Just in time teaching Chlorhexidine Gluconate (CHG) Cloths

Chlorhexidine Gluconate (CHG) cloths are disposable wipes moistened with a rinse-free antiseptic solution. They are alcohol free, pH balanced, and contain skin moisturizers. At Children’s we are using CHG wipes to protect patients from infection. CHG treatments reduce the amount of drug-resistant bacteria on the skin and help prevent infections. It is important to educate patients and families on the importance of CHG and provide them with the CHG bath/treatment teaching sheet. When do I use CHG? CHG Application CHG treatment CHG pre-op bath CHG prior to IV start   

Patient Population All patients with a central line (CVL, PICC, Mediport) All patients in the PICU All patients having a surgical procedure below the neck All patients of all ages unless contraindicated

Area/site Entire body below the head Surgical site and several inches beyond the surgical field PIV puncture site and several inches in all directions

CHG is only used on patients ≥ 37 weeks corrected gestational age (post-menstrual age) unless specified. If your patient is visibly dirty they must receive a bath before application of CHG. Wait one hour after the bath to apply CHG to avoid skin irritation caused by skin vasodilatation and to ensure that the CHG is activated. If your patient has a CVL and is going to surgery or is in the PICU and going to surgery you only need to complete the daily CHG bath/treatment (Refer to above table).

When is CHG contraindicated?  Patients less than 37 weeks corrected gestational age  Patients allergic or sensitive to CHG  Patients with severe skin breakdown, rashes, or burns o These patients can still receive CHG on areas of their skin that is still intact.  Do not use on the head, or genitals  Oncology patients in special circumstances o Patients receiving thiotepa or high-dose cyclophosphamide will not receive CHG the day of or the day after administration o Patients who have a Grade 3 or 4 GVHD o Patients with Grade 1 or 3 GVHD whose skin is irritated by the CHG treatment o Patients undergoing short duration radiation therapy will not receive CHG treatment on all days in which radiation therapy is administered Where do I document?  CHG wash/treatment under “cares” flowsheet in patient’s electronic health record.  Pre-op CHG bath under the Pre-Procedure checklist

© 2014 Children’s Hospital and Health System. All rights reserved. Date to review 08/2017

* Date 08/2014

Contact: Jeanne Braby

How many CHG cloths do I need to use for a CHG wash/treatment? <10kg: Use 2 cloths-1 10-30kg: Use 4 cloths-2 >30kg: Use 6 cloths-3 packet packets packets CHG Cloth 1 Neck, Chest, Both Neck, Chest and Neck, Chest and Arms, Hands, Back Both Arms, Hands Both Arms, Hands CHG Cloth 2 Both Legs, Buttocks, Back and Buttocks Right Leg Perineum CHG Cloth 3 ---------------------Both Legs Left Leg CHG Cloth 4 ---------------------Perineum Back CHG Cloth 5 ------------------------------------------Buttocks CHG Cloth 6 ------------------------------------------Perineum

How many CHG cloths do I need to use for a Pre-op bath?  Wipe the surgical area and several inches beyond the planned surgical field.  Use several cloths if necessary, but always use at least 2 cloths.  Use a separate cloth for different body areas. o Refer to Pre-operative Bathing P&P for a chart of surgical sites. What if my patient reacts to CHG?  A small amount of patients may react to CHG. If your patient develops redness or itching, wash the area with soap and water. If this does not help, have a provider assess the patient.  If your patient has a CVL with a Biopatch and the skin under the patch is unaffected, the reaction is not due to CHG. Biopatches have higher amounts of CHG that can cause skin irritation. Only use Biopatches on patients > 2 months of age. What are some special considerations when using CHG cloths?  CHG wipes are not required to be warmed. They can be warmed for patient comfort.  CHG cloths can only be warmed in the manufacturer’s warmer, NOT in the microwave or any other way.  CHG cloths can only be warmed for a maximum of 84 hours; if the warmer is flashing “expired” the wipes must be thrown out because the CHG is inactivated.  ALOE VESTA lotion is compatible with CHG and can be used when patient is receiving a CHG wash/treatment or bath. Other lotions may not be compatible and can deactivate the antiseptic in the CHG cloth ex: Johnson & Johnson baby lotion. o Refer to the CHG Compatibility Chart on the intranet for additional questions.  Lotions or ointments used around g-tube sites or abrasions are not a problem because CHG cloths are only applied to intact skin. References  Pre-Operative Bathing Policy and Procedure  Skin Integrity Policy and Procedure  CVL Policy and Procedure  Daily CHG Wash teaching sheet  Pre-op Bath JIT  Unit Based Advanced Practice Nurse