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  • Original Article
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Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates

Journal of Perinatology volume 29, pages 808–813 (2009)Cite this article

Abstract

Objective:

The purpose of this pilot trial was to determine whether rates of contact dermatitis following cutaneous antisepsis for central catheter placement were similar among neonates treated with chlorhexidine gluconate and povidone-iodine. Chlorhexidine gluconate absorption was also evaluated.

Study Design:

Infants weighing ⩾1500 g and ⩾7 days of age were randomized to a 10% povidone-iodine or 2% chlorhexidine gluconate site scrub before catheter placement. Primary outcomes evaluated included dermatitis, catheter colonization and chlorhexidine gluconate absorption.

Result:

A total of 48 neonates were enrolled. Colonization rates were similar among treatment groups (P<0.6). Dermatitis did not occur at chlorhexidine gluconate (central catheters, n=24; peripheral catheters, n=29) sites. Seven neonates had measurable chlorhexidine gluconate concentrations (range 13 to 100 ng ml−1) during catheterization.

Conclusion:

In this small trial chlorhexidine gluconate antisepsis was tolerated by study neonates. Chlorhexidine gluconate was cutaneously absorbed. Larger trials are needed to determine efficacy and tolerance of chlorhexidine gluconate in neonates.

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References

  1. Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996; 129: 63–71.

    Article  CAS  Google Scholar 

  2. Gray JE, Richardson DK, McCormick MC, Goldmann DA . Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome. Pediatrics 1995; 95: 225–230.

    CAS  PubMed  Google Scholar 

  3. Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR et al. Incidence, presenting features, risk factors, and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network. Pediatr Infect Dis J 1998; 17: 593–598.

    Article  CAS  Google Scholar 

  4. Sohn AG, Garrett DO, Sinkowitz-Cochran RL, Grohskopf LA, Levine GL, Stover BH et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001; 139: 821–827.

    Article  CAS  Google Scholar 

  5. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292: 2357–2365.

    Article  CAS  Google Scholar 

  6. Smerdely P, Lim A, Boyages SC, Waite K, Wu D, Roberts V et al. Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants. Lancet 1989; 2 (8664): 661–664.

    Article  CAS  Google Scholar 

  7. Parravicini E, Fontana C, Paterlini G, Tagliabue P, Rovelli F, Leung K et al. Iodine, thyroid function, and very low birth weight infants. Pediatrics 1996; 98: 730–734.

    CAS  PubMed  Google Scholar 

  8. Gordan CM, Rowitch DH, Mitchell ML, Kohane IS . Topical iodine and neonatal hypothyroidism. Arch Pediatr Adolesc Med 1995; 149: 1336–1339.

    Article  Google Scholar 

  9. Brown RS, Bloomfield S, Bednarek FJ, Mitchell ML, Braverman L . Routine skin cleansing with povidone-iodine is not a common cause of transient neonatal hypothyroidism in North America: a prospective controlled study. Thyroid 1997; 7: 395–400.

    Article  CAS  Google Scholar 

  10. Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K et al. Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med 1996; 24: 1818–1823.

    Article  CAS  Google Scholar 

  11. Maki DG, Ringer M, Alvarado CJ . Prospective randomized trial of povidone-iodine, alcohol and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991; 338: 339–343.

    Article  CAS  Google Scholar 

  12. Garland JS, Buck RK, Maloney P, Durkin BM, Toth-Lloyd S, Duffy M et al. A comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J 1995; 14: 510–516.

    Article  CAS  Google Scholar 

  13. Chaiyakunapruk N, Veenstra DL, Lipsky B, Saint S . Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002; 136: 792–801.

    Article  CAS  Google Scholar 

  14. Maki DG, Weise CE, Sarafin HW . A semiquantitative culture method for identifying intravenous catheter-related infection. N Engl J Med 1997; 296: 1305–1309.

    Article  Google Scholar 

  15. Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M . Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 1987; 147: 873–877.

    Article  CAS  Google Scholar 

  16. Collignon PJ, Soni N, Pearson IY . Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia? J Clin Microbiol 1986; 24: 532–535.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Cooper GL, Hopkins CC . Rapid diagnosis of intravascular catheter-associated infection by direct Gram staining of catheter segments. N Engl J Med 1985; 18: 1142–1147.

