90: Comparison of 2% Chlorhexidine in 70% Isopropyl Alcohol with 2% Aqueous Chlorhexidine for Skin Antisepsis Prior to Venepuncture in Very Low Birth Weight Infants: A Non-Inferiority Trial

Abstract

Background: Aqueous and alcohol based chlorhexidine solutions are commonly used for skin antisepsis in neonates but their relative efficacy is unknown. Objectives: To compare the efficacy of 2% aqueous chlorhexidine solution (AQC) vs. 2% chlorhexidine in 70% isopropyl alcohol (ALC) for skin antisepsis prior to venepuncture in very low birth weight (VLBW) infants. Design/Methods: A total of 199 VLBW neonates (birth weight <1500 g) between two and 28 days of age were randomized to receive skin antisepsis (single application) with either AQC or ALC prior to a venepuncture. Skin swabs were collected pre‐ and post‐antisepsis and processed by 'swab‐wash' method. Colony forming units (CFU) were quantified up to a maximum of 150 CFU. Primary outcome was the proportion of 'negative' post‐cleansing skin swabs defined as the presence of <15 CFU. Secondary outcomes included reduction in CFU and clearance proportion stratified by type of organism. After cleansing, the site was monitored for adverse reactions for 24 h. Results: Results: There was no difference in the baseline characteristics or any measured outcome between groups (Table 1). The odds ratio for skin clearance using AQC vs. ALC was 1.36 (0.55 to 3.40). Results did not change after excluding infants with 'negative' pre‐swabs or after adjustment for pre‐cleansing CFU. No adverse reactions were noted. Conclusions: The majority of VLBW infants had skin colonization with bacteria in the pre‐cleansing swab, with CONS being the most common organism. When used in a standardized manner, both AQC and ALC provided high skin clearance rates and were not significantly different in antisepsis properties. (Table presented) .