Janssen Lisanne M A, Tostmann Alma, Hopman Joost, Liem Kian D
Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2018 Mar;103(2):F97-F100. doi: 10.1136/archdischild-2017-312694. Epub 2017 May 3.
The skin disinfectant '0.5% chlorhexidine gluconate in 70% alcohol' (0.5% CHG-70% alc) may cause skin lesions in extremely preterm infants (gestational age <26 weeks). In April 2013, 0.2% chlorhexidine gluconate solution in acetate (0.2% CHG-acetate) was introduced as skin disinfectant for extremely preterm infants in our neonatal intensive care units. We aimed to compare the incidence of skin lesions and central line-associated bloodstream infection (CLABSI) among extremely preterm infants when using 0.5% CHG-70% alc and 0.2% CHG-acetate.
Retrospective pre-post comparison cohort study.
All electronic patient records of extremely preterm infants born between January 2011-March 2013 ('0.5% CHG-70% alc' cohort) and April 2013-October 2015 ('0.2% CHG-acetate' cohort) were reviewed.
The incidence of skin lesions and CLABSI. Skin lesions were defined as the presence of erythema, blisters, excoriation, oedema or induration. CLABSI was defined according to the definition of the US Centers for Disease Control and Prevention.
The incidence of skin lesions was 22% (95% CI 11% to 37%) in the '0.5% CHG-70% alc' cohort (n=41) and 5% (95% CI 1% to 15%; p=0.02) in the '0.2% CHG-acetate' cohort (n=41). The incidence of CLABSI was the same in both groups (28%; 95% CI 14% to 46% in '0.5% CHG-70% alc' vs 27%; 95% CI 14% to 44% in '0.2% CHG-acetate'; p=0.98).
Using 0.2% CHG-acetate as skin disinfectant in extremely preterm infants resulted in statistically significant reduction of skin lesions, without increasing the risk of CLABSI as compared with 0.5% CHG-70% alc.
皮肤消毒剂“70%酒精中的0.5%葡萄糖酸氯己定”（0.5%CHG - 70%酒精）可能会导致极早产儿（胎龄<26周）出现皮肤损伤。2013年4月，我们新生儿重症监护病房引入了醋酸盐中的0.2%葡萄糖酸氯己定溶液（0.2%CHG - 醋酸盐）作为极早产儿的皮肤消毒剂。我们旨在比较使用0.5%CHG - 70%酒精和0.2%CHG - 醋酸盐时极早产儿皮肤损伤和中心静脉导管相关血流感染（CLABSI）的发生率。
回顾性前后对照队列研究。
回顾了2011年1月至2013年3月出生的极早产儿（“0.5%CHG - 70%酒精”队列）和2013年4月至2015年10月出生的极早产儿（“0.2%CHG - 醋酸盐”队列）的所有电子病历。
皮肤损伤和CLABSI的发生率。皮肤损伤定义为存在红斑、水疱、擦伤、水肿或硬结。CLABSI根据美国疾病控制与预防中心的定义确定。
“0.5%CHG - 70%酒精”队列（n = 41）中皮肤损伤的发生率为22%（95%CI 11%至37%），“0.2%CHG - 醋酸盐”队列（n = 41）中为5%（95%CI 1%至15%；p = 0.02）。两组CLABSI的发生率相同（“0.5%CHG - 70%酒精”组为28%；95%CI 14%至46%，“0.2%CHG - 醋酸盐”组为27%；95%CI 14%至44%；p = 0.98）。
在极早产儿中使用0.2%CHG - 醋酸盐作为皮肤消毒剂可使皮肤损伤发生率在统计学上显著降低，与0.5%CHG - 70%酒精相比，并未增加CLABSI的风险。
