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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;
    - Molina, et al. (2000), authors evaluated 3 different sterilization agents to determine best way 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; 
                  - Contaminated anterior cruciate ligament grafts: the efficacy of 3 sterilization agents.

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

Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis

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? An in vitro and in vivo assessment.

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.

Preoperative Footbaths Reduce Bacterial Colonization of the Foot 

Time-Dependent Effects of Chlorhexidine Soaks on Grossly Contaminated Bone

Chlorhexidine burns after shoulder arthroscopy.

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