What is chlorhexidine gluconate (CHG)?
Chlorhexidine, first described in 1954, is now the standard of care topical broad-spectrum biocide in the prevention of healthcare-associated infections, with bacteriostatic properties at low concentrations, and bactericidal properties at higher concentrations. It exhibits activity against gram-positive bacteria, gram-negative bacteria, some enveloped viruses, and fungi, and demonstrates longer-lasting residual effects than other antiseptic agents, such as triclosan.1,2 CHG is responsible for the antimicrobial effect of ReliaTect® post-operative dressing.3
How does CHG work?
Positively-charged CHG binds to negatively-charged bacterial cell membranes and walls; at low concentrations, this association interrupts cellular osmoregulatory and metabolic capacity, inhibiting cellular respiration. At higher concentrations, CHG destroys bacterial membrane integrity completely, leading to leakage of cellular contents, cell lysis, and death.1
What about microbial resistance to CHG?
There are no standardized methods for chlorhexidine susceptibility testing—or indeed a consensus definition of CHG “resistance”—which frustrates a clear determination of whether, and to what extent, prolonged use of CHG fosters the development of resistant bacteria.1,4 However, analysis of the potential mechanisms of bacterial resistance, combined with real-world data of CHG use, suggests that concerns about reduced microbial susceptibility to CHG may be overstated.1
What drives bacterial resistance to antiseptic treatment?
Plasmid-mediated multidrug efflux pumps, encoded by qacA and qacB genes, are the most widely reported mechanism of bacterial resistance to CHG: the QacA pump system, found in gram- positive bacteria such as resistant staphylococci, transports chlorhexidine outside the bacterial cell.1,5,6 Expression of qacA is under the regulatory control of the QacR protein, which inhibits qacA transcription; however, when a substrate such as chlorhexidine binds to QacR, the repressor is removed, and the qacA pump gene expressed.1,6
The straightforward story is more complicated than it seems at first...
Gene-prevalence studies that do not assess susceptibility rates may therefore overestimate the rates of CHG-tolerance.1 There is also little evidence suggesting that plasmid-mediated antibiotic resistance common among gram-negative bacteria is associated with CHG-resistance.10
ReliaTect Post-Op Dressing with CHG
ReliaTect is a sterile post-operative dressing consisting of a polyurethane film, coated with a transparent chlorhexidine gluconate acrylic adhesive. CHG distinguishes ReliaTect from other transparent post-op dressings; a recent study found it significantly outperformed both placebo and gauze dressings in reducing MRSA contaminating a surgical wound in a porcine, incisional-wound model.3 By contrast, the current available evidence indicates that dressings containing silver are not associated with a lower incidence of surgical site infections (SSIs) than silver-free dressings.11
Eloquest Healthcare® offers ReliaTect® Post-Op Dressing with CHG, a sterile, post-operative dressing consisting of a polyurethane film, coated with a transparent chlorhexidine gluconate (CHG) acrylic adhesive.
For more information about ReliaTect, please contact your Eloquest Healthcare sales consultant, or request a follow-up here. Eloquest Healthcare is committed to providing solutions that can help you reduce the risk of conditions like post-operative wound contamination, central line-associated bloodstream infection (CLABSI), and medical adhesive related skin injury (MARSI).
- Williamson DA, Carter GP, Howden, BP. Current and emerging topical antibacterials and antiseptics: agents, action, and resistance Clin Microbiol Rev. 2017;30(3):827-860.
- Macias JH, Alvarez MF, Arreguin V, et Chlorhexidine avoids skin bacteria recolonization more than triclosan. Am J Infect Control. 2016;44(12):1530-1534.
- Mana TSC, Donskey C, Carty N, et al. Preliminary analysis of the antimicrobial activity of a postoperative wound dressing containing chlorhexidine gluconate against methicillin-resistant Staphylococcus aureus in an in vivo porcine incisional wound model. Am J Infect Control. 2019;47(9):1048-1052.
- Horner C, Mawer D, and Wilcox M. Reduced susceptibility to chlorhexidine in staphylococci: is it increasing and does it matter? J Antimicrob Chemother. 2012;67(11):2547-2559.
- Alcalde-Rico M, Hernando-Amado S, Blanco P, et al. Multidrug efflux pumps at the crossroad between antibiotic resistance and bacterial Front Microbiol. 2016;7:1483.
- Grkovic S, Brown MH, Roberts NJ, et al. QacR is a repressor protein that regulates expression of the Staphylococcus aureus multidrug efflux pump J Biol Chem. 1998;273(29):18665-18673.
- Schlett CD, Millar EV, Crawford KB, et al. Prevalence of chlorhexidine-resistant methicillin-resistant Staphylococcus aureus following prolonged exposure. Antimicrob Agents Chemother. 2014;58(8):4404-10.
- Fritz SA, Hogan PG, Camins BC, et al. Mupirocin and chlorhexidine resistance in Staphylococcus aureus in patients with community-onset skin and soft tissue Antimicrob Agents Chemother. 2013;57(1):559-68.
- Skovgaard S, Larsen MH, Nielsen LN, et al. Recently introduced qacA/B genes in Staphylococcus epidermidis do not increase chlorhexidine MIC/MBC. J Antimicrob Chemother. 2013;68(10):2226-
- Denton Chlorhexidine. In: Block SS, ed. Disinfection, Sterilization, and Preservation. 5th ed. Lippincot Williams & Wilkins; 2001: 321-336.
- Li HZ, Zhang L, Chen JX, Zheng Y, Zhu XN. Silver-containing dressing for surgical site infection in clean and clean-contaminated operations: a systematic review and meta-analysis of randomized controlled J Surg Res. 2017;215:98-107. doi: 10.1016/j.jss.2017.03.040.