Does Chlorhexidine Cleansing Decrease the Risk for Neonatal Healthcare-Associated Infections?

Although chlorhexidine cleansing was found to have no significant effect on neonatal sepsis, it may be associated with a significantly decreased risk for both neonatal skin bacterial colonization and central line-associated bloodstream infections (CLABSI), according to results of a study published in Archives of Disease in Childhood.

In this systematic review and meta-analysis, researchers assessed results from 6 studies to investigate the effect of chlorhexidine cleansing on the risk for healthcare-associated infections in neonates. Of the 6 studies included in the analysis, 4 were randomized controlled trials (RCT) and 2 were quasi-experimental studies. The primary outcomes were sepsis, skin bacterial colonization, and CLABSI. Quality assessment was completed via version 2 of the Cochrane tool and Joanna Briggs Institute critical appraisal checklist for the RCTs and quasi-experimental studies, respectively.

The researchers assessed results from 4 RCTs that had a primary outcome of skin bacterial colonization (n=4) and/or sepsis (n=3), and used either chlorexidine digluconate 0.25% (n=1), 0.4% (n=1), or 0.44% (n=2). Results from 3 RCTs showed that chlorhexidine cleansing had no significant effect on neonatal sepsis (pooled risk ratio [RR], 0.49; 95% CI, 0.18-1.38, P =.18; I² =0%). Results from 1 RCT that used chlorexidine digluconate 0.25% showed that the risk for neonatal skin bacterial colonization was significantly decreased (pooled RR, 0.61; 95% CI, 0.42-0.90; P =.01; I² = 50%); however, no significant effect was found among the RCTs that used either chlorexidine digluconate 0.4% or 0.44% (P =.09).

Among the 2 quasi-experimental studies included in the analysis that used chlorhexidine gluconate 2%, the primary outcome was CLASBI. On analysis of results from the first study, the researchers found that after the implementation of chlorhexidine cleansing the CLABSI rate per 1000 central line-days decreased from 8.64 to 4.28 (incidence rate ratio [IRR], 0.49; 95% CI, 0.35-0.70). Similar results were observed on analysis of the second quasi-experimental study, for which results showed that the CLABSI rate per 1000 central venous catheter-days decreased from 6.00 to 1.92 after the implementation of chlorhexidine cleansing (adjusted IRR, 0.33; 95% CI, 0.15-0.73).

This study was limited by the small number of studies included in the final analysis, as well as the inability to control for confounding factors caused by the different time periods assessed.

According to the researchers, “…more studies should be carried out to determine the optimal concentration and frequency of chlorhexidine cleansing so as to maximize the effectiveness of chlorhexidine in preventing infections.”

Reference

Zhou J, Mei L, Chen S. Effect of chlorhexidine cleansing on healthcare-associated infections in neonates: a systematic review and meta-analysis. Arch Dis Child. Published online December 23, 2021. doi:10.1136/archdischild-2021-322429