    Article  Google Scholar 

  18. Garland JS, Alex C, Mueller CP, Cisler-Kahill LA . Local reactions to a chlorhexidine gluconate-impregnated antimicrobial dressing in very low birth weight infants. Pediatr Infect Dis J 1996; 15: 912–914.

    Article  CAS  Google Scholar 

  19. Richardson DK, Gray JE, McCormick MC, Workman K, Goldmann DA . Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care. Pediatrics 1993; 91: 617–623.

    CAS  PubMed  Google Scholar 

  20. Aly R, Mailbach HI . Effect of antimicrobial soap containing chlorhexidine on the microbial flora of skin. Appl Environ Microbiol 1976; 31: 931–935.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Shelton DM . A comparison of the effects of two antiseptic agents on staphylococcus epidermis colony forming units at the peritoneal dialysis catheter exit site. Adv Perit Dial 1991; 7: 120–124.

    CAS  PubMed  Google Scholar 

  22. Andersen C, Hart J, Vemgal P, Harrison C . Prospective evaluation of a multi-factorial prevention strategy on the impact of nosocomial infection in very-low-birthweight infants. J Hosp Infect 2005; 61: 162–167.

    Article  CAS  Google Scholar 

  23. Okano M, Nomura M, Hata S, Okada N, Sato K, Kitano Y et al. Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol 1989; 125: 50–52.

    Article  CAS  Google Scholar 

  24. Oda T, Hamasaki J, Kanda N, Mikami K . Anaphylactic shock induced by an antiseptic-coated central venous catheter. Anesthesiology 1997; 87: 1242–1244.

    Article  CAS  Google Scholar 

  25. Garland JS, Alex CP, Sevallius JM, Murphy DM, Good MJ, Volberding AM et al. Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. Infect Control Hosp Epidemiol 2008; 29: 243–249.

    Article  Google Scholar 

  26. Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Harris MC et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001; 107: 1431–1437.

    Article  CAS  Google Scholar 

  27. Obrien CA, Blummer JL, Speck WT, Carr H . Effect of bathing with a 4% chlorhexidine gluconate solution on neonatal bacterial colonization. J Hosp Infect 1984; 5 (Suppl A): 141.

    Google Scholar 

  28. Cowen J, Ellis SH, McAinsh J . Absorption of chlorhexidine from intact skin of newborn infants. Arch Dis Child 1979; 54: 379–383.

    Article  CAS  Google Scholar 

  29. Agget PJ, Copper LV, Ellis SH, McAinsh J . Percutaneous absorption of chlorhexidine in neonatal cord care. Arch Dis Child 1981; 56: 878–891.

    Article  Google Scholar 

  30. Case DE, McAinsh J, Rushton A, Winrow MJ . Chlorhexidine: attempts to detect percutaneous absorption in man. Chemotherapy 1976; 3: 367–374.

    CAS  Google Scholar 

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Acknowledgements

We acknowledge the research coordinator assistance received from the various centers—Wheaton Franciscan Healthcare, St Joseph: Elizabeth Bongert, Melinda P Bushong, Leslie L Hofer, Mary Koehnke, Heidi May, Lori A McLain, Dawn M Murphy, Tiffany N Perine, Jackie M Sevallius, Rae Toman, Amy WernerWoida. Aurora Sinai Medical Center: Joan Becker; Children's Hospital of Wisconsin: Laura Lane; Children's Hospital of Philadelphia: Linda Corcoran, Jane Fricko, Sharon Zirin; Children's Hospital (Boston): Hannah Pawlzendo. Financial support was provided by Enturia (formerly Medi-Flex). The sponsor reviewed the study design developed by the primary investigator. It was not involved with the data collection, implementation, analysis or interpretation of data. They had an opportunity to review the paper before publication. The project described was supported by Grant Number UL1-RR-024134 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pediatrics, Wheaton Franciscan Health Care, St Joseph Hospital, Milwaukee, WI, USA

    J S Garland & C P Alex

  2. Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    M R Uhing

  3. Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    I E Peterside

  4. Joint Program in Neonatology, Harvard Medical School (now at St Vincent Healthcare, Billings, MT), Boston, MA, USA

    A Rentz

  5. Division of Neonatology and Newborn Services, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    M C Harris

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  1. J S Garland
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Correspondence to J S Garland.

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Garland, J., Alex, C., Uhing, M. et al. Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates. J Perinatol 29, 808–813 (2009). https://doi.org/10.1038/jp.2009.161

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