Risks and benefits of using chlorhexidine gluconate in handwashing: A systematic literature review

Background: Antimicrobial soaps containing chlorhexidine gluconate (CHG) are indicated for hand hygiene (HH) in specific situations. This study aimed to identify whether the continuous use of CHG for HH affects the reduction of healthcare-associated infections (HAI), the selection of microorganisms resistant to CHG, or hands skin damage. Methods: Systematic review was performed using the protocol of the Joanna Briggs Institute, including clinical trials and observational comparative studies. Search was conducted via PubMed, Medline, CINAHL, LILACS, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Google Scholar, and gray literature. To evaluate outcomes, 3 independent reviews were conducted: HAI rates, presence of resistance genes or higher minimum inhibitory or bactericidal concentration, and damage to skin integrity. Results: Studies showed no significant difference in HAI rates when using CHG for HH. Among 13 studies, 10 suggested an association with use of and tolerance to CHG. The use of CHG was associated with skin reaction events. Conclusions: Strong evidence regarding the risks and benefits of CHG for HH is still lacking. Due to potential risk of selecting mutants carrying genes for cross-resistance to CHG and antibiotics, it is advisable to reserve the use of CHG for purposes other than HH. (C) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.