Alcohol-Based Chlorhexidine May Lower Infection Risk in Preterm Neonates

Skin antisepsis was recognized as a key measure to prevent central line-associated bloodstream infections (CRBSIs) in neonates. However, the use of alcohol-based chlorhexidine had been limited due to concerns about skin injury.

A double cohort study published in the Archives of Disease in Childhood - Fetal and Neonatal evaluated whether using alcohol-based 2% chlorhexidine instead of aqueous 2% chlorhexidine could reduce CRBSI rates without increasing skin complications.

A total of 1783 neonates and 2493 central line episodes were analyzed. Clinical and demographic characteristics were similar across both periods. The study was conducted over two 3-year periods, separated by a 1-year washout. The first period used aqueous chlorhexidine, and the second used alcohol-based chlorhexidine. In extremely preterm infants, aqueous chlorhexidine was used during the first week of life in both periods.

A significant reduction in CRBSI incidence was observed with alcohol-based chlorhexidine (4.03 vs 9.05 episodes/1000 catheter days; OR 0.45, 95% CI 0.29–0.68). The absolute risk reduction was 0.039, and the number needed to treat was 25. A non-significant reduction was noted in extremely preterm infants during the first week (OR 0.43, 95% CI 0.134–1.379).

Further, no significant difference in skin lesions was found between groups, with erythema being the most common (5.1% vs 4.2%). Alcohol-based 2% chlorhexidine appeared to be safe and effective for reducing CRBSIs in neonates.

(Source: Archives of Disease in Childhood - Fetal and Neonatal Edition. 2025:fetalneonatal-2024-327728. https://fn.bmj.com/content/early/2025/02/03/archdischild-2024-327728.citation-tools)

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