Effect of Chlorhexidine 2% versus Alcohol 70% on Catheter - Related Bloodstream Infections in Neonates: Randomized Control Trial
DOI:
https://doi.org/10.6000/Keywords:
Neonates, catheter-related bloodstream infection, chlorhexidine, central venous catheter, antisepsis, PICC, NICUAbstract
Background: Central venous catheters (CVCs) are essential for neonatal intensive care but are strongly
associated with catheter-related bloodstream infections (CRBSI), which significantly increase morbidity, mortality, and
hospital stay. The optimal antiseptic for neonatal skin disinfection remains debated, with chlorhexidine-alcohol solutions
increasingly recommended but still under investigation for safety and efficacy.
Objective: To compare the effectiveness of 2% chlorhexidine in 70% isopropyl alcohol versus 70% alcohol alone in
reducing catheter-related bloodstream infections among neonates requiring CVCs.
Methods: A prospective randomized controlled trial was conducted on 100 neonates admitted to the NICU at Ain Shams
University Hospital. Participants were randomly assigned to two groups: Group A (alcohol-only antisepsis) and Group B
(chlorhexidine-alcohol antisepsis). Data collected included patient demographics, catheter type and duration, infection
rates, blood culture results, inflammatory markers, and clinical outcomes.
Results: Group B (chlorhexidine-alcohol) demonstrated significantly lower rates of positive blood cultures (notably
Klebsiella and E. coli) compared to Group A. The incidence of infection was highest in neonates with percutaneous
central venous catheters (PCVCs) and umbilical venous catheters (UVCs), while peripherally inserted central catheters
(PICCs) showed the lowest infection burden. Mean catheter duration was 9-11 days, with most infections occurring
beyond the seventh day. Hemoglobin and hematocrit levels declined significantly over time in infected cases. Group B
also required fewer escalations to second-line antibiotics.
Conclusions: Using 2% chlorhexidine in 70% isopropyl alcohol significantly reduced catheter-related bloodstream
infections (CRBSIs) in neonates, compared to 70% alcohol alone. Peripherally inserted central catheters (PICCs)
exhibited the lowest infection rates, highlighting the importance of both antiseptic selection and catheter type in neonatal
infection prevention protocols.
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