Protective film on skin fighting germs

Is Your Skin Prep Really Working? The Truth About Chlorhexidine and Surgical Site Infections

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Theo Raines in Health & Wellness August 2025 • 4 min read.

"Discover how advanced film-forming technology can improve skin antisepsis and reduce the risk of infections after surgery."


Before undergoing surgery, one of the most critical steps in preventing infection is preparing the skin. Antiseptics are applied to reduce the amount of microbes that could cause surgical site infections (SSIs). Chlorhexidine gluconate (CHG) is a popular antimicrobial agent known for its broad-spectrum activity and persistent effects. Often combined with isopropyl alcohol (IPA) for a fast-acting and residual effect, CHG aims to protect the incision site throughout the procedure until it's closed.

However, maintaining this protection isn't always straightforward. During surgery, the prepped skin can be exposed to irrigation fluids and mechanical challenges like wiping with gauze. Since CHG is water-soluble, it can be washed away, leaving the patient vulnerable. This realization has driven researchers to seek better ways to ensure CHG remains effective, even when faced with these common surgical conditions.

Now, imagine a scenario where the antiseptic stays put, providing continuous protection against infection. Researchers have been exploring innovative solutions, and one promising approach involves adding a film-forming acrylate copolymer to CHG-based skin preps. This article dives into a study that investigates whether this addition can minimize CHG loss during surgical procedures, potentially leading to improved patient outcomes. Keep reading to find out what they discovered!

The Science Behind Superior Skin Antisepsis: How Does Film-Forming CHG Work?

Protective film on skin fighting germs

The study aimed to evaluate how adding a film-forming acrylate copolymer to a CHG skin prep affects CHG retention compared to traditional water-soluble CHG preps. The scientists hypothesized that this new formulation would better resist wash-off, maintaining antimicrobial efficacy throughout the surgical procedure. This is crucial because the effectiveness of CHG depends on its ability to stay in contact with the skin, continuously fighting off microbes.

Researchers know that CHG binds to the skin and mucous membranes through electrostatic interactions. Being positively charged, CHG molecules are attracted to the negatively charged skin surface. The new formulation contains a copolymer that also binds to the epidermis, similar to acrylates used in many wound dressing adhesives. While the copolymer itself has both hydrophobic and hydrophilic properties but no overall charge, it’s believed to confine the CHG, offering extra retention at the skin surface.

  • Study Design: The study involved both ex vivo (using excised porcine skin) and in vivo (on human volunteers) experiments.
  • Methods: CHG preps were applied, and the treated sites were subjected to repeated saline soaks and gauze dabbing to mimic surgical conditions.
  • Analysis: The challenged and unchallenged sites were then analyzed for CHG content using high-performance liquid chromatography (HPLC) or for bacterial log recovery, reflecting the remaining CHG activity.
The findings revealed that the film-forming CHG prep retained more CHG on the skin after irrigation and wiping, both in the pig skin and human models. Additionally, the pig skin model showed a lower recovery of inoculated bacteria with the film-forming CHG prep, indicating better antimicrobial activity. Importantly, the human study reported no skin irritation or adverse events, suggesting that the new formulation is safe and well-tolerated.

A Promising Future for Surgical Skin Antisepsis

The study suggests that adding a film-forming copolymer to CHG-containing skin preps has the potential to significantly improve CHG retention and antimicrobial activity during surgical procedures. By creating a more robust barrier against wash-off, this innovative formulation could lead to better protection against surgical site infections and improved patient outcomes. While further clinical studies are needed to confirm these findings, the results are a promising step forward in surgical skin antisepsis.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

Why is skin preparation so vital in preventing surgical site infections (SSIs), and what makes maintaining effective antisepsis challenging during surgery?

Surgical site infections (SSIs) are a serious concern because they can lead to complications, prolonged hospital stays, and increased healthcare costs. Proper skin antisepsis with agents like Chlorhexidine gluconate (CHG) aims to reduce the amount of microbes on the skin before surgery, but factors like irrigation fluids and mechanical wiping can wash away the antiseptic, leaving the patient vulnerable.

2

What is Chlorhexidine gluconate (CHG), and how does it function as a skin antiseptic in surgical settings?

Chlorhexidine gluconate (CHG) is an antimicrobial agent frequently used for skin antisepsis before surgery. It works by binding to the skin and mucous membranes through electrostatic interactions, as CHG molecules are positively charged and attracted to the negatively charged skin surface. When combined with isopropyl alcohol (IPA), CHG provides a fast-acting and residual effect, aiming to protect the incision site until it's closed.

3

How does adding a film-forming acrylate copolymer to Chlorhexidine gluconate (CHG) enhance skin antisepsis?

The film-forming acrylate copolymer is believed to work by confining Chlorhexidine gluconate (CHG) to the skin surface, offering extra retention and resistance to wash-off. This copolymer binds to the epidermis similarly to acrylates used in wound dressing adhesives. While the copolymer itself has both hydrophobic and hydrophilic properties but no overall charge, its presence helps maintain the effectiveness of CHG, especially when exposed to surgical conditions.

4

What methodologies did researchers use to assess the effectiveness of film-forming Chlorhexidine gluconate (CHG) preps in maintaining skin antisepsis?

The study evaluated the efficacy of a film-forming Chlorhexidine gluconate (CHG) prep using both ex vivo (pig skin) and in vivo (human volunteers) experiments. The sites treated with CHG preps were subjected to saline soaks and gauze dabbing to mimic surgical conditions, then analyzed for CHG content using high-performance liquid chromatography (HPLC) or for bacterial log recovery. The study found that the film-forming CHG prep retained more CHG and demonstrated better antimicrobial activity without causing skin irritation.

5

What are the potential long-term implications and next steps in validating the benefits of film-forming Chlorhexidine gluconate (CHG) for surgical skin antisepsis?

While the study suggests that film-forming Chlorhexidine gluconate (CHG) preps have the potential to reduce surgical site infections by improving CHG retention and antimicrobial activity, further clinical trials are needed to confirm these findings. These trials would help determine the long-term impact of this innovation on patient outcomes and establish its effectiveness in real-world surgical settings, as well as comparing against current alternatives.

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