65 Blood Concentrations of Chlorhexidine Gluconate (CHG) in Hospitalized Children Undergoing Daily CHG Bathing

Friday, March 19, 2010: 10:45 AM
International North (Hyatt Regency Atlanta)
Andrew Lee, MHS , Johns Hopkins University, Baltimore, MD
Robert Harlan, MS , Johns Hopkins University, Baltimore, MD
Autumn R. Breaud, MS , Johns Hopkins University, Baltimore, MD
Kathleen Speck, MPH , Johns Hopkins University, Baltimore, MD
Trish Perl, MD, MSc , The Johns Hopkins Hospital, Baltimore, MD
William Clarke, PhD , Johns Hopkins University, Baltimore, MD
Aaron M. Milstone, MD, MHS , Johns Hopkins University, Baltimore, MD
Background: Chlorhexidine gluconate (CHG) is used commonly for infection prevention and control in healthcare settings. Some evidence suggests that CHG may be absorbed through intact skin of neonates. The potential for absorption and accumulation in older pediatric patients following daily CHG bathing is unknown.

Objective: To assess whether CHG is absorbed through the intact skin of children and can be detected in the blood following repeated daily exposure.

Methods: Serial blood samples were collected from patients greater than two months of age in The Johns Hopkins Hospital Pediatric Intensive Care Unit. After obtaining informed consent, patients received daily baths using 2% CHG impregnated cloths as part of an on-going clinical trial to evaluate whether daily CHG bathing reduces healthcare-associated infections. Blood CHG concentrations were measured using turbulent flow liquid chromatography-tandem mass spectrometry.

Results: 12 patients enrolled in the study had samples of sufficient quantity for analysis. Mean age was 6 yrs (range 3 mos-17 yrs). 8 patients (67%) had samples collected after at least 7 days of CHG exposure, including 2 patients ages 2 mos-1 yr, 3 patients ages 2-9 yrs, and 3 patients ages 10-17 yrs. 35 blood samples were collected and analyzed, including 8 pre-exposure and 27 post-exposure (range 1-31 days) samples. 23 post-exposure samples (85%) had a serum CHG concentration below the lower limit of detection (LOD = 4.5ng/mL). Trace CHG concentrations below the limit of quantitation (LOQ = 17ng/mL) were found in 3 samples (11%), whose patient’s ages were 9 mos, 2 yrs, and 10 yrs. 1 sample (4%) collected after 14 days of CHG bathing in a 5 year old tested above the LOQ at 57ng/mL. Two patients with detectable CHG concentrations (5 and 57ng/mL) had no detectable CHG in subsequent samples.

Conclusions: Overall, our data suggest that daily bathing with CHG may result in trace absorption through intact skin, but there was no evidence of accumulation in the bloodstream in children over 2 months of age. There was no clear association between patient age and trace CHG absorption. As CHG use increases in healthcare setting, similar studies are needed to assess the risk of CHG absorption and accumulation in other populations including patients with compromised skin integrity and children less than two months of age.