Use of 2% Chlorhexidine Wipes for Bathing Treatment Welcome to a brief Power Point training reviewing the basics for either bathing with 2% CHG impregnated wipes. Purpose: To prevent colonization of Multi-Drug Resistant Organisms

Purpose of the training: To provide a brief summary of 2% CHG bathing treatment Disclaimer: the authors of this training do not endorse any particular manufacturer’s CHG product. The purpose of providing these training slides is to provide a brief summary of 2% CHG application using impregnated wipes for health care workers interested in implementing CHG application for their patients or residents. Daily use of CHG for bathing or treatments is recommended for hospitalized patients or residents in long term care as a means of reducing colonization of Multi-Drug Resistant Organisms on the skin of patients. The final slide in this training includes references to studies using daily CHG bathing for hospitalized patients. The authors of this training do not endorse any particular manufacturer’s CHG product. Follow your facility’s policy for obtaining products. Currently the only manufacturer of impregnated 2% CHG wipes is Sage, contact a Sage representative for further information regarding these products.

Definitions For the purposes of this training: A patient is either a hospitalized patient OR a resident in a long term care facility CHG treatment is referred to as application of 2% Chlorhexidine from an impregnated wipe by any of the following methods: a full bed bath a partial bath an application of 2% CHG wipes following a bath or shower For the purposes of this training: A patient is either a hospitalized patient OR a resident in a long term care facility CHG treatment is referred to as application of 2% Chlorhexidine from an impregnated wipe by any of the following methods: a full bed bath a partial bath an application of 2% CHG wipes following a bath or shower

Slides 4 and 5 depict a flow chart for use of the 2% CHG impregnated wipes. Feel free to print these slides for use as you implement CHG treatment for your patients. Next slide

Continued from prior slide

General principles of CHG treatment Determine 2% CHG bathing treatment frequency per your facility’s recommendation Some facilities use CHG daily, while others use less frequently (e.g., every other day). Patient may first take a bath or shower prior to application of the CHG Ensure skin is dry before administering the CHG treatment Remember to change gloves after wiping the groin and buttocks area with CHG Prevents cross contamination of potential pathogens to other parts of the body DO NOT use CHG impregnated wipes on: Face Large or deep wounds New surgical wounds Check current evidence for routine use of CHG during perineal care 2% CHG bathing treatment may be daily or less frequent (e.g., every other day), depending on your local policy. It is not recommended to use CHG on the face, on large or deep wounds, or on new surgical wounds. Please discuss the use of CHG for perineal care with your healthcare team; check current evidence. Remember to change gloves when moving from a “dirty” area to a clean area on the body.

The CHG treatment process Gather your supplies prior to entering the patient’s room. The CHG wipes can be kept in a warmer. Anticipate the number of wipes needed for your patient – each individual package holds 3 sets of 2 wipes, stock accordingly. The CHG treatment process begins with gathering the supplies needed for the treatment. The manufacturer typically supplies the unit warmers where the CHG wipes are kept. It is recommended that designated staff at your facility maintain the stocking of the CHG packets in the warmer, especially since the product has limited shelf-life after being placed in warmer.

The CHG bathing treatment process Explain the purpose of the CHG treatment to your patient. Proceed with “wiping” the body in any manner you are accustomed to for cleansing the body Apply CHG BELOW the jawline only (not used on the face or hair) Areas commonly missed are between the fingers and toes, and the six inches closest to the patient’s body when wiping a drainage tube The next steps are taking your wipes to the patient and explaining the CHG treatment to the patient. Proceed with “wiping” the body in any manner you are accustomed to for cleansing the body. CHG is applied BELOW the jawline only. It is not to be used on the face or the hair. Areas commonly missed during the CHG treatment are between the fingers and toes, and the six inches closest to the patient’s body when wiping any drainage tube. Common drainage tubes are Foley catheters, suprapubic catheters, abdominal or chest drains.

Apply wipe firmly to all skin surfaces DO NOT RINSE OFF – let the liquid air dry (it may feel sticky for up to 5 minutes while drying) If a shower or tub bath is preferred, complete as usual, dry off, and then use the wipes to cover the body areas as if bathing with the wipes. Use a new cloth for each numbered area. DO NOT USE on the face or the head. USE on all other body areas. Discard used wipes in the trash, not in the toilet. The image provides a usual application process for 2% bathing treatment using 6 wipes (3 sets of 2 wipes). The numbers show one progression for using the wipes with a single caregiver bathing a patient. If two caregivers bathe a patient, the numbered sequence changes. Feel free to adjust the sequence of using the wipes. Remember to cover all body surface below the jawline and when you are wiping down a “dirty” area such as the groin or perineum, change gloves before you proceed to the next wipe. Here are general tips for application of the CHG using the pre-moistened wipes. Apply wipe firmly to all skin surfaces. DO NOT RINSE OFF – let the liquid air dry (it may feel sticky for up to 5 minutes while drying) If a shower or tub bath is preferred, complete as usual, dry off, and then use the wipes to cover the body areas as if bathing with the wipes. Use a new cloth for each numbered area. DO NOT USE on the face or the head. USE on all other body areas. Discard used wipes in the trash, not the toilet.

Some final thoughts from actual users of the CHG bathing treatment Patients typically report a feeling of “stickiness” from the CHG wipe treatment It takes approximately 5 minutes for the CHG to dry Moisturizers are included within the product. Skin will feel soft throughout the day The patient may be dressed immediately following the CHG treatment The active CHG binds with cells quickly, the remaining dampness of the product is from the added moisturizers To prevent skin dryness with CHG bathing treatment, routinely apply a facility-approved compatible lotion to the patient’s skin after the product dries If patients develop skin irritations from the CHG treatment, discuss options with healthcare team Skin allergic reactions are rare, discontinuing product may be necessary Keep the CHG wipes (not used) during the treatment in the packets to prevent cooling quickly DO NOT microwave heat the packages Some final thoughts gathered from feedback of actual users of the CHG wipe product. Patients typically report a feeling of “stickiness” from the CHG wipe treatment. It takes approximately 5 minutes for the CHG to dry. Moisturizers are included within the product. The skin will feel soft throughout the day. The patient may be dressed immediately following the CHG treatment. The active chlorhexidine binds with cells quickly, and the remaining dampness is from the added moisturizers in the product. To prevent skin dryness, routinely apply a facility-approved compatible lotion to the patient’s skin after the product dries. Some products are not compatible with the CHG and may deactivate the CHG, so use the supplied products that have been evaluated for compatibility with the CHG. If patients develop skin irritations from the CHG bathing treatment, discuss options with healthcare team. Skin allergic reactions are rare, discontinuing product may be necessary. Keep the CHG wipes (not used during the treatment process) in the packaging to prevent cooling too quickly. DO NOT microwave heat any packages.

References Climo, M. W., Yokoe, D. S., Warren, D. K. et al. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. New England Journal of Medicine, 368, 533 – 542. Popovich, KJ. J., Hota, B., Hayes, R., Weinstein, R. A., Hayden, M. K. (2009). Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infection Control & Hospital Epidemiology, 30, 959 – 963. Rhee, Y., Palmer, L., Okamoto, K., Gemunden, S., Hammouda, K., Kemble, S., . . . Hayden, M. K. (2018). Differential effects of chlorhexidine skin cleansing methods on residual chlorhexidine skin concentrations and bacterial recovery. Infection Control & Hospital Epidemiology, 39,(4), 405 – 411.