Background: Chlorhexidine gluconate (CHG) is a broad-spectrum topical antiseptic frequently used to prevent hospital-acquired infections (HAI) and is increasingly used in the NICU. Limited information is available to help guide dosing and frequency of administration in neonates.
Methods: From March 2015 until March 2016, a prospective observational pilot study was conducted in the Johns Hopkins Childrens Center NICU in Baltimore, Maryland, to assess the impact of CHG bathing on the skin bacterial burden of neonates receiving baths as part of clinical care. Bathing schedules varied by indication from twice weekly to two baths 48 hours apart. Arm and groin swabs were obtained in CHG-exposed neonates prior to their first bath, and at 1 hour, 24 hours, 48 hours, and 72 hours after bathing, and in non-exposed neonates at baseline. Bacterial growth was measured quantitatively, and residual CHG concentration was assessed via colorimetric assay.
Results: A total of 36 neonates were enrolled, 15 of whom were CHG-exposed. Mean baseline Gram positive bacterial burden was 2.13 log CFU/ml (range 0-5.86) on the arm and 1.71 log CFU/ml (range 0-5.18) on the groin. Mean baseline Gram negative bacterial burden was 0.03 log CFU/ml (range 0-1.18) on the arm and 0.52 log CFU/ml (range 0-4.00) on the groin. In CHG-exposed neonates, bacterial burden decreased after the first CHG bath, but gradually increased toward baseline (Figures 1 and 2). There was a trend toward statistical significance for a lower arm Gram positive bacterial burden with higher residual CHG concentration (p = 0.05).
Conclusion: CHG bathing reduces skin bacterial burden in hospitalized neonates, but bacterial burden increases back toward baseline 48-72 hours after CHG administration. CHG bathing may be needed more often than twice weekly to adequately suppress bacterial growth on the skin as part of infection prevention in hospitalized neonates.
A. Voskertchian, None
N. Suwantarat, None
T. L. Ross, None
S. W. Aucott, None
K. C. Carroll, None
A. M. Milstone, Sage Products LLC: Grant Investigator , Research grant
MITRE Corporation: Grant Investigator , Research grant