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Catheter-related bloodstream infections are one of the most dangerous complications of healthcare and are associated with considerable morbidity and mortality, especially in neonates. Application of a cutaneous antiseptic solution that will effectively disinfect the site of insertion before placing a central venous catheter (CVC) is an important method of preventing catheter-related infection. A recently published national evidence-based guideline on prevention of healthcare-associated infections recommends 2% chlorhexidine in 70% isopropyl alcohol for cutaneous antisepsis prior to the insertion of CVCs in adults and in children aged >1 year (class A recommendation).1 There is presently no national recommendation to guide adequate skin antisepsis for neonates and infants.
In October 2007 we conducted a survey of all tertiary-level neonatal intensive care units (NICUs) in the UK on current practices of cutaneous antisepsis prior to insertion of central venous and umbilical catheters. This was a telephone survey and data were obtained from the nurse manager or nurse in charge at a unit; we requested each person taking part in the survey to check the actual solution currently being used and to read out to us its name, and its constituents and concentrations.
Data were obtained from all 50 NICUs approached. We found a lack of uniformity across the NICUs with regard to the type or concentration of antiseptic solutions currently being used (table 1). However, few data are available to guide our choice of agents. A study that compared topical 0.5% chlorhexidine/70% isopropyl alcohol with 10% povidone-iodine found similar reduction in bacterial counts on the skin of preterm infants with the two solutions.2 Another study suggested that 0.5% chlorhexidine was superior to 10% povidone-iodine in preventing peripheral venous catheter colonisation in neonates.3 Nonetheless, antiseptic use is not hazard-free in neonates, and extensive chemical burns have been reported with 0.5% chlorhexidine in 70% alcohol.4 Exposure of neonatal skin to iodine has been associated with skin necrosis, prolonged rise of serum iodine levels and hypothyroidism.5 Neonatal alcohol intoxication resulting from cutaneous alcohol absorption following topical application has been described.6 Systemic absorption of chlorhexidine is rare, although it can occur when alcohol is used concurrently.5
Randomised controlled trials are warranted to establish the optimal antiseptic solutions for use in neonates—preparations that will minimise the risk of catheter-related morbidity and mortality and any side effects associated with catheter use.
We thank all the nurses who kindly contributed their unit’s data.
Competing interests: None.
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