Impact of chlorhexidine in alcohol swab for skin antisepsis in preterm neonates A randomised control trial

Abstract

ABSTRACT: Chlorhexidine in alcohol had been widely utilized as an antiseptic agent before venepuncture and vascular access procedures due to its acknowledged benefits of immediate action and sustained residual effects. However, concerns had emerged regarding potential drawbacks, especially concerning skin integrity and systemic absorption in vulnerable populations like preterm neonates. Despite its widespread use, a comprehensive evaluation of the safety and efficacy of the primary concentrations 0.5% and 2% chlorhexidine in alcohol is been notably absent. newlineOBJECTIVE newlineThe research aimed to rigorously evaluate and compare the efficacy and safety metrics associated with the 0.5% and 2% chlorhexidine in alcohol within the Preterm neonate care context. newlineMATERIALS AND METHODOLOGY newlineConducted in the Neonatal intensive care unit(NICU), Chettinad Hospital and Research Institute in Kelambakkam, the study adopted an open-labelled randomized control trial design, further strengthened with blocking and stratification based on gestational age categories: neonates born at less than 28 weeks and those between 28-34 weeks. The research cohort comprised 100 preterm neonates, with each subgroup evenly split between those receiving 0.5% and 2% chlorhexidine in alcohol swabs for pre-venepuncture skin preparation. newlineDATA COLLECTION AND ANALYSIS: newlineData had been acquired through a multifaceted approach, integrating direct observational data, comprehensive reviews of medical records, and laboratory analyses. Subsequent statistical evaluations were meticulously conducted to delineate comparative outcomes, providing insights into chlorhexidine concentration efficacy and safety dynamics in neonatal care settings. newlineRESULTS: newlineAnalysis of skin integrity parameters revealed substantial alterations within both groups, with statistically significant differences observed in skin hydration post- newlineintervention (39.6 vs. 34.4, p=0.009) and 6-12 hours later (34.7 vs. 30.2, p=0.046). However, other parameters, including log reduction in bacterial count, skin pH, and skin condition scores, showed no significant differences between the concentrations. Examination of serum chlorhexidine post-applications demonstrated minimal levels with no significant difference (p=0.220). Skin changes post-application also exhibited no significant difference between 0.5% and 2% chlorhexidine concentrations (p=0.603). newlineCONCLUSION: newlineThis study compares the effectiveness and safety of 0.5% and 2% chlorhexidine concentrations in reducing bacterial counts during preterm neonatal care. Both concentrations demonstrate similar efficacy, supporting their interchangeable use for infection prevention procedures. The significant alteration in the skin hydration following 0.5% CHXA use was not associated with significant changes in other skin integrity parameters . Minimal changes in skin pH and consistent skin condition scores indicate overall safety in preterm neonates. Low levels of serum chlorhexidine further contribute to a favourable safety profile, allowing clinicians flexibility in choosing concentrations based on factors such as skin tolerance. This research informs clinicians that both 0.5% and 2% chlorhexidine concentrations are effective and safe in preterm neonatal care, emphasizing the importance of continued monitoring for sustained safety and efficacy. newline