Implications of chlorhexidine use in burn units for wound healing

Chlorhexidine is known to be a potent antiseptic with evidence of a beneficial role in burn
care. Nevertheless, several in vitro studies have reported cytotoxicity on cultured cells, while
in vivo and clinical data seem to show more controversial results. In the frame of this work, we
aimed to evaluate the use of chlorhexidine in burn units worldwide be sending a survey to
professionals of the field. We associated survey results to those perspectives reported in the
literature to update recommendations for the use of chlorhexidine in specific protocols for
burn management. The survey results showed that there is no clear consensus on the use of
chlorhexidine regarding the concentrations, the type of excipient and the cleansing after
application. Literature searches showed evidence that the skin of premature infants appears
to be more sensitive to chlorhexidine that adult skin, with more reported cases of adverse
effects. It was also determined that aqueous formulations of chlorhexidine do not appear to
be necessarily less efficient than with alcohol as an excipient, and that lower concentrations
are as efficient as higher concentrations. In view of this study, we have adjusted our protocols
for the use of aqueous formulations at low concentrations and investigated further the role of
washing after application in order to standardize the indication of chlorhexidine and
minimize the probability of adverse effects.