I was taught that CHG should be applied to "clean skin" and it has been suggested that perhaps a good cost effect method of cleaning the skin in the pre-sterile preparation of PICC insertion would be Baby Wipes--Any thoughts Pro or Con?Â
Robbin, thanks for posting this query as this is something I do think we should be considering. There are now CHG wipes available which may be perfect for this application. Would love to hear from others whether they are using or would recommend the use of CHG wipes for skin cleansing prior to CHG/alcohol skin prep for PICC insertions? Below is a reference demonstrating the efficacy of CHG wipes in the neonate population. Check out Lynn’s article on Bathing with chlorhexidine reduces CRBSIs.
Daphne Broadhurst, Ottawa, Canada
Darmstadt G et al. Safety and Effect of Chlorhexidine Skin Cleansing on Skin Flora of Neonates in Bangladesh.Pediatric Infectious Disease Journal. 26(6):492-495, June 2007 AbstractBackground: Chlorhexidine cleansing of newborn skin is a highly promising intervention for reducing neonatal mortality in developing countries, yet little is known of the mechanism of action. This study examined the impact of a single skin cleansing of hospitalized newborn infants in Bangladesh with baby wipes containing 0.25% chlorhexidine on both qualitative and quantitative skin flora.Methods: Within 72 hours of birth, the skin of newborns admitted to Dhaka Shishu Hospital was wiped with baby wipes containing 0.25% chlorhexidine (n = 67) or placebo (n = 66) solution. Skin condition was assessed and skin swabs were taken from 3 sites (axillary, peri-umbilical, inguinal) at baseline and 2 hours, 24 hours, 3 days and 7 days after treatment. Skin flora was quantified and colonizing species were identified.Findings: Skin cleansing with chlorhexidine had no adverse effects on skin condition, and resulted in minimal reduction (mean 0.5°C) in body temperature. Positive skin culture rates 2 hours after skin cleansing were approximately 35%–55% lower than the baseline rates for placebo and chlorhexidine groups at all 3 sites. For the chlorhexidine group, positive skin culture rates remained significantly lower than the baseline rates for 24 hours to 3 days, whereas for the placebo group, beyond the first 2-hour follow-up, these values were not lower than baseline in any of the 3 sites.Interpretation: Chlorhexidine skin treatment produced more extended skin cleansing effects than the placebo treatment. It is possible that the quantitative and qualitative reductions observed in the skin flora might contribute to reducing neonatal infections.
I'd vote "con" for baby wipes. Many of them contain lotions or such-like that would complicate decontaminating the skin. I have on numerous occasions given the whole arm a good scrub with Hibiclens prior to placing a line and have been aghast at how much grime I got rid of.
Robbin, thanks for posting this query as this is something I do think we should be considering. There are now CHG wipes available which may be perfect for this application. Would love to hear from others whether they are using or would recommend the use of CHG wipes for skin cleansing prior to CHG/alcohol skin prep for PICC insertions? Below is a reference demonstrating the efficacy of CHG wipes in the neonate population. Check out Lynn’s article on Bathing with chlorhexidine reduces CRBSIs.
Daphne Broadhurst,
Darmstadt G et al. Safety and Effect of Chlorhexidine Skin Cleansing on Skin Flora of Neonates in Bangladesh. Pediatric Infectious Disease Journal. 26(6):492-495, June 2007Ottawa, Canada
Abstract Background: Chlorhexidine cleansing of newborn skin is a highly promising intervention for reducing neonatal mortality in developing countries, yet little is known of the mechanism of action. This study examined the impact of a single skin cleansing of hospitalized newborn infants in Bangladesh with baby wipes containing 0.25% chlorhexidine on both qualitative and quantitative skin flora.Methods: Within 72 hours of birth, the skin of newborns admitted to Dhaka Shishu Hospital was wiped with baby wipes containing 0.25% chlorhexidine (n = 67) or placebo (n = 66) solution. Skin condition was assessed and skin swabs were taken from 3 sites (axillary, peri-umbilical, inguinal) at baseline and 2 hours, 24 hours, 3 days and 7 days after treatment. Skin flora was quantified and colonizing species were identified.Findings: Skin cleansing with chlorhexidine had no adverse effects on skin condition, and resulted in minimal reduction (mean 0.5°C) in body temperature. Positive skin culture rates 2 hours after skin cleansing were approximately 35%–55% lower than the baseline rates for placebo and chlorhexidine groups at all 3 sites. For the chlorhexidine group, positive skin culture rates remained significantly lower than the baseline rates for 24 hours to 3 days, whereas for the placebo group, beyond the first 2-hour follow-up, these values were not lower than baseline in any of the 3 sites.Interpretation: Chlorhexidine skin treatment produced more extended skin cleansing effects than the placebo treatment. It is possible that the quantitative and qualitative reductions observed in the skin flora might contribute to reducing neonatal infections.
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada