CHG (4% Chlorhexidine Gluconate) Treatment before Surgery

These instructions are for caregivers of 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 foam is an antibacterial product that is even more effective than regular soap for cleaning the skin.

• CHG foam 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 apply the foam to your child’s skin on the night before surgery. For the CHG foam 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 the CHG foam 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 foam 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. If your child has any rashes, infections, open areas, or sores on their skin, please call your child’s surgeon before following these instructions and using the CHG foam.

It is very important to read all the instructions before using the CHG foam. If the instructions are not clear or you have questions, please call your child’s surgeon’s office.

Patient instructions: 

The night before your child’s surgery complete a CHG foam cloth treatment or a CHG foam shower.

Instructions for giving a CHG foam treatment with cloths:

You can perform the CHG treatment, or you can assist the nurse in giving your child the CHG treatment. After reading the instructions below, please contact your child’s nurse with any questions.

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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 a soap and water bath or shampoo, do not apply lotions, creams, powder, or other skin products to your child’s skin.

4. Open the package of disposable cloths and fill package with warm water. Use enough water to soak each cloth. 

5. Reseal the package and massage pack to make sure all cloths are wet.

6. Use the instructions below to decide: 

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

   • The order and body site to clean and rinse.

7. Reopen the package and pull out one cloth. Apply CHG foam to the cloth or child’s skin. Cover the skin with the CHG foam, add more as needed. 

8. Use a circular and back and forth motion with friction/light pressure to apply the CHG foam to your child’s skin. Start at your child’s chin and work your way down the body. Follow the instructions below. Do not use the CHG foam on the head or face.

Instructions for children less than 22 lb or 10 kg: 

Requires 4 clothes: 2 CHG cloths and 2 rinse cloths

Cloth 1: CHG chest, both arms*, back, neck

Cloth 2: Rinse chest, both arms*, back, neck 

Cloth 3: CHG both legs*, buttocks, groin area* Do NOT use CHG cloth on inner labial folds, tip of penis or anus

Cloth 4: Rinse both legs*, buttocks, groin area*

* Armpit, the back of the knees, and the groin area typically have the most bacteria. Clean these areas last with the cloth being used in that body area.

Instructions for children 22-66lbs or 10-30 kg

Requires 8 cloths: 4 CHG cloths and 4 rinse cloths

Cloth 1: CHG chest, both arms*, neck

Cloth 2: Rinse chest, both arms*, neck 

Cloth 3: CHG both legs*

Cloth 4: Rinse both legs* 

Cloth 5: CHG groin area *Do NOT use CHG cloth on inner labial folds, tip of penis or anus

Cloth 6: Rinse groin area*

Cloth 7: CHG back, buttocks , 

Cloth 8: CHG back, buttocks

* Armpit, the back of the knees, and the groin area typically have the most bacteria. Clean these areas last with the cloth being used in that body area.

Instructions for children who weigh greater than 66lbs or 30 kg

Requires 10 cloths: 6 CHG cloths and 4 rinse cloths

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

Cloth 1: CHG chest, both arms*, neck 

Cloth 2: Rinse chest, both arms*, neck, 

Cloth 3: CHG right leg*

Cloth 4: CHG left leg*

Cloth 5: Rinse-use rinse cloth 5 for both legs*

Cloth 6: CHG groin area *Do NOT use CHG cloth on inner labial folds, tip of penis or anus

Cloth 7: Rinse groin area*

Cloth 8: CHG back

Cloth 9: CHG buttocks

Cloth 10: Rinse-use rinse cloth 10 for back and buttocks

* Armpit, the back of the knees, and the groin area typically have the most bacteria. Clean these areas last with the cloth being used in that body area.

9. Rinse the CHG foam from your child’s skin using a new cloth following the instructions. Allow your child’s skin to air dry before dressing into clean pajamas.

10. After you have used the CHG foam, do not apply lotions, moisturizers, deodorants, or powders. If you need to apply a product, only approved CHG compatible products may be used. 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. 

12. If there is any redness or itching that does not go away after 10 minutes, rinse off and stop using the CHG foam. Call your child’s healthcare provider if you have any questions.

Instructions for giving a CHG foam shower:

• After reading the instructions below, please contact your child’s nurse with any questions.

• Do not use the CHG foam on the head or face.

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 a soap and water shower and shampoo, make sure your child’s body is thoroughly rinsed of any soap or shampoo on the body.

4. Move away from the water stream. Apply the CHG foam onto the skin using a clean, wet washcloth. Gently wash all body surfaces below the chin with the CHG foam.

5. Step back into the water stream to thoroughly rinse the CHG foam from your child’s body.

6. Dry your child’s skin with a clean towel before dressing into clean clothes. 

7. After you have used the CHG foam, do not apply lotions, moisturizers, deodorants, or powders. If you need to apply a product, only approved CHG compatible products may be used. The CHG works best when left on clean, dry skin.

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

9. If there is any redness or itching that does not go away after 10 minutes, rinse off and stop using the CHG foam. Call your child’s healthcare provider if you have any questions. 

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 treatment at the hospital before surgery.

 

Reviewed January 2024 by Stephen Noll BSN, RN, CCRN