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The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit

Journal of Perinatology volume 39, pages 63–71 (2019)Cite this article

Subjects

Abstract

Objective

To assess the impact of chlorhexidine gluconate (CHG) bathing on skin bacterial burden in neonates.

Study design

In this prospective observational study, arm and groin skin bacterial growth was measured in 40 CHG-exposed and nonexposed neonates admitted to the NICU. Exposed neonates received 2% CHG baths per protocol for central line-associated bloodstream infection (CLABSI) prevention or Staphylococcus aureus decolonization.

Results

Forty neonates were enrolled, 18 of whom were CHG-exposed. Mean baseline Gram-positive (GP) bacterial burden was 2.19 log CFU/ml on the arm and 1.81 log CFU/ml on the groin. Bacterial burden decreased after the first bath, but returned to baseline by 72 h. Residual skin CHG concentration declined over time, with a corresponding increase in GP bacterial burden.

Conclusions

CHG bathing reduces skin bacterial burden, but burden returns to baseline after 72 h. Twice weekly CHG bathing may be inadequate to suppress skin bacterial growth in hospitalized neonates.

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References

  1. Ponnusamy V, Venkatesh V, Clarke P. Skin antisepsis in the neonate: what should we use? Curr Opin Infect Dis. 2014;27:244–50.

    Article  CAS  Google Scholar 

  2. Klevens RM, Edwards JR, Richards CL, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160–6.

    Article  Google Scholar 

  3. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for control and prevention. Clin Infect Dis. 2008;46:274–81.

    Article  Google Scholar 

  4. Vernon MO, Hayden MK, Trick WE, Hayes RA, Blom DW, Weinstein RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med. 2006;166:306–12.

    Article  CAS  Google Scholar 

  5. Bleasdale SC, Trick WE, Gonzalez IM, Lyles RD, Hayden MK, Weinstein RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med. 2007;167:2073–9.

    Article  Google Scholar 

  6. Climo MW, Sepkowitz KA, Zuccotti G, Fraser VJ, Warren DK, Perl TM, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med. 2009;37:1858–65.

    Article  CAS  Google Scholar 

  7. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:753–71.

    Article  Google Scholar 

  8. Mullany LC, Saha SK, Shah R, Islam MS, Rahman M, Islam M, et al. Impact of 4.0% chlorhexidine cord cleansing on the bacteriologic profile of the newborn umbilical stump in rural Sylhet district, Bangladesh. Pediatr Infect Dis J. 2012;31:440–50.

    Article  Google Scholar 

  9. Arifeen SE, Mullany LC, Shah R, Mannan I, Rahman SM, Talukder MR, et al. The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomized trial. Lancet. 2012;379:1022–8.

    Article  Google Scholar 

  10. Sinha A, Sazawal S, Pradhan A, Ramji S, Opiyo N. Chlorhexidine skin or cord care for prevention of mortality and infections in neonates. Cochrane Database Syst Rev. 2015;3:CD007835.

  11. Johnson J, Bracken R, Tamma PD, Aucott SW, Bearer C, Milstone AM. Trends in chlorhexidine use in US Neonatal Intensive Care Units: results from a follow-up national survey. Infect Control Hosp Epidemiol. 2016;37:1116–8.

    Article  Google Scholar 

  12. Tamma PD, Aucott SW, Milstone AM. Chlorhexidine use in the neonatal intensive care unit: results from a national survey. Infect Control Hosp Epidemiol. 2010;31:846–9.

    Article  Google Scholar 

  13. Quach C, Milstone AM, Perpête C, Bonenfant M, Moore DL, Perreault T. Chlorhexidine bathing in a tertiary care neonatal intensive care unit: impact on central line-associated bloodstream infections. Infect Control Hosp Epidemiol. 2014;35:158–63.

    Article  Google Scholar 

  14. Chapman AK, Aucott SW, Milstone AM. Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant. J Perinatol. 2012;32:4–9.

    Article  CAS  Google Scholar 

  15. Popovich KJ, Lyles R, Hayes R, Hota B, Trick W, Weinstein RA, et al. Relation of chlorhexidine gluconate skin concentration to microbial density on skin of critically ill patients bathed daily with chlorhexidine gluconate. Infect Control Hosp Epidemiol. 2012;33:889–96.

    Article  Google Scholar 

  16. Popoola VO, Budd A, Wittig SM, Ross T, Aucott SW, Perl TM, et al. MRSA transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization—challenges for infection prevention. Infect Control Hosp Epidemiol. 2014;35:412–8.

    Article  Google Scholar 

  17. Angeletti S. Matrix assisted laser desorption time of flight mass spectrometry (MALDI-TOF MS) in clinical microbiology. J Microbiol Methods. 2017;138:20–29.

    Article  CAS  Google Scholar 

  18. Climo MA, Wong ES. Daily chlorhexidine bathing and hospital-acquired infection. N Engl J Med. 2013;368:2332.

    Article  CAS  Google Scholar 

  19. Milstone AM, Elward A, Song X, Zerr DM, Orscheln R, Speck K, et al. Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicenter, cluster-randomised, crossover trial. Lancet. 2013;381:1099–106.

    Article  CAS  Google Scholar 

  20. Sankar MJ, Paul VK. Efficacy and safety of whole body skin cleansing with chlorhexidine in neonates—a systemic review. Pediatr Infect Dis J. 2013;32:e227–e234.

    Article  Google Scholar 

  21. Gupta B, Vaswani ND, Sharma D, Chaudhary U, Lekhwani S. Evaluation of efficacy of skin cleansing with chlorhexidine in prevention of neonatal nosocomial sepsis—a randomized controlled trial. J Matern Fetal Neonatal Med. 2016;29:242–7.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors wish to thank the study’s participants and their families, as well as Annie Voskertchian and Anne King for their study support, and Dr. Mary K. Hayden and her colleagues at Rush University for sharing their colorimetric assay protocol.

Funding

This study was supported by an investigator-initiated research grant from Sage Products, LLC, and NIH Training Grant Award T32 HL 125239-1 (JJ).

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Julia Johnson & Susan W. Aucott

  2. Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nuntra Suwantarat, Tracy L. Ross & Karen C. Carroll

  3. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Elizabeth Colantuoni

  4. Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Aaron M. Milstone

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  1. Julia Johnson
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  2. Nuntra Suwantarat
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  3. Elizabeth Colantuoni
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  4. Tracy L. Ross
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  5. Susan W. Aucott
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Correspondence to Julia Johnson.

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The authors declare that they have no conflict of interest.

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Johnson, J., Suwantarat, N., Colantuoni, E. et al. The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit. J Perinatol 39, 63–71 (2019). https://doi.org/10.1038/s41372-018-0231-7

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  • DOI: https://doi.org/10.1038/s41372-018-0231-7

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