CHG (2% Chlorhexidine Gluconate) Treatment before Surgery

These instructions are for Children’s Hospital of Philadelphia (CHOP) patients instructed to use a CHG treatment before surgery.

Important information about CHG treatment:

• Before your child’s surgery, you can help to decrease the risk of infection by reducing the number of germs that normally live on the skin.

• CHG cloths are like baby wipes, but contain CHG, an antibacterial product that is even more effective than regular soap for cleaning the skin. 

• CHG is used often on hospitalized children, even babies, and does not usually irritate or bother the skin. Please contact your healthcare team if your child has sensitive skin or any ongoing skin problems for other antiseptic bathing options.

• You will wipe your child’s skin with the cloths on the night before surgery. For the CHG cloths to work best, you must follow the instructions below. Please note that children who are old enough to bathe themselves may still need your help to use these cloths correctly.

• CHG is available in many forms:

• Prepackaged wipes

• Liquid or foam solution

• If you are given CHG wipes, follow the instructions you were given. 

• If you are given Hibiclens® solution, follow the instructions on the packaging.

• If you do not have the product and your child requires a CHG treatment before surgery, you may purchase it at your local pharmacy.

Important: Do not use the CHG wipes on your child if they are allergic to chlorhexidine. If your child is allergic to chlorhexidine or any other ingredient in this product, please give them a bath or shower with soap and water. You may be instructed to wash your child’s hair with shampoo. If your child has any rashes, infections, open areas, or sores on their skin, or if you have any questions about these instructions, please call your child’s surgeon before following these instructions and using the CHG cloths.

It is very important to read all the instructions before using the CHG cloths. If the instructions are not clear to you or you have questions, please call your child’s healthcare provider for surgery.

Instructions for using CHG cloths:

The night before your child’s surgery:

1. Do not shave on or near the area where the surgery will be performed for at least 2 days before surgery (this includes face, underarms, and legs).

2. Bathe your child with soap and water. If your child’s procedure is for the head or neck area, you may be instructed to wash their hair with shampoo.

3. After this shower or bath, do not apply lotions, creams, powder, or other skin products to your child’s skin. Let the skin completely dry and cool.

4. Open the CHG package(s) and remove the cloths. Leave the CHG cloths on the blue insulating foam and place on a clean surface.

5. Rub each CHG cloth against itself before using. This brings the CHG to the surface of the cloth and makes it easier to apply.

6. Use a circular and back and forth motion with friction/light pressure to wash your child’s skin. Start at the chin and work your way down the body. Do not use the CHG cloths on the head or face.

7. Use the instructions below to decide:

   • The number of CHG cloths to use (based on your child’s weight).

   • The order and body site to clean.

8. Do not rinse your child’s skin. Allow your child’s skin to air dry before dressing them in clean pajamas.

9. It is normal for your child to feel “sticky” for several minutes after cleaning. There may be some itching or redness after using the wipes. This should go away quickly. If the redness or itching does not go away after 10 minutes, rinse off and stop using the wipes. Please call your child’s provider if you have questions.

10. After you have applied the CHG cloths, do not shower, bathe, or apply lotions, moisturizers, deodorants, powders, or makeup. The CHG works best when left on clean, dry skin. 

11. Put clean sheets and pillowcases on your child’s bed the night before surgery.

Directions for children less than 22 lbs (10 kg)-2-cloths

Requires 2 cloths

Cloth 1: Chest, both arms, back, neck*

Cloth 2: Both legs, buttocks, groin area – do not use cloth on inner labial folds, tip of penis or anus

*Armpit, back of the knees and the groin area have the most bacteria. Use the applicable cloth number based on your child’s weight to clean these areas last.

Instructions for children 22-66 lbs (10 –30 kg)

Requires 4 cloths

Cloth 1: Chest, both arms, neck*

Cloth 2: Both legs*

Cloth 3: Groin area – do not use cloth on inner labial folds, tip of penis or anus

Cloth 4: Back, buttocks

*Armpit, back of the knees and the groin area have the most bacteria. Use the applicable cloth number based on your child’s weight to clean these areas last.

Instructions for children over 66 lbs (30 kg)

Requires 6 cloths

Cloth 1: Chest, both arms, neck* 

Cloth 2: Right leg* 

Cloth 3: Left leg* 

Cloth 4: Groin area – do not use cloth on inner labial folds, tip of penis or anus 

Cloth 5: Back 

Cloth 6: Buttocks

*Armpit, back of the knees and the groin area have the most bacteria. Use the applicable cloth number based on your child’s weight to clean these areas last.

Pictures adapted with permission from Children’s Hospital and Clinics of Minnesota

The morning of your child’s surgery:

1. Do not allow your child to shower or bathe at home.

2. Do not apply lotions, creams, powder, or other skin products to your child’s skin.

3. Your child will receive another CHG bath at the hospital before surgery.

Reviewed January 2024 by Stephen Noll BSN, RN, CCRN