Does skin cleansing with chlorhexidine affect skin condition, temperature and colonization in hospitalized preterm low birth weight infants?: a randomized clinical trial

Abstract

Objective: To examine if single skin cleansing with 0.25% chlorhexidine affects skin condition, temperature and bacterial colonization in stable preterm (28-36 weeks gestational age) low birth weight (1001-2000 g) infants admitted in a health facility.Methods: Eligible infants were randomized within 3 h of birth into the following three groups: chlorhexidine, normal saline or no skin cleansing. Infants in the first two groups were wiped once with baby wipes containing either 0.25% chlorhexidine or saline. Skin condition, axillary temperature and skin colonization rates in the axilla and the groin were assessed at specified time intervals after intervention.Results: In all, 60 infants were included in the study (20 in each group). Median skin condition scores at 72 and 168 h after the intervention were 2 and 2, respectively, in all three groups. At 30 min after skin cleansing, two infants each in the chlorhexidine and saline cleansing groups and none in the no cleansing group experienced cold stress (36-36.4 1C). There was, however, no difference in mean skin temperature of the groups (36.6 1C). At 24 h, skin colonization rates in the axilla were 22.2, 52.7, and 57.9%, respectively, in the chlorhexidine, saline and no cleansing groups (P ¼ 0.06); skin cleansing with chlorhexidine reduced the incidence of colonization by 62% compared with no cleansing (relative risk (RR): 0.38, 95% confidence interval (CI): 0.15, 0.98), but there was no significant reduction when compared with saline cleansing (RR: 0.42; 0.16-1.10). Axillary colonization rates at 72 h and colonization at the groin at 24 and 72 h were not significantly different across the three groups.Conclusion: Single skin cleansing with 0.25% chlorhexidine did not adversely affect skin condition or temperature in hospitalized preterm infants and reduced axillary-skin colonization at 24 h after the intervention. Trials are needed to evaluate the efficacy of such an intervention on the incidence of infections in preterm neonates.

Effect of aqueous chlorhexidine on skin colonization with gram negative bacteria in preterm infants admitted in NICU: a blinded RCT

“…16 Among the studies which reported on the effect of chlorhexidine on bacterial skin colonization, the study by Jeeva Sankar et al in 2009 reported the colonization rates with Gram-negative pathogens were comparable between the 0.25 % aqueous chlorhexidine cleansing, normal saline cleansing and no cleansing groups at both 24 and 72h after the single cleansing. 10 This was similar to present study results.…”

“…9,10,17,18 A similar study was done in Bangladesh (2007) attempting to study the extended cleansing effects of 0.25% chlorhexidine. Their skin colonization rates seem comparable to be to us.…”

“…The increased colonisation with gram negative bacteria may predispose to increase in sepsis in NICUs unlike adult ICUs. 10 Therefore, we designed a clinical trial to resolve this equipoise. We hypothesised that the multiple applications of aqueous chlorhexidine in preterm infants admitted in NICUs may increase the pathogenic colonisation with gram negative bacteria compared to placebo.…”

Potential NICU Environmental Influences on the Neonate's Microbiome

“…18 High-risk term and preterm infants are at an increased risk of infection due to their illness, and in preterm infants due to immature skin and immune systems. 19,20 Caregiving equipment not only comes in contact with infants, but items like electrocardiogram (EKG) leads, monitoring probes, adhesive dressings, and chemical burns that can damage the epithelium can also lead to increased risk of microbial invasion. 20 Over the past two decades several NICU outbreaks of Pseudomonas aeruginosa and Klebsiella pneumoniae neonatal infections were linked to healthcare providers and caregiving activities, 21-24 but they fail to inform us about the development of the infant’s microbiome.…”

Update on Newborn Bathing

“…23 In premature infants, bathing with chlorhexidine gluconate reduced skin colonization only transiently. 24 Concerns have also been raised about the potentially negative effect it may have on normal skin colonization.…”