Safety and Effect of Chlorhexidine Skin Cleansing on Skin Flora of Neonates in Bangladesh

Hossain, Monir; Choi, Yoonjoung; Shirin, Mahfuza; Mullany, Luke C.; Islam, Maksuda; Saha, Samir K.

doi:10.1097/01.inf.0000261927.90189.88

Cited by 29 publications

(40 citation statements)

References 17 publications

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“…Similar results have been reported from other studies too. 8,20 The results are, however, in contrast with the observation by Garland et al, 11 who found localized contact dermatitis after the use of chlorhexidine-gluconate impregnated dressing and hence were not in favor of its prolonged use in LBW infants. Unlike the antimicrobial dressing, single skin cleansing does not lead to prolonged exposure, and hence is unlikely to result in severe local reactions in these infants.…”

Section: Discussioncontrasting

confidence: 56%

“…22 The study from Bangladesh that evaluated single skin cleansing with chlorhexidine also showed a significant reduction in the positive culture rates until three days after the intervention. 20 In contrast, the study from Nepal showed reduction in the colonization rates at 2 h but not at 24 h. 8 In this study, skin cleansing with 0.25% chlorhexidine was found to reduce the risk of axillary colonization by almost 60% at 24 h when compared with no cleansing. The incidence of skin colonization at 72 h was, however, not different between the two groups.…”

Section: Discussionmentioning

confidence: 40%

“…8,12,20 As both chlorhexidine and saline wipes would have the same effect on heat loss, we included a third group (no cleansing) in the present study; still, we did not find any significant difference in mean skin temperatures between this group and the other two groups. This could be explained by the fact that most infants were nursed under the radiant warmer in our study, and hence the effect on skin temperature, if any, could have been masked.…”

Section: Discussionmentioning

confidence: 86%

“…17 Initial studies on bathing/cleansing with chlorhexidine involved predominantly term infants or older preterm infants (a few weeks after birth). 18,19 Recently, a study from Bangladesh evaluated the effect of chlorhexidine skin cleansing within the first three days of life in both term and preterm neonates; 20 another study from Nepal has enrolled predominantly term infants (mean gestation 38 weeks). 8 In contrast, we enrolled only preterm (28 to 36 weeks) low birth weight (1000 to 2000 g) infants within 2 to 3 h of birth.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 40%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Balachandran

Bharathi

Kumutha

2018

Int J Contemp Pediatr

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Background: Aqueous chlorhexidine applied repeatedly may predispose to increased gram negative bacterial colonization in preterm skin due to its higher bactericidal action against gram positive bacteria and absence of alcohol. The objective was to study the difference in rates of gram negative bacterial colonization in skin swabs taken from axilla and groin on day 7 after multiple applications of 0.5% aqueous chlorhexidine and placebo (sterile water).Methods: Double blinded, randomised controlled trial recruiting preterm infants(28-34weeks) weighing ≥1000grams, stratified(28-31:32-34week) and randomly allocated to receive multiple body cleansing every 48hours starting from 6hours within birth during first postnatal week. Intervention group received cleansing with 0.5%chlorhexidine wipes and controls cleansed with similar looking sterile water wipes. Comparison of Proportions of swabs showing Gram negative bacterial growth in swabs taken from axilla and groin on day 7 of life after 3 cleansings (primary), at recruitment, 24 and 48 hours after first cleansing (secondary) were outcomes measured.Results: Of 137 eligible neonates, 120 enrolled and 59 infants received chlorhexidine cleansing and 61 received sterile water. At the end of first week, the rate of skin colonization with gram negative bacteria after multiple applications of 0.5% aqueous chlorhexidine was comparable with sterile water cleansing in both axilla (40.9% vs 51.1%, p=0.432) and groin (60.7% vs 54.3%, p=0.592). There was no difference in the rate of gram negative bacterial colonization in axilla and groin skin at 24 and 48 hours after single application also.Conclusions: Aqueous chlorhexidine even after multiple cleansings at 48hours intervals soon after birth has not predisposed to colonization with gram negative bacterial in preterm infants admitted in NICU.

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Umbilical cord antiseptics for preventing sepsis and death among newborns

Imdad

Bautista

Senen

et al. 2013

Cochrane Database of Systematic Reviews

100

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Safety and Effect of Chlorhexidine Skin Cleansing on Skin Flora of Neonates in Bangladesh

Abstract: Chlorhexidine skin treatment produced more extended skin cleansing effects than the placebo treatment. It is possible that the quantitative and qualitative reductions observed in the skin flora might contribute to reducing neonatal infections.

Cited by 29 publications

References 17 publications

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

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

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

Umbilical cord antiseptics for preventing sepsis and death among newborns

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