Understanding the Broad-Spectrum
Antimicrobial Action of Chlorhexidine to Reduce CLABSI

Understand the properties of chlorhexidine in supporting strategies to reduce central line-associated bloodstream infections (CLABSI). It highlights the widespread adoption and clinical benefits of this antiseptic.
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What is Chlorhexidine?

Chlorhexidine is a leading broad-spectrum antiseptic and is a standard of care in infection prevention. In healthcare, chlorhexidine solutions are routinely used for skin preparation, bathing of critical care and surgical patients, hand hygiene products, dressings, ointments and creams for skin care. In addition, a variety of products may be coated with chlorhexidine including surgical mesh, implants and vascular access devices.

Chlorhexidine has been used for antiseptic properties for OVER 70 YEARS

The History of Chlorhexidine

1950

1950s

Chlorhexidine is discovered in the UK during the research and creation of anti-malarial agents.1
1954

1954

The Imperial Chemical Industries, Limited publishes their findings in an article illuminating the potential of chlorhexidine.1
1954

1954

Chlorhexidine digluconate is first released commercially in the UK as a disinfectant and topical antiseptic.1
1970

1970s

Chlorhexidine is introduced in the U.S. Published studies show impact on handwashing with Chlorhexidine, shown to reduce skin flora by up to 92%.1
1976

1976

Chlorhexidine's promise as an oral agent is first recognized as it demonstrates the ability to inhibit the formation and development of plaque.1
1988

1988

The first chlorhexidine and alcohol skin preparation combination is launched in the U.S.1
1990

1990

The first chlorhexidine-based vascular access catheter, Arrowg+ard Blue™ Technology, becomes commercially available in the U.S. It is impregnated with chlorhexidine and silver sulfadiazine.2
1993

1993

The first chlorhexidine sponge dressing is cleared by the FDA.1
2000

2000

Arrowg+rd Blue Plus™ Antimicrobial Protection launched in the U.S.3
2002

2002

CDC Recommends use of antimicrobial CVCs.4
2011

2011

CDC Guidelines state antimicrobial CVCs as a Category 1A recommendation and maximal barrier precautions as a Category 1B.2
2012

2012

Arrowg+ard Blue Advanced™ Technology 510k Antimicrobial and Antithrombogenic Protection.3
2014

2014

SHEA Guidelines recommend antimicrobial-impregnated CVCs.4
2024

2024

INS Guidelines Highest Evidence Rating (I) designated for use of antimicrobial catheters to reduce risk of CLABSI.5

What forms of Chlorhexidine are available?

There are several forms and salts of chlorhexidine available, each with significant differences in terms of solubility, such as Chlorhexidine digluconate (CHG), Chlorhexidine dihydrochloride (CHD), Chlorhexidine diacetate (CHA) and Chlorhexidine base (CHX). Depending on the clinical use of a product, different salts of chlorhexidine are utilized.

Forms of Chlorhexidine

Main characteristics

Forms of Chlorhexidine & Main characteristics

Chlorhexidine digluconate (CHG)
  • Highly soluble in water
  • Ideal for use in skin preparation and disinfecting solutions
Chlorhexidine diacetate (CHA) and Chlorhexidine base (CHX)
  • Less soluble in water
  • Primarily bonded to polyurethane and other surfaces for use in medical devices (such as vascular catheters)
  • Controlled release over a prolonged period

How does Chlorhexidine work?

Chlorhexidine’s antimicrobial effect works through electrostatic interactions, causing breakage and cell death.
Step 1

The positively charged chlorhexidine works by binding to negatively charged sites on the bacteria and fungi cell walls.

Step 2

The chlorhexidine molecule causes the cell wall to rupture.

Step 3

The leakage of cellular fluid ultimately leads to lysis and cell death.

Step 4

Chlorhexidine has been documented to kill most organisms in under 30 seconds.9

Fast-acting

Acts within seconds to minutes,
depending on microbial type,
preventing bacterial cell replication,
which would occur in about 20 minutes.

Nonspecific

Targets fundamental components
of microbial cell membranes,
which are present in
a wide range of microorganisms.

Bacteriostatic & bactericidal effects

At low concentrations,
it disrupts the cell wall and
membrane, inhibiting bacterial
growth (bacteriostatic).
At higher concentrations,
it causes further breakdown,
releasing cytoplasmic fluid
and destroying the nucleus
and genetic material (bactericidal).

How does Chlorhexidine differ from antibiotics?

Main differences compared to antibiotics:

Antibiotics are generally slow-acting and designed to target specific cellular and genetic structures, unique to particular microbial types.
If the bacteria mutates, the antibiotic may no longer be effective. This genetic change is how bacteria evolve into multi-drug-resistant organisms.
While certain pathogens may develop some tolerance to Chlorhexidine, meaning slightly higher amounts may be required to get killing effect, it is highly unlikely that Chlorhexidine would become ineffective against a particular pathogen.10

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References:

  1. About Chlorhexidine: History of Chlorhexidine. Chlorhexidine Partners Network. 2012
  2. 510(K) clearance for Arrowg+ard Blue Antimicrobial Multi-Lumen Central Venous Catheter received 1990.3.
  3. 510(K) clearance for Arrowg+ard Blue Plus Multi-Lumen Central Venous Catheter received March 2000.
  4. O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51(RR-10):1-29.
  5. O’Grady NP, Alexander M, Burns LA, et al; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections, 2011. CDC. Updated October 2017. Accessed January 29, 2024. https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf
  6. 510(K) clearance for Arrowg+ard Blue Advance PICC in May 2012.
  7. Compendium of strategies to prevent healthcare-associated infections in acute care hospitals. SHEA. Accessed January 29, 2024. https://shea-online.org/compendium-of-strategies-to-prevent-healthcare-associated-infections-in-acute-care-hospitals.
  8. Nickel B, Gorski LA, Kleidon TM, et al. Infusion therapy standards of practice. J Infus Nurs. 2024;47(suppl1):S1-S285.
  9. Genuit, Thomas, Grant Bochicchio, Lena M. Napolitano, Robert J. McCarter and Mary-Claire Roghman. "Prophylactic Chlorhexidine Oral Rinse Decreases Ventilator-Associated Pneumonia in Surgical ICU Patients." Surgical Infections March 2001, 2(1): 5-18. doi:10.1089/109629601750185316.
  10. Aftab, R., Dodhia, V.H., Jeanes, C. et al. Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data. Sci Rep 13, 347 (2023). https://doi.org/10.1038/s41598-022-26658-1

Contraindications:

The Arrowg+ard Blue™ and Arrowg+ard Blue Plus™ Catheters are contraindicated for patients with known hypersensitivity to chlorhexidine, silver sulfadiazine and/or sulfa drugs.

Clinical assessment of the patient must be completed to ensure no contraindications exist. Arrowg+ard Blue Advance™ Catheters are contraindicated in the following areas:

No correlation between in vitro/in vivo testing methods and clinical outcomes have currently been ascertained.

Teleflex, the Teleflex logo, Arrow, Arrowg+ard Blue, Arrowg+ard Blue Advance, and Arrowg+ard Blue Plus are trademarks of Teleflex Incorporated or its affiliates, in the U.S. and/or other countries. All other trademarks are trademarks of their respective owners. MCI-102066

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