Chlorhexidine use in the Neonatal Intensive Care Unit: Results from a National Survey

Background: Chlorhexidine gluconate (CHG) is a topical, broad-spectrum antiseptic used to prevent the spread of antibiotic-resistant organisms in numerous settings.  The use of CHG in the NICU setting is confused by data demonstrating efficacy at preventing nosocomial infections, but guidelines that do not support its use in this population. 
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.