burns when used with electrosurgery
Monitoring Parameters
- Skin integrity and signs of irritation or hypersensitivity
- Signs of systemic absorption with extensive use on damaged skin
- Efficacy in reducing microbial counts for intended use
- Patient tolerance with prolonged use
- Ocular symptoms if accidental exposure occurs
Patient Education
- Use only as directed on intact skin unless otherwise instructed by healthcare provider
- Avoid contact with eyes, ears, and meninges
- Rinse thoroughly with water if accidental eye contact occurs
- Discontinue use if skin irritation, rash, or hypersensitivity develops
- Do not use with conventional soaps as they may reduce effectiveness
- Store at room temperature away from excessive heat
- Keep out of reach of children
- Report any adverse reactions to healthcare provider
References
1. FDA prescribing information for Hibiclens (chlorhexidine gluconate) solution. Revised 2022. 2. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999;12(1):147-179. 3. Maiwald M, Chan ESY. The forgotten role of alcohol: a systematic review and meta-analysis of the clinical efficacy of chlorhexidine-alcohol. J Hosp Infect. 2012;81(1):1-12. 4. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis. 2008;46(2):274-281. 5. National Healthcare Safety Network (NHSN). Centers for Disease Control and Prevention. Surgical Site Infection Guidelines, 2022. 6. O'Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193. 7. World Health Organization. WHO Guidelines on Hand Hygiene in Health Care. 2009.