Neonatal skin antisepsis with alcohol-based compared to aqueous 2% chlorhexidine, used in moderate preterm infants or extremely preterm infants after the first week of life, is safe and may be associated with a reduced incidence of catheter-related bloodstream infections

Background Skin antisepsis is one of the most important bundle measures to decrease central line-related bloodstream infections (CRBSIs). However, in the neonatal population, the use of alcoholic chlorhexidine is limited by the risk of skin lesions. Objective We hypothesised that skin antisepsis with alcohol-based 2% chlorhexidine instead of aqueous 2% chlorhexidine could reduce the incidence of CRBSI without increasing skin complications. Design We conducted a double cohort study comparing two periods of 3 years, first using aqueous and second using alcohol-based chlorhexidine, leaving a 1-year washout interval between them. In extremely preterm infants, aqueous chlorhexidine was used during the first week of life in both periods. Results A total of 1783 patients and 2493 episodes of central line catheter were analysed. There were no statistically significant differences in clinical and demographic data from infants in both periods. There was a significant reduction in the pooled incidence density of CRBSI in the second compared with the first period (4.03 vs 9.05 episodes/1000 central line days, OR 0.45 (95% CI 0.29 to 0.68)). The overall absolute risk reduction was 0.039 (95% CI 0.023 to 0.056) and the number needed to treat was 25. A similar but not significant reduction of the small number of CRBSI was observed in extremely preterm infants within the first week of life OR 0.43 (95% CI 0.134 to 1.379). No statistically significant differences in skin lesions were observed between periods, making erythema the most common injury(5.1% vs 4.2%). Relevance Alcohol-based 2% chlorhexidine as a skin antiseptic could reduce the incidence of CRBSI in neonates without producing an increase in skin lesions.