What is CHG Bathing?
Chlorhexidine gluconate (CHG) bathing is a daily or pre-procedural skin decolonization practice in which patients are bathed using a 2% or 4% CHG solution. Unlike standard soap-and-water bathing, CHG has a unique residual antimicrobial effect — it binds to the stratum corneum of the skin and continues killing pathogens for up to 72 hours after application.
CHG is effective against a broad spectrum of organisms including:
- MRSA (Methicillin-resistant Staphylococcus aureus)
- VRE (Vancomycin-resistant Enterococcus)
- Candidozyma auris (C. auris) — CDC Urgent Threat
- Gram-negative bacilli including Klebsiella and Acinetobacter
- Coagulase-negative staphylococci
Why ICU Patients Are at Highest Risk
Critically ill patients in the ICU face a perfect storm of infection risk factors: compromised immune systems, invasive devices (central lines, urinary catheters, endotracheal tubes), prolonged immobility, and frequent contact with healthcare workers who may inadvertently transmit pathogens.
The ABCDE bundle and other ICU care bundles have reduced VAP and CLABSI rates significantly — but skin decolonization through CHG bathing remains one of the highest-yield, lowest-cost interventions available to bedside nurses.
The Evidence Base for CHG Bathing
The evidence supporting universal CHG bathing in the ICU is among the strongest in hospital infection control:
Universal CHG bathing reduced MRSA acquisition by 37% and VRE by 55% in a multicenter RCT of 9 ICUs.
Universal decolonization (CHG + mupirocin) reduced all-cause bloodstream infections by 44% compared to targeted screening.
CHG skin concentrations ≥156 µg/mL reduced C. auris shedding by 80% — critical for outbreak control in SNFs and ICUs.
Strongly recommend daily CHG bathing for all ICU patients with central venous catheters.
Step-by-Step CHG Bathing Protocol
The following protocol is based on SHEA/IDSA guidelines and adapted for bedridden ICU patients using an in-bed shower system:
Gather Supplies
2% or 4% CHG solution (or CHG-impregnated cloths), clean washcloths, gloves, eye protection. For in-bed shower systems: fill reservoir with warm water and add CHG per manufacturer protocol.
Assess Contraindications
CHG is contraindicated near eyes, ears, and open wounds. Assess for CHG allergy (rare but documented). Note any skin integrity issues.
Pre-Bath Preparation
Explain the procedure to the patient. Ensure privacy. Remove dressings that can be temporarily removed. Protect IV sites and central line dressings.
Apply CHG Head to Toe
Begin at the head (avoiding face/eyes), work systematically to feet. Ensure all skin surfaces are covered, including skin folds, axillae, groin, and perineal area — highest-risk zones for pathogen colonization.
Allow Dwell Time
Critical step: allow CHG to remain on skin for at least 2 minutes before rinsing. This dwell time is essential for achieving adequate residual skin concentration (target ≥156 µg/mL per Gussin 2025).
Rinse and Dry
Rinse thoroughly with warm water. Pat dry — do not rub, which can remove CHG from the stratum corneum. Apply moisturizer to prevent skin breakdown.
Document
Record CHG bathing in the patient's chart including date, time, concentration used, skin integrity assessment, and any adverse reactions.
Concentration Requirements: Why This Matters
Critical Finding from Gussin et al. 2025
CHG bathing only reduced C. auris shedding when residual skin concentration reached ≥156 µg/mL. Patients bathed with CHG wipes who did not achieve this threshold showed no significant reduction in shedding — meaning the method of CHG delivery is as important as the product itself.
Traditional CHG wipes and basin baths frequently fail to achieve adequate skin concentrations because:
- ✗Wipes dilute CHG with absorbed moisture before skin contact
- ✗Basin baths allow CHG to be rinsed away before adequate dwell time
- ✗Skin folds and perineal areas are often inadequately covered
- ✗Patient repositioning during bathing disrupts CHG application
In-bed shower systems like the Bed Shower™ Wib™ deliver CHG in a controlled, full-body rinse that maintains consistent concentration across all skin surfaces — including the high-risk perineal and axillary zones — while the patient remains in bed.
7 Common CHG Bathing Errors (and How to Avoid Them)
Skipping the dwell time
✓ Fix: Set a 2-minute timer after CHG application. Use this time to assess skin integrity.
Using CHG near mucous membranes
✓ Fix: Use plain water for face, eyes, and ears. CHG is ototoxic and can cause corneal damage.
