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Impact of 1% chlorhexidine gluconate bathing and emollient application on bacterial pathogen colonization dynamics in
Angela Dramowski1, Sheylyn Pillay2, Adrie Bekker1
1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa.
Insights
Chlorhexidine gluconate (CHG) washes reduced bacterial density in preterm neonates, but colonization rebounded quickly. Emollient improved skin but increased Staphylococcus aureus colonization.
Area of Science:
- Neonatal care
- Infectious disease prevention
- Dermatology
Background:
- Hospital-acquired infections pose risks to preterm neonates.
- Chlorhexidine gluconate (CHG) body washes and emollients may reduce pathogen colonization.
- Preventing neonatal infections is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the impact of CHG body washes and emollient on bacterial colonization in preterm neonates.
- To assess the effect of CHG and emollient on neonatal skin condition.
- To compare CHG and emollient interventions against standard care for infection prevention.
Main Methods:
- Pilot, non-randomized, open-label trial involving preterm neonates (1000-1500g).
- Four arms: 1% CHG, CHG plus emollient (CHG+EM), emollient only (EM), and standard of care (SOC).
- Daily application for 10 days, with skin scoring and bacterial swabs (nose, neck, umbilicus, perianal) at multiple time points.
Main Results:
- Bacterial pathogen acquisition rates varied by body site, highest at the nose and perianal region (71.4%).
- CHG significantly reduced bacterial density at day 10 (neck, umbilicus, perianal) compared to other groups.
- Emollient application improved skin condition scores, but CHG+EM and EM arms showed increased Staphylococcus aureus colonization.
Conclusions:
- CHG washes effectively reduce bacterial colonization density in preterm neonates, though levels rebound post-intervention.
- Emollient application enhances neonatal skin condition but is associated with a higher prevalence of S. aureus colonization.
- Further research is needed to balance infection prevention with potential side effects like S. aureus.
Background:
Chlorhexidine gluconate (CHG) body washes and emollient application may modulate bacterial pathogen colonization and prevent neonatal hospital-acquired infections.
Methods:
This pilot, non-randomized, open-label trial, enrolled preterm neonates (1000-1500g; day 1-3 of life) at a tertiary hospital in Cape Town, South Africa. Participants were sequentially allocated to 4 trial arms (n=20 each): 1% aqueous CHG (CHG), 1% CHG plus emollient (CHG+EM), emollient only (EM) and standard of care (SOC: no antiseptic/emollient). Trial treatment/s were applied daily for 10 days (d) post-enrolment, documenting neonatal skin condition score. Anterior nose, neck, umbilical and perianal swabs for bacterial culture were collected at d1, d3, d10 and d16 post-enrolment, (±1 day), reporting pathogen acquisition rates and semi-quantitative bacterial colony counts. (ClinicalTrials.gov identifier: NCT03896893; trial status: closed).
Findings:
Eighty preterm neonates (mean gestational age 30 weeks [SD 2]) were enrolled between 4 March and 26 August 2019. The bacterial pathogen acquisition rate (comparing d1 and d16 swabs) varied from 33·9% [95%CI 22·9-47·0] at the umbilicus, 39·3% [95%CI 27·6-52·4] at the neck, to 71·4% [95%CI 58·5-81·7] at both the nose and perianal region. At d10, CHG babies had reduced bacterial density detected from neck, umbilicus, and perianal swabs compared to other groups (see Table 3). Following intervention cessation, colonization density was similar across all trial arms, but S. aureus colonization was more prevalent among EM and CHG+EM babies. Neonatal skin condition score improved in babies receiving emollient application (EM: -0·87 [95%CI 0·69-1·06] and CHG+EM: -0·73 [0·45-0·99]), compared to the SOC and CHG arms (Table 2); no CHG-related skin reactions occurred.
Interpretation:
Bacterial colonization density was significantly reduced in babies receiving 1% CHG washes but colonization levels rebounded rapidly post-intervention. Emollient application improved skin condition but was associated with higher rates of S. aureus colonization.
Funding:
South African Medical Research Council; National Institutes of Health (TW010682).
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