2% chlorhexidine–70% isopropyl alcohol versus 10% povidone–iodine for insertion site cleaning before central line insertion in preterm infants: a randomised trial

Kieran, Emily A; O'Sullivan, Anne; Miletin, Jan; Twomey, A; Knowles, S; O’Donnell, Colm P.

doi:10.1136/archdischild-2016-312193

Cited by 42 publications

(31 citation statements)

References 43 publications

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“…As a result of these findings, a randomized trial was designed involving 304 preterm neonates in Dublin comparing 0.2% chlorhexidine gluconate in 70% isopropanol to 10% aqueous povidone‐iodine. Interestingly, the results show no difference in the incidence of catheter‐related bloodstream infection or in skin irritation; however, more thyroid suppression is seen in the povidone‐iodine‐treated group (8% in the povidone‐iodine group vs 0% in the chlorhexidine group) . More research is needed to assess systemic effects of CHG and determine definitively whether 0.2% CHG is a viable alternative to povidone‐iodine in preterm neonates.…”

Section: Resultsmentioning

confidence: 93%

“…however, more thyroid suppression is seen in the povidone-iodinetreated group (8% in the povidone-iodine group vs 0% in the chlorhexidine group). 48 More research is needed to assess systemic effects of CHG and determine definitively whether 0.2% CHG is a viable alternative to povidone-iodine in preterm neonates.…”

Section: Sterilization For Catheter Placement and Proceduresmentioning

confidence: 99%

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Evidence‐based skin care in preterm infants

Kusari

Han

Virgen

et al. 2018

Pediatric Dermatology

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Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence‐based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates—but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase‐negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone‐iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.

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Section: Resultsmentioning

confidence: 93%

Section: Sterilization For Catheter Placement and Proceduresmentioning

confidence: 99%

Evidence‐based skin care in preterm infants

Kusari

Han

Virgen

et al. 2018

Pediatric Dermatology

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show abstract

“…33 It is concerning that more than onethird of the NICUs still use PI before urinary catheterization despite the related reports of hypothyroidism secondary to the systemic absorption of iodine in the newborn infants. [17][18][19]32 It remains unclear if the risk of significant iodine absorption is the same as in other studies reporting larger body surface area exposure or more frequent use of cutaneous PI.…”

Section: Discussionmentioning

confidence: 93%

“…Their study, however, was not adequately powered to detect a difference. 32 In a large historical control cohort, no increase in infection was noted when 0.5% CHG replaced PI as the standard of care for skin antisepsis in the NICU. 33 It is concerning that more than onethird of the NICUs still use PI before urinary catheterization despite the related reports of hypothyroidism secondary to the systemic absorption of iodine in the newborn infants.…”

Section: Discussionmentioning

confidence: 97%

Current Practices of Antiseptic Use in Canadian Neonatal Intensive Care Units

2018

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“…Kieran and colleagues13 deserve praise for having completed one of only very few antiseptic RCTs ever done in neonates for skin disinfection prior to central venous catheter insertion. Studying a large cohort of preterm neonates <31 weeks’ gestation, and with excellent follow-up rates, they present data suggesting that the 2% CHG–70% isopropyl alcohol combination seems comparable in efficacy against CLABSI as 10% povidone-iodine solution.…”

mentioning

confidence: 99%