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Chlorhexidine may reduce infections in neonates

March 1, 2022

Chlorhexidine cleansing reduced rates of central line-associated bloodstream infections (CLABSIs) in neonates compared with conventional or no cleansing but had no effect on sepsis, according to a meta-analysis.

Neonates are at risk of health care-associated infections (HAIs), which can lead to disability or death. Chlorhexidine has been shown to reduce HAIs in adults, but its use in neonates is not well-studied.

Due to a lack of data, the Centers for Disease Control and Prevention does not recommend the topical antiseptic for infants younger than 2 months, and the Food and Drug Administration says it should be used with care in premature infants and those younger than 2 months. Still, surveys show most neonatal intensive care units use chlorhexidine.

To determine the effects of chlorhexidine cleansing on HAIs in neonates, researchers conducted a systemic review and identified six studies that met inclusion criteria. Four were randomized, controlled trials (RTCs), and two had quasi-experimental designs. In all of the studies, chlorhexidine was used to clean the infants’ entire body.

Skin bacterial colonization was an outcome measure for all four RTCs, but different sample collection sites and concentrations of chlorhexidine were used. Researchers analyzed data on collection from the axilla, which was used in all of the studies. Subgroup analysis based on concentration showed 0.25% chlorhexidine significantly reduced skin bacterial colonization, but no significant change was seen with a concentration of 0.4% or 0.44%. Since one study found the decline in colonization was greatest when a higher concentration was used, the authors said more studies are needed.

The two quasi-experimental studies looked at CLABSIs during intervention and control periods. Results showed the infection rate per 1,000 days with central lines or central venous catheters decreased during the intervention period.

Three of the RTCs looked at neonatal sepsis, and no significant effect of chlorhexidine use was found.

“In order to obtain more convincing results, large-scale RTCs are needed,” the authors concluded. “In addition, more studies should be carried out to determine the optimal concentration and frequency of chlorhexidine cleansing so as to maximise the effectiveness of chlorhexidine in preventing infections. However, due to the lack of long-term safety data, chlorhexidine should be cautiously applied.”

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