Impact of chlorhexidine and emollient cleansing on bloodstream infections in a Neonatal ICU.

Background: Among hospital-born babies, infections account for 4% - 56% of deaths in the neonatal period, with bloodstream infections being up to 20 times more frequent in low- and middle-income countries (LMICs). The cleansing of infants with chlorhexidine (without emollient) has been the standard of care in Grey's Hospital Neonatal Intensive Care Unit (NICU) for over a decade.

Objectives: This study evaluated the impact of adding an emollient to chlorhexidine on the prevalence of microbiologically confirmed infections.

Method: A retrospective observational cohort study of all microbiologically confirmed bloodstream infections in the neonatal unit before (01 June 2022 to 30 November 2022) and after (01 December 2022 to 31 May 2023) the implementation of the quality improvement project was conducted. The rates of microbiologically confirmed infections were compared between the two periods.

Results: There was a total number of 2741 positive blood cultures over the study period with a significant reduction in positive cultures in the intervention group (46.1% vs. 27%, p < 0.001) but no significant reduction in the proportion of different organisms (Gram-positive, Gram-negative, and fungal isolates) in the two groups (p = 0.58) Gram-positive organisms accounted for most infections in the pre- and post-intervention study groups. There was no significant reduction in the rate of sepsis-associated mortality (p = 0.20).

Conclusion: Further research evaluating the response in larger study populations is needed.

Contribution: Although there was no significant reduction in sepsis-associated mortality, cleansing infants using chlorhexidine with an emollient may reduce bloodstream infections in this vulnerable population in LMICs.