Efficacy and safety of three antiseptics for neonatal skin disinfection: a cohort study.

Background: The choice of the ideal antiseptic is not only based on its efficacy but also on safety and skin-friendliness. There are no standard recommendations regarding ideal skin preparation in neonates.

Methods: This was a prospective cohort study to evaluate the efficacy of 3 antiseptics[10% Povidone Iodine(PI), 70% isopropyl alcohol(AL), 2% chlorhexidine in 70% alcohol(CHG-IPA)] in disinfecting the skin before venipuncture in term neonates as assessed by logarithmic reduction in skin bacterial colony counts post-application. Secondary objectives were to assess the changes in skin condition. Measurements were done pre-, post-antiseptic and 6-24 h (for residual effect) later. Fifty neonates were enrolled in each group.

Results: All three antiseptics caused a significant reduction in bacterial load post-application, but maximal efficacy [2.6(2.2-2.8)log reduction] and, maximal residual effect at 6-24 h was seen with CHG-IPA [2.4(2.2-2.6)log reduction]. The logarithmic reduction in colony counts from pre-intervention to 6-24 h later remained significant for all three groups [(PI, p-0.039; CHG-IPA, p-0.00; AL, p - 0.01)]. After an initial alteration in hydration, and skin condition score, there was a return to baseline after 6-24 h.

Conclusion(s): 2% CHG-IPA had better efficacy than AL or PI for skin antisepsis in term neonates. There was no significant change in skin integrity in all three groups.

Impact: All three antiseptics [2% chlorhexidine gluconate in 70% isopropyl alcohol(CHG + IPA), 10% Povidone Iodine(PI), and 70% isopropyl alcohol(AL)] cause significant reduction in bacterial colony counts. CHG + IPA has the maximum efficacy as assessed by log reduction of bacterial colony counts with optimal residual effect favouring its usage in term neonates. The least efficacy is seen with 70% isopropyl alcohol. All three antiseptics are skin-friendly and do not affect the skin integrity. Future studies addressing the clinical outcomes and safety in preterm populations with these commonly used antiseptics should be done.