Current Practices of Antiseptic Use in Canadian Neonatal Intensive Care Units

McCord, Helen; Fieldhouse, Elise; El-Naggar, Walid

doi:10.1055/s-0038-1661406

Cited by 14 publications

(7 citation statements)

References 33 publications

(22 reference statements)

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“…36 A recent survey in 124 Canadian neonatal units showed that nearly 68% of the users had experienced severe skin-related adverse events after using chlorhexidine. 27 The present study provides reassuring safety data from a large cohort regarding routine use of 1% and 2% aqueous CHG solutions in neonates born after 26 weeks' gestation.…”

Section: Original Researchmentioning

confidence: 54%

“…Original research many units have incorporated it as a routine skin antiseptic in the neonatal intensive care unit (NICU). [24][25][26][27] There may be a higher risk of dermatitis and systemic absorption of chlorhexidine with an alcoholic preparation as compared with aqueous preparation. [28][29][30] Therefore, we compared the efficacy of aqueous chlorhexidine in 1% and 2% concentration in terms of the rates of negative post-antisepsis skin swab cultures in neonates of 26-42 weeks of gestation in a randomised noninferiority (NI) trial.…”

Section: What This Study Adds?mentioning

confidence: 99%

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Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: a randomised non-inferiority trial

Sharma

Kulkarni

Thukral

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo evaluate whether 1% aqueous chlorhexidine gluconate (CHG) when compared with 2% aqueous chlorhexidine gluconate is non-inferior for neonatal skin antisepsis.DesignParallel, blinded, non-inferiority randomised trial.SettingLevel III, academic, neonatal intensive care unit.PatientsInfants born at 260/7 to 426/7 weeks of gestation from June 2019 to December 2019.InterventionsParticipants were randomised to skin antisepsis by either 1% aqueous CHG or 2% aqueous CHG.Main outcome measuresThe primary outcome was the proportion of negative skin swab cultures after skin antisepsis. Secondary outcomes were local skin reactions at 0, 6, 12 and 24 hours and plasma chlorhexidine levels in a subset of the study population.ResultsA total of 308 neonates with a median gestation age of 34 (31–37) weeks and mean birth weight of 2029 g were randomised on 685 occasions (1% CHG: n=341; 2% CHG: n=344). 93.0% of the post-antisepsis skin swabs were sterile in 1% CHG group compared with 95.6% of the swabs in the 2% CHG group (risk difference −2.7%, 95% CI −6.2% to +0.8%). The lower bound of 95% CI crossed the pre-specified absolute non-inferiority limit of 5%. Neonates developed mild dermatitis on 16 (2.3%) occasions. There was no significant difference in median plasma CHG levels in the two groups, 19.6 (12.5–36.4) and 12.6 (8.7–26.6) ng/mL, respectively.ConclusionsApplication of 1% aqueous CHG was not shown to be non-inferior to 2% chlorhexidine aqueous for skin antisepsis in neonates. There were no severe skin-related adverse events in either of the two groups.Trial registration numberCTRI/2019/06/019822; (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=33453&EncHid=&userName=CTRI/2019/06/019822)

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Section: Original Researchmentioning

confidence: 54%

Section: What This Study Adds?mentioning

confidence: 99%

Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: a randomised non-inferiority trial

Sharma

Kulkarni

Thukral

et al. 2021

Arch Dis Child Fetal Neonatal Ed

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“…To ensure the safety of infants, no observed adverse effect level for sustained exposure to alcohol in premature infants should be established and used to assess risk, and BACs should be maintained at the lowest possible levels. In this study, we focused on ethanol, but another type of alcohol, isopropanol, commonly used in ABDs, 20 , 21 , 22 shares strong structural and chemical similarity with ethanol 23 , 24 and may need to be considered similarly.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Alcohol Exposure From Alcohol-Based Disinfectants Among Premature Infants in Neonatal Incubators in Japan

