Chlorhexidine

[Vicky Payne]

Dear all- I am posting this via the 99NICU app to test it!! But I am also interested to know what strength Chlorhexidine people use prior to central line insertion in ELBW infants and 23 (?22?) to 25 weeks???
Thanks in advance!
Best wishes
Vicky x

[Stefan Johansson]

And I reply on the app :) (which I find a bit clunky still)
we would use phys sodium chloride for ELBW infants

[Stefan Johansson]

@Vicky Payne Found these previous threads: 

 

 

 

[Vicky Payne]

On 11/12/2020 at 6:29 PM, Stefan Johansson said:

And I reply on the app (which I find a bit clunky still)
we would use phys sodium chloride for ELBW infants

Hmmm I didn't even realise this had posted from the app!! ooops! Interesting you use saline only. What are your infection rates per 1000 CL days in this particular cohort of babies????

[Karen]

Hi Vicky

Due to skin fragility in this cohort of infants (and previous experience), we use the 0.1% Chlorhexidine irrigation solution in all infants < 28/40 until the epidermal layers stratify

 

[James Marceau]

Hi Vicky

We use 0.5% Aqueous Chlorhexidine for premature infants less than 30/40 or less than 1000grams.

We have only had one 24/40 triplet with 6-7% partial thickness contact burns from this solution.

James

[Stefan Johansson]

On topic - a recent meta-analysis out in ADC/FN: https://fn.bmj.com/content/early/2021/12/22/archdischild-2021-322429

Quote

The results of the meta-analysis revealed that chlorhexidine cleansing had no significant effect on neonatal sepsis (RR: 0.49, 95% CI 0.18 to 1.38, p=0.18, I2=0%), but significantly reduced neonatal skin bacterial colonisation (RR: 0.61, 95% CI 0.42 to 0.90, p=0.01, I2=50%). In addition, this systematic review showed that chlorhexidine cleansing could significantly reduce central line-associated bloodstream infection in neonates based on large-sample studies. However, more studies are needed to determine the optimal concentration and frequency of chlorhexidine cleansing.

BTW, I wonder whether the "no significant effect" on sepsis is really a "true no effect" or just an example of how p-values steer how we report and interpret research finding as written about here: https://www.nature.com/articles/d41586-019-00857-9
(yes, I signed this call)

[Vicky Payne]

I liked the link here to the reporting of stats paper!! Some good points in here.

Perhaps also the fact that skin cleaning is only one part of how central lines (and other invasive devices) may cause infection is also something to think about in this particular research area. Reducing colonisation good but transient....other practices are also likely to be important and may be different across all the studies included in a meta-analysis?