Phone Us0800 18 19 19
View Favourites

Articles

Are You Trading Infection Control for Impaired Healing?

Chlorhexidine gluconate has earned its place as a standard antiseptic in clinical settings. It reduces bacterial surface counts quickly and significantly after application — a genuine short-term win. But a growing body of evidence, including research by Cheong et al. (2022), reveals a troubling trade-off hiding beneath that initial benefit.
Wound care

Are You Trading Infection Control for Impaired Healing?

Capes Medical Supplies
Published on

The Hidden Cost of Chlorhexidine in Wound Care

The study describes what researchers call a “Robbing Peter to Pay Paul” phenomenon: CHG provides a brief reduction in surface bacteria, but this comes at a progressive and compounding cost to the very tissue you’re trying to heal.

What the evidence shows

  • The antimicrobial effect is short-lived. While CHG achieves a 3–6 log reduction in bacterial surface counts immediately after application, bacteria dwelling deep within wound tissue act as a reservoir — repopulating the wound surface within 48 hours.
  • The tissue damage does last. Unlike its antibacterial effect, CHG’s impact on healthy cells is not transient. Cell viability studies show progressive cell death continuing over 14 days of CHG use. Of all wound cleansers tested — including saline and povidone iodine — CHG produced the highest metabolic reduction in tissue cells.
  • Healing is directly impaired. Daily CHG use in vivo significantly inhibits re-epithelialisation — the process by which new skin cells migrate across the wound to close it. In simple terms: the wound takes longer to close because the very cells responsible for healing it are being damaged by the treatment.

How does CHG compare to other cleansers?


When placed side by side with saline (PBS) and povidone iodine (PVI), the picture becomes clearer:
  • Saline (PBS) offers no antimicrobial activity, but crucially, it preserves long-term tissue viability — cells remain healthy and stable for 14 or more days.
  • Povidone iodine provides low to moderate antimicrobial activity with high long-term tissue viability, making it a more balanced option for many wound types.
  • CHG (2%) delivers high antimicrobial activity in the short term, but this comes with very low long-term tissue viability — a progressive loss that compounds with each application.
  • For a patient with an acute wound that heals quickly, this trade-off may be manageable. For elderly residents in aged care with chronic wounds, pressure injuries, or burns — where treatment continues over weeks — the cumulative cytotoxic burden of CHG can become a serious clinical concern.

Why PHMB/Poloxamer solutions offer a better path forward


Polyhexanide (PHMB) combined with poloxamer — the active combination in products like Actolind® Solution Plus — represents a fundamentally different approach to wound care. Rather than accepting the trade-off between infection control and tissue health, PHMB/poloxamer solutions are designed to deliver both.
 
  • PHMB is antimicrobial without being cytotoxic. Unlike CHG, PHMB achieves effective antimicrobial and antibiofilm activity without the progressive cell damage. It neither inhibits granulation nor epithelialisation — meaning it supports, rather than opposes, the natural healing process.
  • Poloxamer enhances cleaning through physical action. By optimising the wetting effect and reducing surface tension, poloxamer helps physically detach contaminants, biofilm layers, necrotic tissue, and encrusted dressings from the wound — reducing reliance on chemical toxicity.
  • Together, they address the full wound environment. PHMB/poloxamer solutions fill the wound bed, prevent pathogen colonisation, and keep the wound surface moist — all without the 14-day deterioration in cell viability that CHG produces.
  • Well-suited to our elderly population. PHMB/poloxamer formulations are dermatologically tested, mucous membrane compatible, and well tolerated by allergic and diabetic patients — profiles that are extremely common in aged care settings. They are appropriate for long-term treatment in a way that CHG is not.
  • Broad-spectrum efficacy remains intact. Products like Actolind® Solution Plus are highly effective against multi-resistant organisms including MRSA and VRE, as well as mycotic pathogens such as Candida albicans — the infections of greatest concern in clinical and aged care environments.

What this means for your practice/facility


This research does not suggest abandoning antiseptic wound care. It suggests choosing the right antiseptic — one whose benefits don’t erode the outcome you’re working toward.

For wound types commonly seen in aged care and clinical settings — chronic wounds, pressure injuries, diabetic foot ulcers, burns, and infected post-surgical wounds — the evidence increasingly supports transitioning away from CHG-based cleansers toward PHMB/poloxamer formulations.

“If a wound cleanser is damaging the tissue responsible for healing, it is working against you.”

 

A Note on Actolind® Solution Plus

Actolind® Solution Plus is a Class III medical device combining polyhexanide (PHMB) and poloxamer in a patented formulation designed for the full spectrum of wound care needs. It is indicated for acute, chronic, infected, and thermal wounds, compatible with all modern wound dressings, and available in a range of sizes from single-use monodose strips to 1000 ml bottles for clinical settings.

It can be used as a standalone wound cleanser and irrigation solution, or in combination with Actolind® Gel Plus for wounds requiring higher moisturisation or protection against exudate.

If you'd like to trail Actolind Solution Plus, please get in touch.