Objective: Our objective was to assess the current practice of CHG use in United States NICUs to explore real and perceived safety concerns of CHG in the neonatal population.
Methods: In July 2009, a survey was distributed via e-mail to all 100 neonatology training program directors in the United States.
Results: There was a 96% response rate from 39 states and the District of Columbia. All respondents practiced at level 3b or higher NICUs in the United States. Sixty-one percent of respondents reported use of CHG in their NICU; but those in the field for more than 30 years were less likely to report its use (p= .08) . In NICU’s in which CHG was utilized, a neonatologist was involved in 87% of the decision-making and an infection control practioner in 43%. The most commonly reported use of CHG in the NICU was for central venous catheter (CVC) maintenance (78%). Other uses of CHG include CVC insertion site preparation (70%), peripheral venous catheter insertion (60%), skin preparation for umbilical catheter insertion (51%), or a combination of umbilical catheter insertion, other CVC insertion, and CVC maintenance (40%). One institution reported routinely bathing neonates with CHG and 4 institutions use CHG for MRSA decolonization. Of those respondents who use CHG, 27% restrict use by chronological age and 51% limit by birth weight or gestational age. Fifty-three percent of those who use CHG have noticed adverse reactions; all reactions were local skin reactions ranging from erythema to second degree burns. No systemic toxicities were reported.
Conclusions: Current practices of CHG utilization in United States NICUs are very heterogenous. Despite guidelines discouraging the use of CHG in infants less than 2 months of age, the majority of participants use CHG in their NICUs. Prospective studies are needed to determine sub-populations in the NICU in which CHG is both safe and effective.