Optimizing skin antisepsis for neonatal surgery: A quality improvement initiative | Inclusion Criteria - 50 patients: | Neonate ≥ 1500gr | ≥ 34 weeks | Thoracic or abdominal surgery | Prospective data collection | Single institution | Evidence review | Skin antisepsis protocol with chlorhexidine gluconate (CHG) | Application in the OR | Data Collection and comparison with previous cohort of povidone-iodine (PI) | RESULTS | 0% Dryness, erythema or skin breakdowns | SSIs: 4% CHG vs 14% IP | p = 0.53 | (Control cohort) | Conclusion: | The use of alcoholic CHG for skin antisepsis in neonates has proven to be safe and effective. | https://doi.org/10.1016/j.jpedsurg.2022.02.027 | Source: Sophie Carr et al. | Faculty of Medicine, University of British Columbia, Vancouver, Canada | @StayCurrentMD | @cecilipstick | Cincinnati Children's | Journal of Pediatric Surgery
Optimizing skin antisepsis for neonatal surgery: A quality improvement initiative
Infographic · Sep 2022 · 1 min read
In brief
In brief
Quality improvement study demonstrates that chlorhexidine-alcohol skin prep is safe and effective for neonatal surgery, reducing SSI rates from 14% to 8% compared to povidone-iodine without adverse skin reactions. Protocol targeted infants ≥1500g and ≥34 weeks gestational age undergoing thoracic or abdominal procedures.
- 2% CHG-70% IPA or 0.5% CHG-70% IPA can be safely used for neonatal surgical skin prep in infants ≥1500g and ≥34 weeks gestational age.
- CHG-based skin antisepsis reduced SSI rates from 14% to 8% compared to povidone-iodine in matched neonatal surgical cohorts.
- No adverse skin reactions occurred in 50 consecutive neonates using age-appropriate CHG concentrations with validated skin integrity monitoring.
- Gestational age-based CHG concentration protocols enable safe adoption despite FDA labeling cautions for infants <2 months.
- Stakeholder engagement and validated skin assessment tools are critical for implementing CHG antisepsis protocols in the NICU setting.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with icons including a calendar with checkmark, wrapped newborn, antiseptic bottle, and surgical team illustration. Information flows top to bottom with yellow arrows connecting protocol steps. Results are displayed in a split layout with white text on teal background and yellow conclusion box.
Infographic by Gigena Cecilia
"Optimizing skin antisepsis for neonatal surgery: A quality improvement initiative" Sophie Carr et.al.
Full article: https://doi.org/10.1016/j.jpedsurg.2022.02.027
Authors: Sophie Carr, Carmina Gogal, Kourosh Afshar, Joseph Ting, Erik Skarsgard
Abstract
Purpose
Surgical site infections (SSIs) are a significant determinant of morbidity in the Neonatal Intensive Care Unit (NICU). Chlorhexidine gluconate/isopropyl alcohol (CHG-IPA) skin prep has demonstrated superiority over Povidone-Iodine (PI) in preventing SSIs in adults, however FDA labeling discourages CHG use in infants <2 months. This project aimed to i) create evidence for safe CHG skin antisepsis in neonates; and ii) evaluate the safety and effectiveness of CHG skin prep for neonatal surgery.
Methods
A literature review was conducted to assess the safety and effectiveness of neonatal CHG skin antisepsis. Following stakeholder engagement, a CHG surgical skin prep protocol and validated neonatal skin integrity tool to assess prep-associated skin injury were implemented in 50 consecutive, eligible neonates ≥1500 g and ≥34 weeks post conceptual age undergoing abdominal or thoracic surgery. SSI rates were compared to a matched, historical PI skin prep cohort.
Results
2%CHG-70%IPA or 0.5%CHG-70%IPA were used based on gestational age cutoffs. None of the CHG patients experienced adverse skin prep outcomes while 8% developed SSIs, compared to 14% in the historical PI cohort.
Conclusion
This project engaged NICU stakeholders in quality improvement work and informed the implementation of a safe and effective CHG skin prep protocol for neonatal surgery.