Safety and Impact of Chlorhexidine Antisepsis Interventions for Improving Neonatal Health in Developing Countries 2006
Mullany, Darmstadt & Tielsch / Literature review of randomized and non-randomized studies / Review of 28 studies from 1975-2005 / · CHG dressing on for > 7 days: < 28 wk gestation/<1000 g- 5% dev contact dermatitis
-occlusive dsg vs chg
-no dermatitis from preplacement scrub with 0.5% chg
-No dermatitis with full body wiping, bathing, cord cleansing
· Absorption:
-daily bathing (N=34; 29 preterm)- 5 detectable chg in blood (all less than 36 w gestation)
-50 full term infants- no detection of chg in blood, no adverse effects after 1 yr / Some absorption may occur in premature infants.
Transient contact dermatitis with chg impreg. Dsg- monitor carefully / Larger studies haven’t measured absorption in newborns
Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line-Associated Bloodstream Infections
Quach et al. 2014 / Quasi-experimental design / 790 neonates with CVCs in study- 219 bathed with CHG.
Bathing protocol based on age and wt. Pts > 1000 g or < 1000 g and greater than 28 days old were bathed with 2% CHG-impregnated cloth according to schedule.
CHG used for all patients for insertion and dressing change. / · No reported adverse events
· CHG group (infants with bw 1000 g +, aged at least 28 days): CLABSI rates decreased from 4.92 to 1.28/1000 CVC-days
· Infants with bw 1000 g or less, aged at least 28 days: CLABSI rates decreased from 8.97 to 5.73/1000 CVC-days
· Non CHG group- CLABSI rates remained stable- 8.57 in reference period 8.62 intervention period / No dermatitis or adverse events reported during the 2012-2013 period
No other interventions to decrease CLABSI infection rates implemented during intervention period / Not able to state if infection rate decreased due to intervention bathing protocol or faster removal of unnecessary CVC
Effect of the first bath with chlorhexidine on skin colonization with Staphylococcus areus in normal healthy term newborns
Da Cunha et al. 2008 / Masked randomized clinical trial / 93 term neonates either received the first bath with chlorhexidine or neutral liquid soap. Samples were taken for culture before bath, 30 min and 24 h after bath. / · First bath with chg reduced S. aureus colonization on the newborn’s skin in a 24 hr period
Neonatal Skin and Chlorhexidine: A Burning Experience
Kutsch & Ottinger, 2014 / Case Study / Two case studies-
Pt A: 610 g born at an outside facility, UVC/UAC placed. CHG was disinfectant agent
Pt B: 600 g, 24 week neonate born at an outside facility, UVC/UAC placed. CHG was disinfectant agent / · Both patients was deemed that wound was a chemical burn secondary to chg exposure during initial line placements
· Pt A: DOL 0, physical exam noted erythema to the dermis resembling full-thickness burns. Worsening skin breakdown from DOL 2-9 extending to entire abdomen. Wound with débridement and treatment. Permanent scaring
· Pt B: DOL 0 noted patchy ecchymosis with 4mmx4mm skin breakdown around umbilicus. / Caution when choosing disinfectant agents in ELBW infants.
CHG solution should be wiped away on ELBW infants to prevent chemical burns
Umbilical cord antisepsis for preventing sepsis and death among newborns (Review)
Imdad, Senen, Mantaring, Za 2013 / Intervention Review / Evaluated all studies that assessed antisepsis applied to the umbilical cord to determine the risk of cord infection/death.
-34 studies evaluated
-69,338 neonates involved
-22 interventions
-Community and hospital based studies / · Most frequently studied intervention was 70% alcohol, triple dye, chlorhexidine / Chg to umbilical cord reduces neonatal mortality and omphalitis in developing countries.
No evidence to support application of antiseptic to umbilical cord in hospital settings vs dry cord care in developed countries / Hospital studies were small with limitations
Efficacy and Safety of Whole Body Skin Cleansing With Chlorhexidine in Neonates- A Systemic Review
Sankar, M. & Paul, V. 2013 / Literature Review / Seven randomized trials and 2 before and after studies that evaluated single cleansing with chlorhexidine were included in the review. Low-resource settings / · No conclusive evidence for any beneficial effect after single skin cleansing with chg / No discussion on impact
CHG and immunocompromised patients: Not able to locate any current research on CHG bathing- did find articles with CHG and immunocompromised patients as it relates to catheter device, oral care, CVC dressing. See results below
Article / Study Type / Method / Findings / Learning / LimitationsReduction of catheter-related infections in neutropenic patients: a prospective controlled randomized trial using chlorhexidine and silver sulfadiazine-impregnated central venous catheter
Jaeger, K et al. / Prospective randomized clinical trial / 106 patients with malignant hematological diseases undergoing chemotherapy.
-51 had CH-SS impregnated CVCs placed
-55 non-impregnated CVC placed / · 9 standard CVCs colonized vs 5 antiseptic bonded ones
· Most common microorganism: S. epidermis, S. haemolyticus, S. aureus, Enterococcus faecalis, corynebacterium amycolatum
· / CH-SS impregnated CVCs associated with lower rate of