Chlorhexidine use common in neonatal ICUs despite risks

More than half of health care workers who participated in a survey reported using chlorohexidine gluconate in neonatal intensive care units despite recommendations to the contrary, survey results presented at the Fifth Decennial International Conference on Healthcare-Associated Infections in Atlanta indicated.

Researchers from Johns Hopkins University in Baltimore surveyed all 100 U.S. neonatology training program directors in July 2009 with the goal of exploring real and perceived safety concerns of chlorhexidine gluconate (CHG) use in neonatal ICUs.

Ninety-six percent of the polled population — who practiced at a level 3b hospital or higher — responded from 39 states and Washington, D.C. The researchers said that 61% of respondents reported the use of CHG in their neonatal ICUs. Practitioners who had worked in the field for more than 30 years, however, were less likely to report its use (P=.08).

A neonatologist was involved in 87% of the decision-making in neonatal ICUs that employed CHG, according to the researchers, and an infection control practitioner in 43%. Commonly reported reasons for CHG use included:

Central venous catheter maintenance (78%);
Central venous catheter insertion site preparation (70%);
Peripheral venous catheter insertion (60%);
Skin preparation for umbilical catheter insertion (51%);
A combination of umbilical catheter insertion and other central venous catheter insertion and maintenance (40%).

The researchers also noted that hospitals differed in their CHG practices, with one institution routinely bathing neonates with CHG and four institutions using CHG for methicillin-resistant Staphylococcus aureus decolonization.

Even though results indicated CHG use was high, physicians expressed apprehension, according to Pranita D. Tamma, MD, of Johns Hopkins University.

“Sixty-five percent of all respondents reported concern regarding chlorhexidine use in the neonatal population. Some open-ended questions included concerns about the off-label, unapproved use of chlorhexidine in neonates with immature skin and limited safety data on its use in premature infants,” Tamma said.

Twenty-seven percent of respondents also said they restricted CHG use by chronological age, whereas 51% limited use by birth weight or gestational age.

Among the respondents who reported using CHG, 53% noticed adverse, local skin reactions, which ranged from erythema to second degree burns. – by Melissa Foster

For more information:

Tamma PD. #64. Presented at: Fifth Decennial International Conference on Healthcare-Associated Infections; Mar. 18-22, 2010; Atlanta.

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