Optimizing skin antisepsis for neonatal surgery: A quality improvement initiative

Area of Science:

• Neonatal surgery
• Infection control
• Antiseptic efficacy

Background:

• Surgical site infections (SSIs) are a major cause of morbidity in Neonatal Intensive Care Units (NICUs).
• Chlorhexidine gluconate/isopropyl alcohol (CHG-IPA) is superior to povidone-iodine (PI) for SSI prevention in adults.
• FDA guidelines currently advise against CHG use in infants under two months old.

Purpose of the Study:

• To generate evidence supporting the safe use of CHG skin antisepsis in neonates.
• To evaluate the safety and effectiveness of CHG skin prep for neonatal surgical procedures.

Main Methods:

• A literature review assessed CHG safety and effectiveness in neonates.
• A CHG skin prep protocol was developed and implemented in 50 neonates (≥1500g, ≥34 weeks post-conceptual age) undergoing surgery.
• A validated tool assessed skin integrity, and SSI rates were compared to a historical PI cohort.

Main Results:

• CHG-IPA (0.5% or 2%) was used based on gestational age.
• No adverse skin prep outcomes were observed in the CHG group.
• The CHG group had an 8% SSI rate, compared to 14% in the historical PI group.

Conclusions:

• NICU stakeholders were engaged in quality improvement initiatives.
• Evidence supports the implementation of a safe and effective CHG skin prep protocol for neonatal surgery.
• This study provides Level IV evidence for CHG use in neonates.