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Differential Effects of Chlorhexidine Skin Cleansing Methods on Residual Chlorhexidine Skin Concentrations and Bacterial Recovery

  • Yoona Rhee (a1), Louisa J. Palmer (a2) (a3), Koh Okamoto (a1), Sean Gemunden (a2) (a3), Khaled Hammouda (a2) (a3), Sarah K. Kemble (a1) (a4), Michael Y. Lin (a1), Karen Lolans (a5), Louis Fogg (a6), Derek Guanaga (a2) (a3), Deborah S. Yokoe (a7), Robert A. Weinstein (a1) (a8), Gyorgy Frendl (a2) (a3), Mary K. Hayden (a1) (a5) and for the Centers for Disease Control and Prevention Epicenter Program...



Bathing intensive care unit (ICU) patients with 2% chlorhexidine gluconate (CHG)–impregnated cloths decreases the risk of healthcare-associated bacteremia and multidrug-resistant organism transmission. Hospitals employ different methods of CHG bathing, and few studies have evaluated whether those methods yield comparable results.


To determine whether 3 different CHG skin cleansing methods yield similar residual CHG concentrations and bacterial densities on skin.


Prospective, randomized 2-center study with blinded assessment.


Healthcare personnel in surgical ICUs at 2 tertiary-care teaching hospitals in Chicago, Illinois, and Boston, Massachusetts, from July 2015 to January 2016.


Cleansing skin of one forearm with no-rinse 2% CHG-impregnated polyester cloth (method A) versus 4% CHG liquid cleansing with rinsing on the contralateral arm, applied with either non–antiseptic-impregnated cellulose/polyester cloth (method B) or cotton washcloth dampened with sterile water (method C).


In total, 63 participants (126 forearms) received method A on 1 forearm (n=63). On the contralateral forearm, 33 participants received method B and 30 participants received method C. Immediately and 6 hours after cleansing, method A yielded the highest residual CHG concentrations (2500 µg/mL and 1250 µg/mL, respectively) and lowest bacterial densities compared to methods B or C (P<.001).


In healthy volunteers, cleansing with 2% CHG-impregnated cloths yielded higher residual CHG concentrations and lower bacterial densities than cleansing with 4% CHG liquid applied with either of 2 different cloth types and followed by rinsing. The relevance of these differences to clinical outcomes remains to be determined.

Infect Control Hosp Epidemiol 2018;39:405–411


Corresponding author

Address correspondence to Yoona Rhee, MD, ScM, Division of Infectious Diseases, Rush University Medical Center, 600 South Paulina Street, Suite 143, Chicago, IL 60612 ( or Mary K. Hayden, MD, Division of Infectious Diseases and Clinical Microbiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612 ( or Louisa Palmer, MBBS, and Gyorgy Frendl, MD, PhD, Brigham and Women’s Hospital, Department of Anesthesiology, CWN-L1, 75 Francis Street, Boston, MA 02115 ( and


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PREVIOUS PRESENTATION. This study was presented in part at The Society for Healthcare Epidemiology of America Spring 2016 Conference, May 20, 2016, Atlanta, GA, USA, in a poster titled “Comparison of 2% Chlorhexidine Gluconate (CHG)— impregnated Cloth vs. 4% CHG Cleansing.”


First authors of equal contribution.


Senior authors of equal contribution.



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Differential Effects of Chlorhexidine Skin Cleansing Methods on Residual Chlorhexidine Skin Concentrations and Bacterial Recovery

  • Yoona Rhee (a1), Louisa J. Palmer (a2) (a3), Koh Okamoto (a1), Sean Gemunden (a2) (a3), Khaled Hammouda (a2) (a3), Sarah K. Kemble (a1) (a4), Michael Y. Lin (a1), Karen Lolans (a5), Louis Fogg (a6), Derek Guanaga (a2) (a3), Deborah S. Yokoe (a7), Robert A. Weinstein (a1) (a8), Gyorgy Frendl (a2) (a3), Mary K. Hayden (a1) (a5) and for the Centers for Disease Control and Prevention Epicenter Program...


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