et al. 2023

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ImportanceThe risk of premature infants in neonatal incubators exposed to evaporated alcohol from alcohol-based disinfectants (ABDs) is unknown.ObjectiveTo assess alcohol concentrations in the peripheral blood of premature infants and neonatal incubators.Design, Setting, and ParticipantsA quality improvement study comparing 2 different populations before and after introduction of ABD practice (ABD-PRAC) was conducted in a neonatal intensive care unit of a single tertiary hospital in Japan. Participants included premature infants who were born before 34 weeks of gestational age and received medical care in neonatal incubators. The study consisted of 3 periods: (1) September 1, 2020, to August 1, 2021 (prospective observation of pre–ABD-PRAC, (2) August 2 to August 22, 2021 (introduction of ABD-PRAC to medical staff and parents in the neonatal intensive care unit), and (3) August 23, 2021, to March 31, 2022 (prospective observation of post–ABD-PRAC). No follow-up studies were initiated.InterventionsAn ABD-PRAC that aimed to reduce alcohol evaporation from ABDs inside neonatal incubators was instituted: (1) place alcohol preps in the incubator just before use and remove them from the incubator as soon as possible and (2) withhold placing hands into the incubators until 60 seconds after using ABDs for disinfection (applied only to family members).Main Outcomes and MeasuresBlood alcohol concentration and evaporated alcohol concentrations in neonatal incubators.ResultsDisinfectant practice was assessed among 28 infants during the pre–ABD-PRAC (17 infants [10 girls]; median gestational age at birth, 29.4 [IQR, 26.3-30.3] weeks) and post–ABD-PRAC (11 infants [3 girls]; median gestational age at birth, 30.0 [IQR, 25.3-32.2] weeks) study periods. The median blood alcohol concentration was 7.0 (IQR, 5.4-9.3) mg/dL pre–ABD-PRAC and 4.2 (IQR, 2.5-7.2) mg/dL post–ABD-PRAC. The median evaporated alcohol concentration inside neonatal incubators during pre–ABD-PRAC during the day was 23.6 (IQR, 15.9-36.5) ppm and, at night, was 13.2 (IQR, 8.9-19.4) ppm; during post–ABD-PRAC, the concentration was 9.4 (IQR, 6.0-16.0) ppm during the day and 5.7 (IQR, 3.6-9.7) ppm at night. The introduction of ABD-PRAC at 22 weeks’ corrected gestational age was associated with a lower blood alcohol concentration in premature infants: regression coefficient value, −8.3 (95% CI, −12.0 to −4.7).Conclusions and RelevanceIn this study, alcohol evaporated from ABDs was absorbed by premature infants in neonatal incubators. The findings suggest that introduction of ABD-PRAC was associated with lower alcohol concentrations in neonatal incubators and in the blood of premature infants.

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“…Antiseptics may effectively reduce skin colonization with pathogens, and chlorhexidine gluconate and octenidine dihydrochloride are among the most common antiseptics used in preterm and term neonates [78, 79]. Given the risk of absorption and subsequent systemic effects as well as potential development of skin necrosis, alcohol-based antiseptics must be avoided.…”

Section: Clinical Implications and Translation Into Practicementioning

confidence: 99%

The Delicate Skin of Preterm Infants: Barrier Function, Immune-Microbiome Interaction, and Clinical Implications

et al. 2023

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The skin of preterm infants is a delicate organ with critical structural and functional differences as compared to term born infants. Unique features contribute to an increased susceptibility to injury, infection, thermal instability, and water loss. During rapid, often accelerated adaption of the physical barrier function of preterm skin, a parallel and mutual development of host skin immunity and skin microbiome seem to be crucial for skin homeostasis. Recent advances in molecular biology have enabled researchers to gain a deeper understanding of the microbial community composition of preterm skin and the important relationship with microbiome composition of other body sites. Nevertheless, several questions remain to be answered, including niche factors and environmental influences on skin maturation. In line with that, evidence-based guidelines on skin care practice in preterm infants are missing. This review articles aims to provide an overview of the current knowledge of preterm infant skin development including immune and barrier function, host-microbial interactions, and potential clinical implications.

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Current Practices of Antiseptic Use in Canadian Neonatal Intensive Care Units

Cited by 14 publications

References 33 publications

Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: a randomised non-inferiority trial

Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: a randomised non-inferiority trial

Assessment of Alcohol Exposure From Alcohol-Based Disinfectants Among Premature Infants in Neonatal Incubators in Japan

The Delicate Skin of Preterm Infants: Barrier Function, Immune-Microbiome Interaction, and Clinical Implications

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