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Safety of Biweekly Chlorhexidine Gluconate Bathing in Infants 36 To 48 Weeks' Postmenstrual Age
Celeste J Chandonnet1, Cheryl Toole2, Vanessa Young2
1Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School. celeste.chandonnet@childrens.harvard.edu.
Background:
Little evidence supports use of chlorhexidine gluconate (CHG) baths to reduce health care-associated infections, including central catheter-associated bloodstream infections in infants less than 2 months old.
Objective:
To describe the safety of biweekly CHG baths in infants less than 2 months old by measuring blood levels of CHG, liver and renal function, skin reactions, and adverse events.
Methods:
Study participants received twice-weekly 2% CHG baths, weekly blood tests, and twice-daily skin assessments. Adverse events were monitored.
Results:
Ten infants 36 to 48 weeks' postmenstrual age with central venous catheters admitted to the neonatal or cardiac intensive care unit were enrolled before the study was closed by the Food and Drug Administration. The 9 patients contributing data had 83 CHG exposures; 31 CHG levels were analyzed. All patients had evidence of CHG absorption. Seven patients had CHG levels of 100 ng/mL or greater. Findings did not support accumulation of CHG but did show evidence of higher absorption than previously reported. Results of liver and renal function studies remained within reference limits. No patient had any adverse events, including skin reactions.
Conclusions:
Although no adverse events were observed, our patients had evidence of CHG absorption. The effects of this absorption remain unknown. More research is needed to determine safe blood levels of CHG in infants less than 2 months of age.
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