Applying moisturizer before CHG dries
✓ Fix: Allow CHG to fully dry on skin before applying any emollient — moisturizers can dilute residual CHG.
Inconsistent frequency
✓ Fix: Daily CHG bathing is required for sustained decolonization. Missed days allow pathogen recolonization within 24–48 hours.
Using tap water to dilute CHG
✓ Fix: Use sterile water or follow manufacturer dilution instructions. Tap water can introduce contaminants.
Not covering all skin surfaces
✓ Fix: Use a systematic head-to-toe approach. Skin folds, axillae, and perineal areas are highest-risk zones.
Failing to document
✓ Fix: Document every CHG bath including concentration, skin assessment, and any reactions. This is required for HAI prevention program compliance.
In-Bed Shower vs. CHG Wipes: A Clinical Comparison
| Factor | CHG Wipes | Bed Shower™ Wib |
|---|---|---|
| Skin concentration achieved | Variable (often subtherapeutic) | Consistent ≥156 µg/mL |
| Full-body coverage | Difficult in skin folds | Complete head-to-toe |
| Patient transfer required | No | No |
| Nurse time per bath | 20–30 min | 15–20 min |
| Patient comfort | Cold, clinical | Warm water, dignified |
| C. auris shedding reduction | Inconsistent | 80% reduction (Gussin 2025) |
| Documentation support | Manual | Automated care report |
CHG Bathing and C. auris: The 2025 Breakthrough
The 2025 study by Gussin et al. published in Clinical Infectious Diseases represents a landmark in C. auris management. For the first time, researchers quantified the exact CHG skin concentration needed to reduce C. auris shedding — and found that 80% of shedding events occur during caregiving activities such as bed baths and repositioning.
This finding has direct implications for ICU nurses: every bed bath is an opportunity to either reduce or amplify C. auris transmission, depending on whether adequate CHG concentration is achieved and maintained.
Clinical Implication for ICU Nurses
If your facility has a confirmed or suspected C. auris case, standard CHG wipe protocols may be insufficient. Consider upgrading to an in-bed shower system that can reliably deliver and maintain CHG concentrations above the therapeutic threshold of 156 µg/mL.
Read the full C. auris protocol guideFrequently Asked Questions
How often should CHG bathing be performed in the ICU?
Daily CHG bathing is recommended for all ICU patients with central venous catheters per SHEA/IDSA guidelines. For C. auris decolonization, twice-daily bathing may be considered during active outbreaks.
Can CHG bathing cause skin irritation or allergic reactions?
CHG allergy is rare (estimated <1% of patients) but documented. Monitor for contact dermatitis, urticaria, or anaphylaxis. Avoid CHG in patients with known allergy. Diluting to 0.5% CHG may reduce irritation in sensitive patients while maintaining some antimicrobial effect.
Is CHG bathing safe for patients with open wounds?
CHG should not be applied directly to open wounds, mucous membranes, or eyes. Use waterproof dressings to protect wound sites during CHG bathing. Consult wound care protocols for patients with complex wounds.
Does CHG bathing replace hand hygiene for nurses?
No. CHG bathing reduces patient colonization but does not replace standard hand hygiene protocols. Both interventions are required components of a comprehensive HAI prevention bundle.
What is the difference between 2% and 4% CHG for bathing?
Both concentrations are effective for skin decolonization. 4% CHG is typically used for pre-surgical scrubs and high-risk decolonization protocols. 2% CHG is commonly used for daily ICU bathing. The Gussin 2025 study used 2% CHG and still achieved 80% C. auris shedding reduction when adequate skin concentration was maintained.
See How Bed Shower™ Wib Delivers CHG Protocol
Schedule a clinical demonstration for your ICU team. We'll show you how the Wib™ system achieves and maintains the CHG concentrations required by the Gussin 2025 protocol.
References
- 1. Gussin GM et al. Can Chlorhexidine Bathing Reduce Candidozyma auris Shedding? Clinical Infectious Diseases. 2025. DOI: 10.1093/cid/ciaf704
- 2. Climo MW et al. Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection. NEJM. 2013;368:533-542.
- 3. Huang SS et al. Targeted versus Universal Decolonization to Prevent ICU Infection. NEJM. 2013;368:2255-2265.
- 4. SHEA/IDSA/APIC Practice Recommendation: Strategies to Prevent Healthcare-Associated Infections Through Hand Hygiene. 2022.
- 5. CDC. Healthcare-Associated Infections (HAI) Data. Centers for Disease Control and Prevention. 2024.