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Good Afternoon
I was interested in what other Hospitals use as a skin prep for long lines with Neonates particularly with Neonates that are less than 1000 grams and less than 1500 grams. We have heard a variety of Alcoholic/Aqueous Chlorhexidine skin preparations being used as well as Betadine/Iodine. The issue is often to do with skin burns due to the fragility of the skin of Neonates. Anecdotally information has mostly been reported as a result of pooling of solutions under the neonates.
Any experience recommendations/articles/trials most welcome.
Kind RegardsJodie Powell
Manager of Infection Control
Mater Health Services
Level 1, Original Mater Mother’s Hospital || Raymond Tce ||South Brisbane || Qld 4101
t: (07) 3163 5338 e: jodie.powell@mater.org.au m: 0401 226 608
f: (07) 3163 2176 w: http://www.mater.org.auMater’s 2009 Annual Review: 2009.mater.org.au
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Dear Jodie,
I have done some enquiries about this in the past and have also posted on
this topic on AICA List before. But unfortunately, I have not come up with
a clear picture and a firm conclusion.It appears that for skin antisepsis for mature neonates (some also include
30 weeks and above), almost anything goes, i.e. aqueous chlorhexidine,
alcoholic chlorhexidine and alcohol alone. There is a reservation about
using povidone-iodine (betadine) because of iodine absorption toxicity. In
terms of antimicrobial activity, alcohol plus chlorhexidine is best when
lines are inserted (alcohol provides immediate kill, chlorhexidine residual
activity), while alcohol alone is best for one-time venipuncture when no
residual activity is needed.Early premature neonates are indeed a problem. It appears that alcohol may
cause skin “burns” on the very thin, fragile skin of these tiny babies, and
there seem to be toxicity issues with chlorhexidine. Apparently in the
1960s and 1970s there were reports of neurotoxicity when chlorhexidine was
used on a large scale (e.g. for whole body washes). However, these toxicity
issues are apparently not a concern if it is used on a small scale such as
for skin antisepsis before line insertion, so that some neonatal units
apparently use aqueous chlorhexidine for that purpose (my impression is
that 2-4% would be the right concentration then). I am also aware that some
neonatal units use alcohol or alcohol-chlorhexidine, but use it very
carefully, so that the alcohol is left on skin for only a short time and
wiped off so that it does not get absorbed or cause skin burns. But again,
there is no good solution of the problem, and when an antiseptic is left on
skin for too short, it may not act as desired.In Europe, a compound called Octenidine is used for that purpose, i.e. skin
antisepsis of very early premature neonates. This is a mild biguanide
antiseptic, and despite being mild apparently still has reasonable activity
against microorganisms on skin:http://en.wikipedia.org/wiki/Octenidine_dihydrochloride
In Europe (and here in Asia) it is available through the company Schuelke &
Mayr, but it is apparently not available in Australia.http://www.schulke.co.uk/news/octenidine-a-unique-antiseptic/
It is also suitable for mucous membrane antisepsis in any age group, such
as for pre-surgical antisepsis when surgery is through mucous membranes.
Alcohol, which is the preferred agent for superficial skin is obviously not
suitable for mucous membranes.Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 1389
Fax +65 6394 1387“Powell, Jodie”
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Sent by: AICA AICALIST@AICALIST.ORG.AU
Infexion cc
Connexion
Long Lines skin prep for Neonates26/08/2010 01:00
PMPlease respond to
AICA Infexion
ConnexionGood Afternoon
I was interested in what other Hospitals use as a skin prep for long lines
with Neonates particularly with Neonates that are less than 1000 grams and
less than 1500 grams. We have heard a variety of Alcoholic/Aqueous
Chlorhexidine skin preparations being used as well as Betadine/Iodine. The
issue is often to do with skin burns due to the fragility of the skin of
Neonates. Anecdotally information has mostly been reported as a result of
pooling of solutions under the neonates.Any experience recommendations/articles/trials most welcome.
Kind RegardsJodie Powell
Manager of Infection Control
Mater Health Services
Level 1, Original Mater Mother’s Hospital || Raymond Tce ||South Brisbane || Qld 4101
t: (07) 3163 5338 e: jodie.powell@mater.org.au m: 0401 226 608
f: (07) 3163 2176 w: http://www.mater.org.auMater’s 2009 Annual Review: 2009.mater.org.au
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